LTRAs urged for poorly controlled asthma

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A leucotriene receptor antagonist should be offered before a combination inhaler in patients with poorly controlled asthma, draft guidance from the National Institute for Health and Care Excellence (NICE) recommends.1

The generic leucotriene receptor antagonist montelukast costs just 7p (€0.08; $0.09) a day, and NICE estimates that the shift in practice would save £3m a year among every 10 000 people who take up the new recommendation. Leucotriene receptor antagonists are tablets taken once a day to stop airways becoming inflamed.

Patients with newly diagnosed asthma should still have a short acting beta2 agonist reliever inhaler prescribed to use whenever they have symptoms, says NICE. If the asthma is poorly controlled they should still be given a low dose inhaled corticosteroid. And the guidance says that the next step, if asthma is still uncontrolled, is to offer a leucotriene receptor antagonist in addition to the inhaled corticosteroid.

This is a change from current guidelines, which recommend either a combination inhaler containing a corticosteroid and a long acting beta2 agonist, or a leucotriene receptor antagonist.

If patients’ asth...