Monaldi Arch Chest Dis

The use of leukotriene receptor antagonists (LTRAs) as complementary therapy in asthma L. Bjermer, Z. Diamant* Asthma is a variable disease, characterized by airway hyperresponsiveness and chronic airway inflammation [1, 2]. Even in mild disease, these events give rise to structural changes within the airways, called airway remodelling, that may in-duce progressive airway narrowing with serious clinical consequences [3, 4]. Hence, current guidelines on asthma manage-ment stress the importance of early introduction of anti-inflammatory therapy [5]. Although inhaled corticosteroids (ICS) are still the first choice of an-ti-inflammatory agents in the treatment of asthma, recent data demonstrate superior clinical effective-ness of combination therapy in which lower doses of ICS are combined with other classes of anti-asthma drugs versus higher doses of ICS alone. In management-steps 2 and 3 of persistent asthma there are presently two major combinations of an-ti-asthma regimens: low to moderate doses of ICS with either long-acting b 2-agonists (LABAs) orleukotriene receptor antagonists (LTRAs). The choice for either combination has both clinical and pathophysiological implications which we will discuss in this overview. According to recent insights, inflammatory in-dices such as airway hyperresponsiveness [mea-sured by methacholine, histamine or adenosine monophosphate (AMP) challenges], exhaled nitri