Intended for healthcare professionals


Inhaled glucocorticoids versus leukotriene receptor antagonists as single agent asthma treatment: systematic review of current evidence

BMJ 2003; 326 doi: (Published 22 March 2003) Cite this as: BMJ 2003;326:621
  1. Francine M Ducharme, associate professor (Francine.ducharme{at}
  1. Departments of Paediatrics and of Epidemiology and Biostatistics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
  • Accepted 29 January 2003


Objective: To compare the safety and efficacy of anti-leukotrienes and inhaled glucocorticoids as monotherapy in people with asthma.

Design: Systematic review of randomised controlled trials comparing anti-leukotrienes with inhaled glucocorticoids for 28 days or more in children and adults.

Main outcome measure: Rate of exacerbations that required treatment with systemic glucocorticoids.

Results: 13 trials (12 in adults, one in children) met the inclusion criteria; all were in people with mild and moderate asthma. Leukotriene receptor antagonists were compared with inhaled glucocorticoids at a daily dose equivalent to 400–450 μg beclometasone dipropionate. Patients treated with leukotriene receptor antagonists were 60% more likely to suffer an exacerbation requiring systemic glucocorticoids (relative risk 1.6, 95% confidence interval 1.2 to 2.2; number needed to treat 27, 13 to 81). A 130 ml greater improvement (80 ml to 170 ml) in forced expiratory volume in one second and a 19 l/min greater increase (14 l to 24 l) in morning peak expiratory flow rate were noted in favour of inhaled glucocorticoids. Differences in favour of inhaled glucocorticoids were also observed for nocturnal awakenings, use of rescue β2 agonists, and days without symptoms. Risk of side effects was no different between groups, but leukotriene receptor antagonists were associated a 2.5-fold increase risk of withdrawals due to poor asthma control (relative risk 2.5, 1.8 to 3.5).

Conclusions: Inhaled glucocorticoids doses equivalent to 400 μg/day beclometasone are more effective than leukotriene receptor antagonists in the treatment of adults with mild or moderate asthma. There is insufficient evidence to conclude on the efficacy of anti-leukotrienes in children.

What is already known on this topic

What is already known on this topic In 2000 a Cochrane systematic review tentatively concluded that control of asthma was better in patients treated with inhaled glucocorticoids as single agents than with anti-leukotrienes

The 2002 Global Initiative for Asthma guidelines still classify the role of anti-leukotrienes as “under investigation”

What this study adds

What this study adds Anti-leukotrienes as single agent are less effective than low doses of inhaled glucocorticoids for patients with mild and moderate persistent asthma


  • Funding Senior salary award of the Fonds de la Recherche en Santé du Québec. No research funding was available for the review. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests The author has received travel support, research funds, and fees for speaking from AstraZeneca, producer of zafirlukast; Merck Frosst, producer of montelukast; and GlaxoSmithKline, producer of inhaled glucocorticoid preparations with which leukotriene receptor antagonists were compared.

  • Accepted 29 January 2003
View Full Text