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Leukotriene antagonists as good as LABAs for step 2 asthma

By Nigel Praities

Researchers are insisting asthma guidelines ‘need rewriting' after a study showed leukotriene antagonists were just as good as long-acting beta agonists, when added to inhaled steroids.

Current NICE guidance recommends LABAs as the ‘first choice' add-on therapy for adults and children over 12 years with asthma already taking inhaled steroids, with oral leukotriene antagonists as an alternative option.

But new UK data in 352 patients challenge the preeminent position of LABAs, showing equivalent improvements in asthma control and quality of life with leukotriene antagonists in a general practice population.

After two years, LABAs improved percentage peak flow from 87.0 to 89.7, which was not statistically different from the improvement seen with leukotriene antagonists, which improved percentage PEF from 89.2 to 90.3.

There were also no significant differences in asthma control and quality of life, prompting the authors to call for revisions to asthma guidelines.

Dr Mike Thomas, a GP in Minchinhampton, Gloucestershire, and research fellow of the General Practice Airways Group, said the study showed a ‘real choice' for GPs between LABAs and leukotriene antagonists for step 2 asthma.

‘Guidelines are based on classic randomised, controlled trials, but only one in 20 of general practice patients would get into those studies.

‘But this is a much more pragmatic real world study that reflects the kind of patients we see in general practice, and suggests perhaps we should not automatically assume that LABA therapy is the best option for all patients,' he said.

The research was presented at the conference in Seville last week.

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