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Management of Asthma

The Potential Role of Zafirlukast

  • Drugs in Disease Management
  • Published:
Disease Management and Health Outcomes

Abstract

Asthma is a chronic inflammatory disorder of the airways. The worldwide prevalence of asthma has increased in recent decades. There is an approximately 20-fold variation (range 1.6% to 36.8%) in the prevalence of childhood asthma throughout the world. The highest prevalence rates are in the UK, Australia, New Zealand, the Republic of Ireland and Canada. The indirect costs of asthma, which include absence from school, lost productivity and premature death, are substantial.

The goals of asthma therapy include controlling the disease and maintaining the well-being of the patient. Identification and avoidance of factors that precipitate asthma attacks are important in achieving satisfactory control of asthma. A stepped-care approach to drug therapy, in which anti-inflammatory therapy is the cornerstone, is recommended.

Zafirlukast is a cysteinyl leukotriene type 1 receptor antagonist that causes bronchodilation and has anti-inflammatory properties. Oral zafirlukast 20mg twice daily was more effective than placebo in relieving symptoms, improving lung function, reducing requirements for as-needed β2-agonists and preventing exacerbations in patients ≥12 years of age with mild to moderate asthma. Zafirlukast 20mg twice daily produced improvements in symptoms and reductions in as-needed β2-agonist rescue medication similar to inhaled sodium cromoglycate in patients with asthma. As an alternative to inhaled corticosteroids, zafirlukast 20mg twice daily produced improvements in night-time wakenings, mornings with asthma and reductions in the use of β2-agonist rescue medication in patients with mild to moderate asthma. However, beclomethasone dipropionate 200 to 250µg twice daily produced greater improvement than zafirlukast in all efficacy parameters and significantly greater improvements in morning peak expiratory flow rate, forced expiratory volume in 1 second and daytime symptoms than zafirlukast. In patients with asthma uncontrolled on low dosages of inhaled corticosteroids, the addition of oral zafirlukast 40 or 80mg twice daily was as effective as doubling the dose of the inhaled corticosteroid.

The most common adverse events associated with zafirlukast in trials ≤20 weeks long were pharyngitis, headache and aggravation reactions, the incidence of which was similar to that in placebo recipients. Drug-drug interactions involving zafirlukast and aspirin, erythromycin, terfenadine, theophylline and warfarin have been described.

Zafirlukast is indicated for the prophylactic treatment of chronic asthma. The drug is currently recognised in the US guidelines as an alternative to inhaled corticosteroids in patients aged ≥12 years with mild persistent asthma. As an adjunct to corticosteroids, the role of zafirlukast is still evolving, but it seems likely that patients with asthma of all severities may benefit from the drug.

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References

  1. Adkins JC, Brogden RN. Zafirlukast: a review of its pharmacology and therapeutic potential in the management of asthma. Drugs 1998 Jan; 55: 121–44

    Article  PubMed  CAS  Google Scholar 

  2. Lemanske Jr RF, Busse WW. Asthma. JAMA 1997 Dec 10; 278: 1855–73

    Article  PubMed  Google Scholar 

  3. National Asthma Education and Prevention Program. Expert Panel Report II: Guidelines for the diagnosis and management of asthma. Bethesda (MD): National Heart, Lung, and Blood Institute Information Center, 1997

    Google Scholar 

  4. National Heart Lung and Blood Institute. Global Initiative for Asthma. Global strategy for asthma management and prevention. NHLBI/WHO workshop report. National Heart, Lung and Blood Institute Publication No. 95-3659, Jan 1995

  5. O’Byrne PM, Gauvreau GM, Wood LJ. Pharmacologic modulation of airway inflammation. Allergy 1998; 53: 41–7

    Article  PubMed  Google Scholar 

  6. O’Byrne PM, Israel E, Drazen JM. Antileukotrienes in the treatment of asthma. Ann Intern Med 1997 Sep 15; 127: 472–80

    PubMed  Google Scholar 

  7. Hay DWP. Pharmacology of leukotriene receptor antagonists: more than inhibitors of bronchoconstriction. Chest 1997 Feb; 111 Suppl.: 35S–45S

