Leukotriene modifiers - Role in the maintenance treatment of asthma in children

Abstract

Introduction: Asthma is one of the most prevalent chronic diseases in childhood. Leukotriene modifiers (LM) are anti-inflammatory drugs recently introduced in asthma therapeutics and broadly used in clinical practice. Objective: Determine if, in children, the LM, when compared to placebo or other controller drugs, are safe and effective in the maintenance treatment of asthma. Determine the indications to use LM in the maintenance treatment of asthma, in children. Methods: We searched MEDLINE, Guidelines Finder, National Guideline Clearinghouse, Canadian Medical Association Infobase, The Cochrane Library, DARE, Bandolier and TRIP, using the terms asthma, leukotriene modifiers e children. We limited the search to articles published until January 2007, written in English or Portuguese. We also searched for Scientific Societies Recommendations. To evaluate the Level of Evidence, we used the rating system of the American Family Physician. Results: Safety: LM are safe and well tolerated, exhibiting a low incidence of mild adverse effects. Efficacy: LM are effective in the treatment of asthma, although less than inhaled corticosteroids. The result of adding LM to the inhaled corticosteroids is a modest improvement of asthma control. Indications: LM are an alternative to low dose inhaled corticosteroids. In children with asthma inappropriately controlled with medium to high inhaled corticosteroids doses or with the association of low dose inhaled corticosteroids with long acting b2 agonist, adding the LM brings benefit. In children with exercise induced bronchoconstriction, LM are an effective therapeutic alternative. Discussion: The paucity of methodological well-built paediatric studies disparages with the high prescription rate of LM. It would be advisable to do high quality, long during, controlled and randomized studies about the safety and efficacy of LM.