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Leukotrienreceptorantagonisten montelukast och dess plats i astmabehandlingen
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
2013 (Swedish)Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesisAlternative title
The leukotriene receptor antagonist montelukast and its role in the treatment of asthma (English)
Abstract [sv]

Astma är ett inflammatoriskt syndrom med flera fenotyper, som påverkar luftvägarna och ger symptom som återkommande episoder med dyspné, ronki och hosta. Symptomen är vanligen förenade med en reversibel obstruktion av luftvägarna som beror på en bronkiell hyperreaktivitet, ökad slembildning och på sikt strukturella förändringar i dessa.

Grunden i astmabehandlingen utgörs sedan 70-talet av inhalerade kortikosteroider. Behandlingsarsenalen vid astma har varit relativt oförändrad sedan dess. I slutet av 90-talet registrerades leukotrienreceptorantagonisten montelukast på indikationen astma. Detta arbete söker tydliggöra dess roll i behandlingen så här 15 år efter registrering.

Artikelsökning gjordes i PubMed enligt definierade sökkriterier: dubbelblinda randomiserade kontrollerade prövningar med stora populationsstorlekar. Sökresultaten, 31 studier, jämfördes med de senaste behandlingsrekommendationerna från Läkemedelsverket samt de metaanalyser som ligger bakom dessa.

Montelukast förefaller vara ett lättadministrerat läkemedel med mycket god biverkningsprofil. Tillägg av montelukast till inhalationssteroider visar viss ökad astmakontroll liksom en steroidsparande effekt, men som monoterapi kan montelukast inte rekommenderas annat än som profylax vid ansträngningsutlöst bronkokonstriktion eller som ersättning för låga doser inhalationssteroider hos framför allt pediatriska patienter. Montelukast uppvisar ingen bättre effekt hos patienter med NSAID-intolerant astma jämfört med genomsnittliga astmatiska patienter. I den akuta vården av patienter med astmaattacker har montelukast ingen plats i terapin. Långverkande beta2-receptoragonister är överlägsna montelukast som tillägg till inhalationssteroider och är därför förstahandsvalet då tillägg krävs för ökad sjukdomskontroll eller minskad steroiddos.

Abstract [en]

Asthma is an inflammatory syndrome, compromising several phenotypes. The disease is affecting the airways, giving symptoms such as dyspnea, ronchi and cough. The symptoms are usually associated with a reversible obstruction of the airways, caused by a bronchial hyperresponsiveness, increased mucous secretion and, in the long term, structural changes.

The cornerstone in asthma treatment has, since the seventies, been inhaled corticosteroids. The treatment arsenal has been more or less the same since. In the end of the nineties the leukotriene receptor antagonist montelukast was registered representing a novel asthma treatment. This report tries to clarify its role in the treatment as it is now 15 years since its registration.

Literature was collected using PubMed with defined search criteria: double-blind randomized controlled trials with large populations. The 31 studies obtained were compared with the latest treatment recommendations from the Swedish Medical Products Agency and the underlying meta-analyses.

Montelukast appears to be an easily administered drug with a very benign risk profile. The addition of montelukast to inhaled corticosteroids shows some increased control of asthma as well as a corticosteroid-sparing effect. As a single-therapy agent however, montelukast can not be recommended other than as a prophylaxis against exercise induced bronchoconstriction or as a substitute for low doses of inhaled corticosteroids in primarily pediatric patients. Montelukast shows no better efficacy in treatment of NSAID-intolerant patients than in the average asthmatic population. In the treatment of acute asthmatic attacks montelukast has no place in the therapy. Long-acting beta2 receptor agonists are superior to montelukast when added to inhaled corticosteroids and hence are the treatment of choice when add-on therapy is needed to increase control of the asthmatic disease or reduce the doses of corticosteroids.

Place, publisher, year, edition, pages
2013. , 74 p.
Keyword [en]
montelukast, asthma, leukotrienes, anti-leukotrienes, leukotriene receptor antagonists, cysteinyl leukotrienes, CysLT, CysLT1, CysLT2, leukotriene C4, leukotriene D4, leukotriene E4, leukotriene F4, LTC4, LTD4, LTE4, LTF4, Churg-Strauss syndrome, exercise induced asthma, EIB, slow-reacting substance, slow-reacting substance of anaphylaxis, SRS-A, S.R.S, aspirin exacerbated respiratory disease, AERD, aspirin-induced asthma, AIA, NSAID
Keyword [sv]
montelukast, astma, leukotriener, antileukotriener, leukotrienreceptorantagonister, cysteinylleukotriener, CysLT, CysLT1, CysLT2, leukotrien C4, leukotrien D4, leukotrien E4, leukotrien F4, LTC4, LTD4, LTE4, LTF4, Churg-Strauss syndrom, ansträngningsutlöst bronkokonstriktion, slow-reacting substance, slow-reacting substance of anaphylaxis, SRS-A, S.R.S, AERD, AIA, acetylsalicylsyra, NSAID
National Category
Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:uu:diva-200443OAI: oai:DiVA.org:uu-200443DiVA: diva2:624485
Subject / course
Pharmaceutical Pharmacology
Educational program
Freestanding course
Supervisors
Examiners
Available from: 2013-06-03 Created: 2013-05-28 Last updated: 2013-06-03Bibliographically approved

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