    Article  PubMed  CAS  Google Scholar 

  8. Marom Z, Shelhamer JH, Bach MK, et al. Slow-reacting substances, leukotrienes C4 and D4 increase the release of mucus from human airways in vitro. Am Rev Respir Dis 1982; 126: 449–51

    PubMed  CAS  Google Scholar 

  9. Laitinen LA, Laitinen A, Haahtela T, et al. Leukotriene E4 and granulocytic infiltration into asthmatic airways. Lancet 1993 Apr; 341: 989–90

    Article  PubMed  CAS  Google Scholar 

  10. Piacentini GL, Kaliner MA. The potential role of leukotrienes in bronchial asthma. Am Rev Respir Dis 1991; 143: s96–9

    PubMed  CAS  Google Scholar 

  11. Camp RDR, Coutts AA, Greaves MW, et al. Responses of human skin to intradermal injections of leukotrienes C4, D4, B4. Br J Pharmacol 1980; 80: 497–502

    Article  Google Scholar 

  12. Soter NA, Lewis RA, Corey EJ, et al. Local effects of synthetic leukotrienes (LTC4, LTD4, LTE4 and LTB4) in human skin. J Invest Dermatol 1983; 80: 115–9

    Article  PubMed  CAS  Google Scholar 

  13. Coles SJ, Neill KH, Reid LM, et al. Effects of leukotrienes C4 and D4 on glycoprotein and lysozyme secretion by human bronchial mucosa. Prostaglandins 1983; 25: 155–70

    Article  PubMed  CAS  Google Scholar 

  14. Spada CS, Krauss AH, Nieves AL, et al. Effects of leukotrienes B4 (LTB4) and D4 (LTD4) on motility of isolated normodense human eosinophils and neutrophils. Adv Exp Med Biol 1997; 400B: 699–706

    PubMed  CAS  Google Scholar 

  15. Laitinen LA, Laitinen A, Lindqvist A, et al. Effects of inhaled leukotriene E4 (LTE4) on airway inflammation in asthmatics, assessed by bronchial biopsy. Data on file: Zeneca Pharmaceuticals, 1998

  16. Lundbäck B. Epidemiology of rhinitis and asthma. Clin Exp Allergy 1998 Jun; 28 Suppl. 2: 3–10

    PubMed  Google Scholar 

  17. Sears MR. Epidemiology of childhood asthma. Lancet 1997 Oct 4; 350: 1015–20

    Article  PubMed  CAS  Google Scholar 

  18. Kaur B, Anderson HR, Austin J, et al. Prevalence of asthma symptoms, diagnosis, and treatment in 12–14 year old children across Great Britain (International Study of Asthma and Allergies in Childhood, ISAAC UK). BMJ 1998 Jan 10; 316: 118–24

    Article  PubMed  CAS  Google Scholar 

  19. Sly RM, O’Donnell R. Stabilization of asthma mortality. Ann Allergy Asthma Immunol 1997 Apr; 78: 347–54

    Article  PubMed  CAS  Google Scholar 

  20. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema:ISAAC. Lancet 1998 Apr 25; 351: 1225–32

    Article  Google Scholar 

  21. Asthma mortality and hospitalization among children and young adults–United States, 1980–1993. MMWR Morb Mortal Wkly Rep 1996 May 3; 45 (17): 350-3

  22. Hyndman SJ, Williams DRR, Merrill SL, et al. Rates of admission to hospital for asthma. BMJ 1994 Jun 18; 308: 1596–600

    Article  PubMed  CAS  Google Scholar 

  23. Grol MH, Gerritsen J, Postma DS. Asthma: from childhood to adulthood. Allergy 1996 Dec; 51: 855–69

    PubMed  CAS  Google Scholar 

  24. Lange P, Ulrik CS, Vestbo J. Mortality in adults with self-reported asthma. Lancet 1996 May 11; 347: 1285–9

    PubMed  CAS  Google Scholar 

  25. Lange P, Parner J, Vestbo J, et al. A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med 1998; 339: 1194–200

    Article  PubMed  CAS  Google Scholar 

  26. Blaiss MS. Outcomes analysis in asthma. JAMA 1997 Dec 10; 278: 1874–80

    Article  PubMed  CAS  Google Scholar 

  27. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med 1992 Mar 26; 326: 862–6

