Emerging treatments

Pharmacogenomic therapy

Future treatment of asthma could be directed by patient genotype, with potential therapies including targeting beta-2 adrenoreceptor and leukotriene C4 synthase polymorphisms.[62]

Co-administration of an inhaled corticosteroid with a short-acting beta-2 agonist in mild exacerbations

There is emerging evidence that co-administration of an inhaled corticosteroid (ICS) with a short-acting beta-2 agonist can have beneficial effects in the management of a mild exacerbation. These effects can be seen in the absence of the administration of a systemic corticosteroid. Patients more likely to benefit are those who have not been previously using ICS. The role of ICS used with systemic corticosteroids is not well defined.[63] In patients previously using ICS, dose titration may reduce exacerbation. [ Cochrane Clinical Answers logo ]

Long-acting beta agonists

Initiation of a long-acting beta agonist concomitantly with an inhaled corticosteroid is safe and significantly reduces asthma hospitalisations, although further large-scale clinical trials are required.[64][65]

Leukotriene receptor antagonists

The addition of an oral leukotriene receptor antagonist to standard care for acute asthma exacerbations does not have a meaningful impact on clinical outcomes, and the currently available data do not support their routine use for this indication.[66] [ Cochrane Clinical Answers logo ] ​ Intravenous formulations are not yet available outside research trials, but promising results have been reported. For example, intravenous montelukast in addition to standard therapy was shown to provide rapid bronchodilation (within 10 minutes).[67]​ Montelukast carries warnings for the potential risk of neuropsychiatric adverse events, including new-onset nightmares, behavioural and mood problems (e.g., agitation, hyperactivity, irritability, nervousness, aggression), and suicidal ideation.[1]

Proton-pump inhibitors

Although proton-pump inhibitor therapy results in a small, yet statistically significant, improvement in morning peak expiratory flow rates, this improvement is unlikely to be of clinical significance, and there is insufficient evidence to recommend empirical use of such therapy in the management of asthma.[68]

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