Asthma: NICE recommends LTRA tablets over combination inhaler

Access to the full content of this site is available only to registered healthcare professionals. Register to read more


  • The new NICE draft guideline on asthma management currently under consultation recommends leukotriene receptor antagonist (LTRA) tablets over combination inhaler therapy in a move to boost savings for the NHS.

Key highlights

  • Newly diagnosed patients with asthma should be offered a short-acting beta2 agonist (SABA) to relieve symptoms as and when they occur.
  • A low-dose inhaled corticosteroid (ICS) is suitable as maintenance therapy for patients with symptoms uncontrolled by SABA.
  • If symptoms remain uncontrolled with ICS, patients should be offered an LTRA along with ICS before considering the combination (LABA + ICS) inhaler therapy.
  • If LTRAs fail to work, adult and young patients can be switched to a combination inhaler. Children, however, should be referred to a specialist in such a scenario. 
  • NICE recommends initiating treatment with the 7 pence a day LTRA tablet earlier than the current practice. This could translate to a saving £3 million a year for the NHS.
  • The clinical efficacy of both LTRAs and combination inhalers are strongly backed by evidence; however, the cost-effectiveness of LTRAs make them the primary choice.