    Article  PubMed  CAS  Google Scholar 

  28. Legorreta AP, Christian-Herman J, O’Connor RD, et al. Compliance with national asthma management guidelines and specialty care: a Health Maintenance Organization experience. Arch Intern Med 1998 Mar 9; 158: 457–64

    Article  PubMed  CAS  Google Scholar 

  29. Krahn MD, Berka C, Langlois P, et al. Direct and indirect costs of asthma in Canada, 1990. Can Med Assoc J 1996 Mar 15; 154: 821–31

    CAS  Google Scholar 

  30. Mellis CM, Peat JK, Bauman AE, et al. The cost of asthma in New South Wales. Med J Aust 1991; 155: 522–8

    PubMed  CAS  Google Scholar 

  31. Rea HH, Sears MR, Beaglehole R, et al. Lessons from the national asthma mortality study: circumstances surrounding death. N Z Med J 1987; 100: 10–3

    PubMed  CAS  Google Scholar 

  32. Flaum M, Lung CL, Tinkelman D. Take control of high-cost asthma. J Asthma 1997; 34(1): 5–14

    Article  PubMed  CAS  Google Scholar 

  33. Taitel MS, Kotses H, Bernstein IL. A self-management program for adult asthma. Part II: Cost-benefit analysis. J Allergy Clin Immunol 1995 Mar; 95: 672–6

    Article  PubMed  CAS  Google Scholar 

  34. Kotses H, Bernstein IL, Bernstein DI, et al. A self-management program for adult asthma. Part I: development and evaluation. J Allergy Clin Immunol 1995 Feb; 95: 529–40

    Article  PubMed  CAS  Google Scholar 

  35. D’Souza W, Crane J, Burgess C, et al. Community-based asthma care: trial of a ‘credit card’ asthma self-management plan. Eur Respir J 1994; 7: 1260–5

    Article  PubMed  Google Scholar 

  36. D’Souza W, Burgess C, Ayson M, et al. Trial of a “credit card” asthma self-management plan in a high-risk group of patients with asthma. J Allergy Clin Immunol 1996 May; 97: 1085–92

    Article  PubMed  Google Scholar 

  37. Ignacio-Garcia JM, Gonzalez-Santos P. Asthma self-management education program by home monitoring of peak expiratory flow. Am J Respir Crit Care Med 1995; 151: 353–9

    PubMed  CAS  Google Scholar 

  38. Boulet L-P, Boutin H, Côté J, et al. Evaluation of an asthma self-management education program. J Asthma 1995; 32(3): 199–206

    Article  PubMed  CAS  Google Scholar 

  39. Lahdensuo A, Haahtela T, Herrala J, et al. Randomised comparison of guided self management and traditional treatment of asthma over one year. BMJ 1996 Mar 23; 312: 748–52

    Article  PubMed  CAS  Google Scholar 

  40. Kelso TM, Abou-Shala N, Heilker GM, et al. Comprehensive long-term management program for asthma: effect on outcomes in adult African-Americans. Am J Med Sci 1996 Jun; 311: 272–80

    Article  PubMed  CAS  Google Scholar 

  41. Lahdensuo A, Haahtela T, Herrala J, et al. Randomised comparison of cost effectiveness of guided self management and traditional treatment of asthma in Finland. BMJ 1998 Apr 11; 316: 1138–9

    Article  PubMed  CAS  Google Scholar 

  42. Bender B, Milgrom H, Rand C. Nonadherence in asthmatic patients: is there a solution to the problem? Ann Allergy Asthma Immunol 1997 Sep; 79: 177–85

    Article  PubMed  CAS  Google Scholar 

  43. Creer TL, Levstek D. Medication compliance and asthma: overlooking the trees because of the forest. J Asthma 1996; 33(4): 203–11

