Leukotriene Antagonists as Effective as Other Asthma Therapies?

Leukotriene-receptor antagonists may be as effective as inhaled corticosteroids for first-line treatment of asthma and as effective as long-acting beta agonists for add-on therapy, according to two "real-world" trials reported in the New England Journal of Medicine.

The two trials included individuals aged 12 years and older with asthma. In one, some 300 patients beginning asthma therapy were randomized to open-label treatment with either a leukotriene antagonist or an inhaled glucocorticoid. In the other, roughly 350 patients already taking an inhaled glucocorticoid were randomized to add-on therapy with a leukotriene antagonist or a long-acting beta agonist.

The primary endpoint — asthma-related quality of life at 2 months — was similar between treatment groups. However, the researchers report that at 2 years, outcomes did not quite meet equivalence criteria.

Editorialists note that leukotriene antagonists likely work well in real-world settings because of their ease of use (i.e., pill vs. inhaler).

My First Case:introduction in brief

A 48 year old woman with a past mediacl history of asthma presented to Emergency Department complaining of cough/hemoptysis ,dyspnea .

She has experienced cough productive of green sputum since 2 month ago and it's had a progressive course.The symptoms deteriorate at night and when lying in bed.

Past Medical History:She has had a history of 2 times admission in Emergency Deoartment in 2005 and early 2009:both with episodes of Asthmatic Exacerbation; on 2005 admission the patient was presented with coma and peripheral cyanosis in upper and lower extremities.

Drug History:Salbutamol/Atrovent

the patient has shown allergic response to Penicillin,Azithromycin,ASA,Anti-Histamine

Habitual Hx:-

Family Hx: Tuberclosis in her mother

Ph/Ex:

On initial presentation she had a Respiratory Rate of 25/min Temperature:37(Axi) BP:120/70 PR:88

Head and Neck: NL

Chest: Heart : S1S2 NL

Chest :Generalized Wheezing through both lungs fields

The remainder of Physical Exam was NL

no signs of heart failure were detected

The patient's dyspnea was refractory to all standard Therapy

A light imorovement was mentioned during Ntbiotic therapy but after discontinuation the symptoms including productive cough ,dyspnea,ortopnea got worse.

on the PA view of patient's chest x-ray there was an apparent huge consolidation area in lower lobe of right lung.

Bsic Laboratory tests were within normal limits.

An Spiral CT scan is orequested and it's arranged for saturday .

till then the patient recieves:

Nasal O2

Amp Enoxaparin 1mg/kg Q12h

Spray Salbutamol 3puff /QID

Spray Ipratropium Bromide 4puff/QID

Differential Diagnosis :

1-Asthma Exacerbation

2-Pneumonia

3-Paroxysmal Nocturnal Dyspnea

to be continued...