Expert opinion on montelukast and acebrophylline combination in the management of asthma

Asthma control is highly inadequate in India, with worse outcomes and poor adherence to inhaled corticosteroids (ICSs). As per the Global Initiative for Asthma guidelines, leukotriene receptor antagonist (LTRA) can be added when a low-to-moderate dose of ICS does not provide sufficient disease control. The combination of montelukast with its anti-inflammatory action and acebrophylline with its mild bronchodilator, anti-inflammatory, and mucolytic actions may be beneficial in patients with asthma. This manuscript aims to present an expert opinion to discuss the role of montelukast and acebrophylline combination in the management of asthma. An expert panel comprising nine specialists in respiratory medicine took part in a roundtable discussion to review the role of montelukast–acebrophylline combination in the management of asthma. A qualitative question-and-answer-based format was used to help facilitate the discussion. It was concurred that the montelukast and acebrophylline combination may be used if asthma symptoms remain uncontrolled with ICS and long-acting β2-agonists. This combination can also be preferred in patients with severe pulmonary obstruction along with allergic bronchopulmonary aspergillosis, in patients with asthma–chronic obstructive pulmonary disease overlap syndrome, and in patients with a history of smoking. There is adequate evidence for the role of montelukast and acebrophylline as individual drugs in asthma. However, evidence related to their combination therapy is lacking. The panel has reiterated the need for studies to evaluate the safety and efficacy of montelukast and acebrophylline combination in patients with asthma and its variants.