    Article  PubMed  CAS  Google Scholar 

  44. The British Guidelines on asthma management 1995 review and position statement. Thorax 1997 Feb; 52 Suppl. 1: S1-S21

  45. von Mutius E. Towards prevention. Lancet 1997 Oct; 350 Suppl. 2: 14–7

    Google Scholar 

  46. Quirce S, Sastre J. Occupational asthma. Allergy 1998 Jul; 53: 633–41

    Article  PubMed  CAS  Google Scholar 

  47. Venables KM, Chan-Yeung M. Occupational asthma. Lancet 1997 May 17; 349: 1465–9

    Article  PubMed  CAS  Google Scholar 

  48. Davis R, Noble S. Management of asthma: defining the role of salmeterol. Dis Manage Health Outcomes 1997 Jul; 2: 34–49

    Article  Google Scholar 

  49. Zeneca Pharmaceuticals. Zafirlukast prescribing information. Wilmington, Delaware, USA, 1998

  50. Zeneca Pharmaceuticals. Zafirlukast product monograph. Cheshire, UK, August 1997

  51. Merck & Co. Inc. Montelukast prescribing information. White-house Station, New Jersey, USA, 1997

  52. Abbott Laboratories. Zileuton prescribing information. Abbott Laboratories, North Chicago, Illinois, USA, 1998

  53. Merck’s Singulair cited in 173 U.K. ADR case reports since Feb. launch. FDC Reports–Pink Sheet- Prescription Pharmaceuticals and Biotechnology 1998 Sep 7; 60: 17

  54. Barnes PJ. Current issues for establishing inhaled corticosteroids as the antiinflammatory agents of choice in asthma. J Allergy Clin Immunol 1998 Apr; 101 (Pt 2) Suppl.: S427–33

    Article  PubMed  CAS  Google Scholar 

  55. Dworski R, Fitzgerald GA, Oates JA, et al. Effect of oral prednisone on airway inflammatory mediators in atopic asthma. Am J Respir Crit Care Med 1994; 149: 953–9

    PubMed  CAS  Google Scholar 

  56. Jatulis DE, Meng Y-Y, Elashoff RM, et al. Preventive pharmacologic therapy among asthmatics: five years after publication of guidelines. Ann Allergy Asthma Immunol 1998; 81: 82–8

    Article  PubMed  CAS  Google Scholar 

  57. Bousquet J, Knani J, Henry C, et al. Undertreatment in a non-selected population of adult patients with asthma. J Allergy Clin Immunol 1996 Sep; 98: 514–21

    Article  PubMed  CAS  Google Scholar 

  58. Lang DM, Sherman MS, Polansky M. Guidelines and realities of asthma management: the Philadelphia story. Arch Intern Med 1997 Jun 9; 157: 1193–200

    Article  PubMed  CAS  Google Scholar 

  59. Knorr B, Matz J, Bernstein JA, et al. Montelukast for chronic asthma in 6- to 14-year-old children. JAMA 1998; 279: 1181–6

    Article  PubMed  CAS  Google Scholar 

  60. Knorr BA, Matz J, Sveum RJ, et al. Montelukast (MK-0476) improves asthma over 6 months of treatment in 6- to 14-year old patients [abstract]. Eur Respir J 1997 Sep; 10 Suppl 25: 219s

    Google Scholar 

  61. Hui KP, Barnes NC. Lung function improvement in asthma with a cysteinyl-leukotriene receptor antagonist. Lancet 1991 May 4; 337: 1062–3

    Article  PubMed  CAS  Google Scholar 

  62. Dahlén B, Zetterström O, Björck T, et al. The leukotriene-antagonist ICI-204, 219 inhibits the early airway reaction to cumulative bronchial challenge with allergen in atopic asthmatics. Eur Respir J 1994 Feb; 7: 324–31

    Article  PubMed  Google Scholar 

  63. Findlay SR, Barden JM, Easley CB, et al. Effect of the oral leukotriene antagonist, ICI 204, 219, on antigen-induced bronchoconstriction in subjects with asthma. J Allergy Clin Immunol 1992 May; 89: 1040–5

    Article  PubMed  CAS  Google Scholar 

  64. O’Shaughnessy KM, Taylor IK, O’Connor B, et al. Potent leukotriene D4 receptor antagonist ICI 204, 219 given by the inhaled route inhibits the early but not the late phase of allergen-induced bronchoconstriction. Am Rev Respir Dis 1993 Jun; 147(Pt 1): 1431–5

