Alternative Asthma Treatment for Patients with Increased Intraocular Pressure

Introduction to Non-Steroid Alternatives

Increased intraocular pressure is a known potential side effect of corticosteroids, including inhaled corticosteroids found in Trelegy, necessitating alternative treatment approaches that avoid steroids 1, 2

The American Academy of Family Physicians suggests that montelukast (Singulair) and zafirlukast (Accolate) are widely available leukotriene receptor antagonists (LTRAs) for asthma treatment 3, 4
LTRAs work by interfering with the pathway of leukotriene mediators released from mast cells, eosinophils, and basophils, providing good control of asthma symptoms in many patients without the use of corticosteroids 1, 3, 4
The American Academy of Family Physicians recommends that LTRAs have the advantages of ease of use and high rates of compliance 3, 4

For mild persistent asthma, the first choice is montelukast (once daily) or zafirlukast (twice daily), with alternatives including cromolyn, nedocromil, or theophylline 1, 3, 4
For patients with allergic asthma, consider biologics like omalizumab (anti-IgE) for severe persistent asthma 1, 4

LTRAs are generally less effective than inhaled corticosteroids (ICS) for controlling asthma but provide a viable non-steroid alternative, according to the American Family Physician 3, 4
The American Family Physician suggests ensuring the patient has access to a short-acting beta-agonist (SABA) like albuterol for rescue use 1, 3
Schedule a follow-up visit within 2-4 weeks of changing therapy to assess response, as recommended by the American Family Physician 3