Defining the role of antileukotriene agents in the management of asthma

The newest class of asthma medications to be marketed in the United States are the antileukotriene agents (ALAs). They include one 5-lipoxygenase inhibitor, zileuton, and two leukotriene receptor antagonists, zafirlukast and montelukast. By inhibiting the formation of cysteinyl leukotrienes or blocking their action, these agents attenuate many of the clinical manifestations of asthma. Current consensus guidelines recommend ALAs as an alternative to inhaled corticosteroids in patients with mild persistent asthma. While clinical data suggest that inhaled corticosteroids may offer greater improvements in asthma control, the ALAs offer potential advantages in ease of administration and patient compliance. The ALAs demonstrate an additive benefit to inhaled corticosteroid therapy and appear to benefit patients with exercise-induced or aspirin-sensitive asthma. Nevertheless, the duration of clinical experience with these agents is still limited, and their appropriate role remains to be more fully elucidated.