    PubMed  Google Scholar 

  65. Taylor IK, O’Shaughnessy KM, Fuller RW, et al. Effect of cysteinyl-leukotriene receptor antagonist ICI 204, 219 on allergen-induced bronchoconstriction and airway hyperreactivity in atopic subjects. Lancet 1991 Mar 23; 337: 690–4

    Article  PubMed  CAS  Google Scholar 

  66. Roquet A, Dahlén B, Kumlin M, et al. Combined antagonism of leukotrienes and histamine produces predominant inhibition of allergen-induced early and late phase airway obstruction in asthmatics. Am J Respir Crit Care Med 1997; 155: 1856–63

    PubMed  CAS  Google Scholar 

  67. Nathan RA, Glass M, Minkwitz MC. Inhaled ICI 204, 219 blocks antigen-induced bronchoconstriction in subjects with bronchial asthma. Chest 1994 Feb; 105: 483–8

    Article  PubMed  CAS  Google Scholar 

  68. Calhoun WJ, Lavins BJ, Minkwitz MC, et al. Effect of zafirlukast (Accolate) on cellular mediators on inflammation: bronchoalveolar lavage fluid findings after segmental antigen challenge. Am J Respir Crit Care Med 1998 May; 157(Pt 1): 1381–9

    PubMed  CAS  Google Scholar 

  69. Kylstra JW, Sweitzer DE, Miller CJ, et al. Zafirlukast (Accolate) in moderate asthma: patient-reported outcomes and peripheral eosinophil data from a 13-week trial [abstract]. Am J Respir Crit Care Med 1998; 157(3): A410

    Google Scholar 

  70. Laitinen LA, Laitinen A, Lindqvist A, et al. Inhaled leukotriene E4 (LTE4) induces a persistent eosinophilia & airway obstruction which is reversed by regular zafirlukast treatment [abstract]. Data on file: Zeneca Pharmaceuticals, 1998

  71. Smith LJ, Hanby LA, Lavins BJ, et al. A single dose of zafirlukast reduces LTD4 induced bronchoconstriction in patients on maintenance inhaled corticosteroid therapy. Ann Allergy Asthma Immunol 1998; 81: 43–9

    Article  PubMed  CAS  Google Scholar 

  72. Lazarus SC, Wong HH, Watts MJ, et al. The leukotriene receptor antagonist zafirlukast inhibits sulfur dioxide-induced bronchoconstriction in patients with asthma. Am J Respir Crit Care Med 1997 Dec; 156: 1725–30

    PubMed  CAS  Google Scholar 

  73. Finnerty JP, Wood-Baker R, Thomson H, et al. Role of leukotrienes in exercise-induced asthma. Inhibitory effect of ICI 204219, a potent leukotriene D4 receptor antagonist. Am Rev Respir Dis 1992 Apr; 145: 746–9

    PubMed  CAS  Google Scholar 

  74. Israel E, Lavins BJ, Miller CJ, et al. Effect of zafirlukast (20 and 40 mg) on cold-air-induced bronchoconstriction in patients with bronchial asthma [abstract no. P0381]. Eur Respir J 1996; 9 Suppl. 23: 51s

    Google Scholar 

  75. Koraulov A, Didkovski N, Treskunov V, et al. Estimation of efficiency of anti-leukotriene preparation in patients with aspirin-induced asthma [abstract]. Eur Respir J 1998; 12 Suppl. 28: 274S

    Google Scholar 

  76. Fish JE, Kemp JP, Lockey RF, et al. Zafirlukast for symptomatic mild-to-moderate asthma: a 13-week multicenter study. Clin Ther 1997; 19(4): 675–90

    Article  PubMed  CAS  Google Scholar 

  77. Nguyen MH, O’Connor JP, Johnson NE. Stratified analysis of clinical response to zafirlukast in patients with mild-to-moderate asthma [abstract]. Pharmacotherapy 1997 Sep–Oct; 17: 1118

    Google Scholar 

  78. Spector SL, Smith LJ, Glass M, et al. Effects of 6 weeks of therapy with oral doses of ICI 204, 219, a leukotriene D4 receptor antagonist, in subjects with bronchial asthma. Am J Respir Crit Care Med 1994 Sep; 150: 618–23

