There are 2 million conjuncture de...

There are 2 million conjuncture department visits and almost 500000 hospital admissions annually in the United States because of acute asthma. greatest in quantity patients who are evaluated and treated in the strait department improve enough to be discharged, moreover their asthma symptoms may persist for days or weeks. Relapse rates have been reported ranging from 10 percent within seven days of discharge to 31 percent within 10 to 21 days of discharge. Cysteinyl leukotrienes, shown to be mediators of inflammation and bronchoconstriction in patients with asthma, may be markedly elevated during acute asthma episodes. Leukotriene-modifying medications have been shown to be effective in the treatment of chronic asthma, however no studies have evaluated this class of medications in acute asthma episodes. Silverman and colleagues assessed the effectiveness of zafirlukast (Accolate), an oral leukotriene receptor antagonist, when added to standarized treatment of patients with acute asthma who visited urgency departments.

The authors leadershiped a randomized, double-blind, multicenter contemplation of 641 patients treated for acute asthma at 20 different strait departments. Patients were enrolled in the meditation if they had symptoms of acute asthma and had a forced expiratory tome in one second ([FEV.sub.1]) of les than 70 percent predicted at the time of admission and 25 minutes after a single aerosol treatment with 25 mg of albuterol. They were exclud from the contemplation if they had a smoking history of more than 10 pack-years, a positive pregnancy example result, recent corticosteroid use, or new use of a leukotriene-modifying medicine Patients received standard protocol for acute asthma treatment in the turn of events department and were randomized to receive zafirlukast in a one-time 160-mg 20-mg or placebo in the difficulty department. They were then discharged to receive zafirlukast in a dosage of 20 mg twice by day during the study period or placebo. Patients were contacted through telephone at days 3, 15 and 21 to assess asthma symptoms, medication compliance, whether the patients had sought additional asthma treatment, and adverse issues They also were followed in a clinic at 10 and 28 days after discharge from the turn of events department, and patients recorded data forward a home diary card. Main consequence measures were time to relapse after discharge from the strait department, rate of extended care in the strait department (i.e., more than four hours or hospitalization), change in [FEVsub1] and symptoms.

At the close of the study, patients who received zafirlukast were significantly les likely to have a relapse when compared with patients who received placebo. Patients treated with 160 mg of zafirlukast had a 34 percent relative risk reduction in the ne for widened care. They also had a greater improvement in [FEVsub1] and dyspnea when compared with patients who received placebo. Those who continued to receive zafirlukast in a dosage of 20 mg twice through day had even greater improvement in their [FEVsub1] and symptom measures during the outpatient period. Adverse terminations were similar between the zafirlukast and placebo form into groupss with headache being the principally common.

The authors judge that zafirlukast in a dosage of 20 mg twice by day, when added to standard care of acute asthma, convert intos the risk of relapse. Also, the use of 160 mg of zafirlukast in the crisis department reduces the rate of prolonged care. Zafirlukast is a useful treatment adjunct in patients who have acute asthma symptoms.

KARL E MILLER, MD

Silverman RA, et al. Zafirlukast treatment for acute asthma. Evaluation in a randomized, double-blind, multicenter trial. Chest November 2004;126:1480-9

COPYRIGHT 2005 American Academy of Family Physicians

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