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• W1982718208 abstract "Douglas Robinson and colleagues1Robinson DS Campbell D Barnes PJ Addition of leukotriene antagonists to therapy in chronic persistent asthma: a randomised double-blind placebo-controlled trial.Lancet. 2001; 357: 2007-2011Summary Full Text Full Text PDF PubMed Scopus (144) Google Scholar object that the studies of montelukast they discuss give no clear selection criteria for treatment, and, as a consequence, cannot be trusted to give clinically relevant results. The opposite is true. Previous studies have tightly defined the inclusion criteria for selection of patients and, perhaps more importantly, the criteria for a diagnosis of asthma. Indeed, by insisting on proof of β-agonist reversibility at screening, the investigators might have been prejudiced against an agent that does not primarily work through broncho-dilation. Robinson and colleagues' own inclusion criterion, asthma diagnosed by a Royal Brompton physician, is by comparison a dog's dinner. I question why patients with an eminently treatable disease should end up at this centre of excellence. In secondary care there are two obvious causes of difficult asthma. First, the asthma is difficult because it is not asthma. Second, the patient has asthma but does not take the treatment. In an effort to justify selection of patients, Robinson and colleagues claim peak flow variability is present in 67 of the 72 patents compliant with peak expiratory flow rate recordings. However, in 31 of these patients, the variability is described as spontaneous, which presumably means without discernible pattern, and, therefore, not necessarily diagnostic of asthma. Even in those patients with diurnal variability we do not know the consistency of this observation. Symptoms are taken as an indication of poor asthma control but no effort has been made to assess whether such symptoms are in reality due to hyperventilation. Of course many patients in secondary care have both asthma and hyperventilation, and conventional effective asthma treatment does little for their symptoms. Finally as Ruth Green and Ian Pavord point out in their June 23 commentary,2Green RH Pavord ID Leukotriene antagonists and symptom control in chronic persistent asthma.Lancet. 2001; 357: 1991-1992Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar the fact that only two-thirds of patients could be bothered to fill out a brief diary of peak expiratory flow rate does not inspire confidence in their adherence to the trial medication. The results of Robinson and colleagues' study should be stacked against the several multicentre randomised controlled trials that show the efficacy in asthma of zafirlukast and montelukast. The lack of effect they note is probably due not to any inadequacy in treatment but reflects the selection of patients unlikely to respond. Montelukast for persistent asthmaAuthors' reply Full-Text PDF" @default.
• W1982718208 created "2016-06-24" @default.
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• W1982718208 date "2001-10-01" @default.
• W1982718208 modified "2023-09-24" @default.
• W1982718208 title "Montelukast for persistent asthma" @default.
• W1982718208 cites W1985615113 @default.
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• W1982718208 doi "https://doi.org/10.1016/s0140-6736(01)06497-2" @default.
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