    PubMed  CAS  Google Scholar 

  79. Nathan RA, Hanby LA, Kylstra JW, et al. Zafirlukast improves symptoms of asthma and quality of life in asthmatic patients with moderate airflow obstruction [abstract]. Eur Respir J 1997 Sep; 10 Suppl. 25: 438s

    Google Scholar 

  80. Minkwitz MC, Bonuccelli CB, Warren MS. Zafirlukast (Accolate) response in severe persistent asthma [abstract]. Am J Respir Crit Care Med 1998; 157(3): A410

    Google Scholar 

  81. Kemp JP, Glass M, Minkwitz MC. Onset of action of the leukotriene-receptor antagonist, zafirlukast, in patients with asthma [abstract]. Eur Respir J 1995 Sep; 8 Suppl. 19: 288s

    Google Scholar 

  82. Wu LYF, Bonuccelli C, Simonsen S, et al. Early benefits of zafirlukast in patients with mild-to-moderate asthma [abstract]. Eur Respir J 1998; 12 Suppl. 28: 360S

    Google Scholar 

  83. Hassall SM, Miller C, Harris A, et al. Zafirlukast (Accolate) reduces the need for oral steroid bursts [abstract]. Am J Respir Crit Care Med 1998; 157(3): A411

    Google Scholar 

  84. Holgate ST, Anderson KD, Rodgers EM. Comparison of Accolate (zafirlukast) with sodium cromoglycate in mild to moderate asthmatic patients [abstract]. Allergy 1995; 50 Suppl. 26: 319–20

    Google Scholar 

  85. Nathan RA, Glass M, Snader L. Thirteen weeks of treatment with zafirlukast (Accolate) or cromolyn sodium (Intal) in patients with mild or moderate asthma [abstract]. Asthma 95: Theory to Treatment; 15 July 1995: 46

  86. Kemp JP, Korenblat PE, Scherger J, et al. Zafirlukast in clinical practice: overall results of the Accolate clinical experience and pharmacoepidemiology trial (ACCEPT) in patients with asthma [abstract]. Annual Meeting of the American College of Allergy and Immunology, 1998 Nov 6–11; Philadelphia

    Google Scholar 

  87. Korenblat PE, Kemp JP, Scherger J, et al. Accolate (zafirlukast) clinical experience and pharmacoepidemiology trial (ACCEPT) in patients with asthma: results by age group stratification [abstract]. Annual Meeting of the American College of Allergy, Asthma and Immunology, 1998 Nov 6–11; Philadelphia

    Google Scholar 

  88. Hofstra WB, Sterk PJ, Neijens HJ, et al. Two weeks treatment with zafirlukast (Accolate), sodium cromoglycate or placebo on exercised-induced bronchoconstriction in asthmatic adolescents [abstract]. Am J Respir Crit Care Med 1997; 155 (4 Pt 2): A665

    Google Scholar 

  89. Lockhart A, Djaballah K, Dessanges JE, et al. The protective effect of zafirlukast against exercise-induced asthma [abstract]. Eur Respir J 1997 Sep; 10 Suppl. 25: 419s

    Google Scholar 

  90. Laitinen LA, Naya IP, Binks S, et al. Comparative efficacy of zafirlukast and low dose steroids in asthmatics on prn β2-ag-onists [abstract]. Eur Respir J 1997 Sep; 10 Suppl. 25: 419s

    Google Scholar 

  91. Zeneca Pharmaceuticals. Zafirlukast product monograph. Cheshire, UK, August, 1998

  92. Nayak AS, Anderson P, Charous BL, et al. Equivalence of adding zafirlukast versus double-dose inhaled corticosteroids in asthmatic patients symptomatic on low-dose inhaled corticosteroids [abstract]. J Allergy Clin Immunol 1998 Jan; 101 (Pt 2): 233

    Article  Google Scholar 

  93. Virchow JC, Hassall SM, Summerton L, et al. Reduction of asthma exacerbations with zafirlukast in patients on inhaled corticosteroids [abstract]. Eur Respir J 1997 Sep; 10 Suppl. 25: 420s

    Google Scholar 

  94. Ringdal N, Whitney JG, Summerton L. Problems with inhaler technique and patient preference for oral therapy–tablet zafirlukast vs inhaled beclomethasone [abstract]. Am J Respir Crit Care Med 1998; 157(3): A416

