High-dose zafirlukast in emergency department provides small benefit in acute asthma

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  • Clinical Question: Does high-dose zafirlukast reduce the need for hospital admission in patients with an acute asthma exacerbation, and does 1 month of zafirlukast prevent relapse?
  • Study Design: Randomized controlled trial (double-blinded)
  • Allocation: Concealed
  • Setting: Emergency department (ED)
  • Synopsis: Zafirlukast is a leukotriene inhibitor, and the authors of this study speculate that its anti-inflammatory effect may improve outcomes in adolescents and adults with an acute exacerbation of asthma. Patients aged 12 to 65 years presenting with acute asthma were considered for inclusion if they had an forced expiratory volume at 1 second (FEV1) of less than 70% of predicted at admission to the ED and 25 minutes after a single dose of inhaled albuterol. They were excluded if they smoked; were pregnant; had recently used steroids or leukotriene inhibitors; needed intubation; or had pneumonia, fever, or any serious comorbidity.


Bottom Line

A high dose of zafirlukast (Accolate) slightly reduces the number of patients who have an extended stay in the emergency department (number needed to treat [NNT]=20). Continuing zafirlukast at a dose of 20 mg twice a day slightly improves outpatient outcomes, as well (NNT=20 to prevent relapse).

Other studies have shown that inhaled corticosteroids are better long-term monotherapy for patients with asthma than leukotriene inhibitors. It is difficult to say whether this approach should be widely adopted—although the results are intriguing, I’d like to see at least one confirmatory study. This approach is, however, simple and relatively inexpensive. (LOE=1b)

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