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LRTAs backed for role in childhood asthma

Asthma guidelines for children should be reconsidered in light of the results of a major new Government-funded study, respiratory experts conclude.

An NHS Health Technology Assessment found leukotriene receptor antagonists are as effective as inhaled steroids and long-acting ß-agonists at key treatment stages.

But concerns over cost could still see those responsible for guidelines stop short of offering the drugs a major new role in asthma treatment.

Study leader Professor David Price, professor of primary care respiratory medicine at the University of Aberdeen, said: 'There was no significant difference between leukotriene receptor antagonists and inhaled ster-oids at step two, or long-acting ß-agonists at step three. Which I guess means we need to talk about whether the asthma guidelines need rewording.'

Professor Price's study randomised 933 12-year-olds to LRTAs versus steroids, for those at step two of the BTS/SIGN guidelines, and LRTAs versus long-acting ß-agonists for those at step three.

At both step two and step three, each drug treatment substantially improved quality of life, but with no significant difference between groups at either two or 24 months (see below).

But the results, presented at the General Practice Airways Group meeting in Keele last week, have caused controversy, with experts divided over how widely LRTAs should be prescribed.Dr Dermot Ryan, a GP in Loughborough and a member of the group, said: 'They're greatly underused and their potential has not been realised.

'If patients are taking medication and have marked diurnal variation I'd put them on a long-acting ß-agonist. If they haven't, suffer from wheeze and have rhinitis I'd use a LTRA.'

Dr Kevin Gruffydd-Jones, committee member of the group and a GP in Box, Wiltshire, said: 'I still think steroids are the treatment of choice for most patients. But there is a role [for LTRAs], certainly in children.'

Dr Mike Thomas, a clinical research fellow for the group at the University of Aberdeen and a GP in Minchinhampton, Gloucestershire, described the results as 'very interesting'.

But he added: 'They need to be published in a peer-reviewed journal before they can be considered for guidelines.'

• For an asthma update, go to searchmedica.co.uk

How study challenged guidelines
• The study recruited 933 patients aged 12
• Randomised to receive LRTAs or inhaled steroids at step two of BTS/SIGN guidelines, or LRTAs or LABAs at step three
• Quality of life assessed with asthma quality of life questionnaire
• All treatments gave large improvements in quality of life at two-month and two-year time-points
• At step two, no significant difference between LRTAs and inhaled steroids
• At step three, quality of life scores 0.1 better with LRTAs at two and 24 months, but difference not significant

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