    Google Scholar 

  95. Weinberg EG, Summerton L, Harris A. Assessment of preference for oral zafirlukast vs inhaled beclomethasone in adolescent asthmatics [abstract]. Eur Respir J 1998; 12 Suppl. 28: 37S

    Google Scholar 

  96. Ringdal N, Whitney JG, Summerton L. Acomparison of patient preference for treatment with oral zafirlukast or inhaled beclomethasone [abstract]. Eur Respir J 1997; 10 Suppl. 25: 437s

    Google Scholar 

  97. Chung KF, Kennelly JC, Summerton L, et al. Compliance with an oral asthma treatment: electronic monitoring of twice daily dosing with zafirlukast [abstract]. 16th International Congress on Allergology and Clinical Immunology; 1997 Oct 22–23; Mexico, Suppl. 4, 241

  98. Kelloway JS, Wyatt RA, Adlis SA. Comparison of patient’s compliance with prescribed oral and inhaled asthma medications. Arch Intern Med 1994; 154: 1349–53

    Article  PubMed  CAS  Google Scholar 

  99. Barnes NC. Clinical tolerability of zafirlukast, a new oral anti-leukotriene drug. Eur Resp Rev 1998; 8: 194–8

    Google Scholar 

  100. Wechsler ME, Garpestad E, Flier SR, et al. Pulmonary infiltrates, eosinophilia, and cardiomyopathy following corticosteroid withdrawal in patients with asthma receiving zafirlukast. JAMA 1998 Feb 11; 279: 455–7

    Article  PubMed  CAS  Google Scholar 

  101. Food and Drug Administration. Health advisory for new asthma drug. Media Release: [2 pages], 23 Jul 1997. USA

  102. Josefson D. Asthma drug linked with Churg-Strauss syndrome [news]. BMJ 1997 Aug 9; 315: 330

    PubMed  CAS  Google Scholar 

  103. Churg A, Brallas M, Cronin SR, et al. Formes frustes of Churg-Strauss syndrome. Chest 1995; 108: 320–3

    Article  PubMed  CAS  Google Scholar 

  104. Burgher LW, Kass I, Schenken JR. Pulmonary allergic granulomatosis: a possible drug reaction in a patient receiving cromolyn sodium. Chest 1974 Jul; 66(1): 84–6

    Article  PubMed  CAS  Google Scholar 

  105. Lobel H, Machtey I, Eldor MY. Pulmonary infiltrates with eosinophilia in an asthmatic patient treated with disodium cromoglycate [letter]. Lancet 1972 Nov 11; 1032

  106. Muller J, Kowalski J. Unusual side effects during disodium cromoglycate (Intal) therapy in a case of bronchial asthma. Pneumologie 1975 May 30; 151(4): 323–8

    Article  CAS  Google Scholar 

  107. Rosenberg JL, Edlow D, Sneider R. Liver disease and vasculitis in a patient taking cromolyn. Arch Intern Med 1978 Jun; 138: 989–91

    Article  PubMed  CAS  Google Scholar 

  108. Slater EE. Cardiac tamponade and peripheral eosinophilia in a patientreceiving cromolyn sodium. Chest 1978; 73: 878–9

    Article  PubMed  CAS  Google Scholar 

  109. Vargo DL, Yeh C, Lasseter K, et al. Effect of zafirlukast on prothrombin time and area under the curve of warfarin [abstract]. J Clin Pharmacol 1997; 37: 870

    Google Scholar 

  110. Suttle AB, Vargo DL, Wilkinson LA, et al. Effect of zafirlukast on the pharmacokinetics of R- and S-warfarin in healthy men [abstract no. 584]. Allergy 1997; 52 Suppl. 37: 184

    Google Scholar 

  111. Morkunas A, Graeme K. Zafirlukast-warfarin drug interaction with gastrointestinal bleeding [abstract]. J Toxicol Clin Toxicol 1997 Aug; 35: 501

    Google Scholar 

  112. Katial RK, Stelzle RC, Bonner MW, et al. A drug interaction between zafirlukast and theophylline. Arch Intern Med 1998; 158: 1713–5

