Review Article

Pediatric Drugs

, Volume 14, Issue 5, pp 317-330

First online:

Role of Leukotriene Receptor Antagonists in the Management of Pediatric Asthma

An Update
  • Catalina DumitruAffiliated withDepartment of Asthma, Allergy and Respiratory Science, Guy’s Hospital, King’s College London, King’s Health Partners, Asthma-UK Centre in Allergic Mechanisms of AsthmaGuy’s and St Thomas’ NHS Foundation Trust, National Institute for Health Research (NIHR), Biomedical Research Centre
  • , Susan M. H. ChanAffiliated withDepartment of Asthma, Allergy and Respiratory Science, Guy’s Hospital, King’s College London, King’s Health Partners, Asthma-UK Centre in Allergic Mechanisms of AsthmaGuy’s and St Thomas’ NHS Foundation Trust, National Institute for Health Research (NIHR), Biomedical Research Centre
  • , Victor TurcanuAffiliated withDepartment of Asthma, Allergy and Respiratory Science, Guy’s Hospital, King’s College London, King’s Health Partners, Asthma-UK Centre in Allergic Mechanisms of AsthmaGuy’s and St Thomas’ NHS Foundation Trust, National Institute for Health Research (NIHR), Biomedical Research Centre Email author 

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

At present, the main indications for leukotriene receptor antagonists (LTRA) in pediatric asthma are as add-on therapy to inhaled corticosteroids (ICS) and as initial controller therapy in children with mild asthma, especially those who cannot or will not use ICS.

LTRA are also useful for patients who have concomitant rhinitis, and patients with viral-induced wheeze and exercise-induced asthma. It should be noted that the benefits of LTRA therapy have been demonstrated in children as young as 6 months of age and recent clinical trials have further proven the benefits of LTRA in acute asthma exacerbations.

However, considering the important pro-inflammatory effects that leukotrienes (LT) have in experimental models of asthma, it may seem surprising that LTRA treatment outcomes are not better and that in some clinical trials only a minority of patients could be classified as full responders. This could be explained by potential additional LT receptors that are not affected by LTRA. Such receptors could represent new therapeutic targets in asthma.

Furthermore, progress in differentiating between asthma phenotypes that result from different pathogenic mechanisms, some of which may involve LT to a lesser degree, should lead to an improved, personalized use of LTRA for treating asthma.