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Snapshot
  • A 13-year-old girl with a history of asthma presents to her pediatrician with increasing shortness of breath. She has been using a low-dose fluticasone/salmeterol inhaler daily with good control of symptoms for the past year. However, she recently joined the track team and has been needing to use her albuterol regularly since starting daily track practice. She is prescribed montelukast. (Moderate persistent asthma)
Overview
  • One of seven medications used for asthma aimed to reduce inflammation and obstruction
    • corticosteroids 
    • beta-agonists 
    • muscarinic antagonists 
    • methylxanthines 
    • cromolyn 
    • antileukotrienes
    • omalizumab 
Antileukotrienes
  • Mechanism of action
    • inhibit 5-lipoxygenase to reduce the synthesis of leukotrienes from arachidonic acid
      • example: meclofenamate sodium and zileuton
    • antagonize leukotriene receptor
      • example: montelukast, zafirlukast, and pranlukast
  • Clinical use
    • chronic asthma 
      • persistent asthma
      • aspirin-induced asthma
      • exercise-induced bronchoconstriction
    • chronic obstructive pulmonary disease
    • mast cell activation syndrome
  • Adverse effects
    • suicidality
    • hypersensitivity
    • zafirlukast increases the anticoagulant effect of warfarin 
 

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