    Article  PubMed  CAS  Google Scholar 

  113. Grimm SW, Slams KR, Aaron EJ. Zafirlukast is a substrate for CYP2C9 and an inhibitor of CYP2C9 and CYP3A in vitro [abstract]. 7th North American International Society for the Study of Xenobiotics Meeting; 1996 Oct 20–24; San Diego, California, 392

    Google Scholar 

  114. Suttle AB, Birmingham BK, Vargo DL, et al. The pharmacokinetics of zafirlukast and terfenadine after coadministration to healthy men [abstract]. J Clin Pharmacol 1997; 37: 870

    Google Scholar 

  115. Garey KW, Peloquin CA, Nafziger AN, et al. Effect of zafirlukast (ZAF) on the pharmacokinetics of clarithromycin (CLAR) and 14-hydroxy clarithromycin (14-OHC) [abstract no. A-80]. Abstracts of the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, CA 1998 Sep 24–27: 25

    Google Scholar 

  116. Suissa S, Dennis R, Ernst P, et al. Effectiveness of the leukotriene receptor antagonist zafirlukast for mild-to-moderate asthma: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 1997 Feb 1; 126: 177–83

    PubMed  CAS  Google Scholar 

  117. Klim JB, Brown J, Syrett N, et al. Cost impact of reducing exacerbations of asthma in multi-national clinical trials with zafirlukast [abstract no. P0382]. Eur Respir J 1996; 9 Suppl. 23: 52s

    Google Scholar 

  118. Cockcroft DW. Practical issues in asthma management: correct use of inhalation devices. Ann Allergy 1993 Aug; 71: 83–4

    PubMed  CAS  Google Scholar 

  119. Larsen JS, Hahn M, Kochevar JW, et al. Administration errors with a conventional metered dose inhaler versus a novel breath actuated device. Ann Allergy 1993 Aug; 71: 103–6

    PubMed  CAS  Google Scholar 

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    Blair Jarvis & Julie C. Adkins

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Correspondence to Blair Jarvis.

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Various sections of the manuscript reviewed by: N.C. Barnes, The London Chest Hospital, London, England; J. Bousquet, Service des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, Montpellier, France; W. Busse, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA; W.J. Calhoun, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; E.J. Duiverman, Department of Pulmonary Pediatrics, Juliana Children’s Hospital, The Hague, The Netherlands; S.T. Holgate, School of Medicine, University of Southampton, Southampton, UK; R.A. Nathan, Asthma and Allergy Associates, Colorado Springs, Colorado, USA; L.J. Smith, Pulmonary Division, Northwestern University Medical School, Chicago, Illinois, USA; S. Suissa, Division of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec, Canada; J.C. Virchow, Department of Pneumology, University Medical Clinic Freiburg, Freiburg, Germany.

Data Selection

Sources: Medical literature published in any language since 1966 on zafirlukast, identified using AdisBase (a proprietary database of Adis International, Auckland, New Zealand), Medline and EMBASE. Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.

Search strategy: AdisBase search terms were ‘asthma’, ‘guidelines’, ‘consensus’, ‘policy’, ‘cost of illness’, ‘epidemiology’, ‘pharmacoeconomics’ and ‘zafirlukast’. Medline and EMBASE search terms were ‘asthma’, ‘guidelines’, ‘decision-making’, ‘health policy’, ‘managed care programs’, ‘guideline’, ‘consensus’, ‘policy’, ‘disease management’, ‘algorithms’, ‘epidemiology’, ‘practice guideline’, ‘expert panel’, ‘utilization review’, ‘epidemiology’, ‘economics’, ‘zafirlukast’, ‘ICI 204219’ and ‘Accolate’. Searches were last updated 9 Nov, 1998.

Selection: Studies in patients with asthma who received zafirlukast. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic and pharmacokinetic data are also included, as well as background data on pathophysiology and epidemiology and management guidelines.

Index terms: Zafirlukast, asthma, therapeutic use, disease management, reviews on treatment.

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Jarvis, B., Adkins, J.C. Management of Asthma. Dis-Manage-Health-Outcomes 4, 337–353 (1998). https://doi.org/10.2165/00115677-199804060-00004

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