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The Cochrane Database of Systematic... Apr 2006Non-specific cough is defined as non-productive cough in the absence of identifiable respiratory disease or known aetiology. It is commonly seen in paediatric practice.... (Review)
Review
BACKGROUND
Non-specific cough is defined as non-productive cough in the absence of identifiable respiratory disease or known aetiology. It is commonly seen in paediatric practice. These children are treated with a variety of therapies including a variety of asthma medications. The leukotriene pathway is reported to be involved in the sensory (neurogenic) pathway, which is a mechanism thought to be involved in the pathogenesis of chronic cough.
OBJECTIVES
To evaluate the effectiveness of leukotriene receptor antagonist (LTRA) in treating children with prolonged non-specific cough.
SEARCH STRATEGY
The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE and EMBASE databases were searched by the Cochrane Airways Group. The latest searches were carried out in September 2005.
SELECTION CRITERIA
All randomised controlled trials comparing LTRA with a placebo medication in children with non-specific cough.
DATA COLLECTION AND ANALYSIS
Results of searches were reviewed against pre-determined criteria for inclusion. One eligible trial was identified but no data was available for analysis. It was not possible to separate results from children with non-specific cough from those without.
MAIN RESULTS
There was no significant difference in all study endpoints between the montelukast and placebo groups (total N=256).
AUTHORS' CONCLUSIONS
With the lack of evidence, the routine use of LRTA in treating children with non-specific cough cannot be recommended.
Topics: Acetates; Child; Cough; Cyclopropanes; Humans; Leukotriene Antagonists; Quinolines; Sulfides
PubMed: 16625643
DOI: 10.1002/14651858.CD005602.pub2 -
The Cochrane Database of Systematic... 2004Anti-leukotriene (AL) agents are being considered as 'add-on' therapy to inhaled corticosteroids (ICS), in chronic asthma. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Anti-leukotriene (AL) agents are being considered as 'add-on' therapy to inhaled corticosteroids (ICS), in chronic asthma.
OBJECTIVES
To examine the safety and efficacy of daily AL plus ICS compared to ICS alone, and determine the corticosteroid-sparing effect of AL when added to ICS in chronic asthma.
SEARCH STRATEGY
We searched MEDLINE, EMBASE, CINAHL (until August 2003), reference lists of review articles and trials, contacted international headquarters of AL manufacturers and looked at American Thoracic Society and European Respiratory Society meeting abstracts (1998 to 2003).
SELECTION CRITERIA
Randomised placebo-controlled trials of asthmatics aged two years and older with at least one month intervention.
DATA COLLECTION AND ANALYSIS
Two reviewers assessed quality and extracted data independently. Trials were grouped by asthma control at baseline (symptomatic or well-controlled) and dose of ICS in the control group (same or double).
MAIN RESULTS
Of 587 citations, 27 (25 adult and 2 paediatric) trials met inclusion criteria. Sixteen trials were published in full-text and 16 trials reported data in a way that allowed meta-analysis. In symptomatic patients, addition of licensed doses of anti-leukotrienes to ICS resulted in a non-significant reduction in the risk of exacerbations requiring systemic steroids: Relative Risk (RR) 0.64; 95% Confidence Interval (CI) 0.38 to 1.07). A modest improvement group difference in PEF was seen (Weighted Mean Difference (WMD) 7.7 L/min; 95% CI 3.6 to 11.8 L/min) together with decrease in use of rescue short-acting beta2-agonist use (WMD 1 puff/week; 95%CI 0.5 to 2). With only 3 trials comparing the use of licensed doses of anti-leukotrienes with increasing the dose of inhaled glucocorticoids, no firm conclusion can be drawn about the equivalence of both treatment options. In ICS-sparing studies of patients who were well controlled at baseline, addition of anti-leukotrienes produced no overall difference in dose of inhaled glucocorticoids (WMD -21 mcg/d, 95%CI -65, 23 mcg/d), but it was associated with fewer withdrawals due to poor asthma control (RR 0.63, 95% CI 0.42 to 0.95).
REVIEWERS' CONCLUSIONS
The addition of licensed doses of anti-leukotrienes to add-on therapy to inhaled glucocorticoids brings modest improvement in lung function. Although addition of anti-leukotrienes to inhaled glucocorticoids appears comparable to increasing the dose of inhaled steroids, the power of the review is insufficient to confirm the equivalence of both treatment options. Addition of anti-leukotrienes is associated with superior asthma control after glucocorticoid tapering; although the glucocorticoid-sparing effect cannot be quantified at present, it appears modest.
Topics: Administration, Inhalation; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Chronic Disease; Drug Therapy, Combination; Humans; Leukotriene Antagonists; Steroids
PubMed: 15106191
DOI: 10.1002/14651858.CD003133.pub2 -
The Cochrane Database of Systematic... 2000Leukotriene receptor antagonists are a new class of drug that were initially identified for use in asthma. As they have an effect on neutrophil mediated inflammation,... (Review)
Review
BACKGROUND
Leukotriene receptor antagonists are a new class of drug that were initially identified for use in asthma. As they have an effect on neutrophil mediated inflammation, they may be of benefit in bronchiectasis.
OBJECTIVES
To determine whether leukotriene receptor antagonists have any additive benefit over and above conventional treatment for bronchiectasis (usually consisting of antibiotics and postural drainage).
SEARCH STRATEGY
The Cochrane Airways Group clinical trials register derived from MEDLINE, EMBASE and hand searching of major journals was searched using the terms:Bronchiec* AND leukotrien* OR anti-leuk* OR cysteinyl, Bronchiec* AND monteluk*, Bronchiec* AND zafirluk*
SELECTION CRITERIA
Only randomised, controlled trials were considered
DATA COLLECTION AND ANALYSIS
The results of searches were analysed by both authors
MAIN RESULTS
No randomised, controlled trials were identified
REVIEWER'S CONCLUSIONS
Further research is required to establish any benefit from the use of leukotriene antagonists in bronchiectasis.
Topics: Acetates; Bronchiectasis; Clinical Trials as Topic; Cyclopropanes; Humans; Indoles; Leukotriene Antagonists; Phenylcarbamates; Placebos; Quinolines; Sulfides; Sulfonamides; Tosyl Compounds
PubMed: 11034744
DOI: 10.1002/14651858.CD002174