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)