3.3.2 Leukotriene receptor antagonists

General guidance
 

• These agents are an option at step 3 of the BTS guidelines rather than adding a long acting beta2 agonist. However, evidence of their superiority over this option is lacking. Locally, in adults, these agents are used in more severe disease to try to achieve disease control and/or to try to reduce high dose inhaled corticosteroids.
• Locally, in children there is a lower threshold for using these agents, starting at step 3. Montelukast has proved useful in paediatric asthma. It has a modest anti-inflammatory activity and should be used in conjunction with inhaled corticosteroids (except in exercise induced asthma were it can be used on its own). Due to systemic activity it can also prove useful when allergic rhinitis coexists with asthma as it often does.
• In children, the 4mg chewable tablet is used for 2-5 year olds, and 5mg chewable tablet for 5-14 year olds. Once daily administration makes it a convenient drug to administer. Response appears to be highly variable, necessitating a 4-6 week therapeutic trial to determine response.

Recommended drugs

Montelukast

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low