Leukotriene mediators, which are released from mast cells, eosinophils, and basophils, can cause bronchospasm and increase airway inflammation. Two LTRAs, montelukast and zafirlukast, are approved for use in children.

• LTRAs are alternative, not preferred, therapy for patients who require step 2 care for mild persistent asthma.
• They can be used as adjunctive therapy with ICSs for children 1 to 11 years of age. In the aged 12 or older group, a long-acting beta-agonist (LABA) is the preferred add-on agent and an LTRA is a nonpreferred alternative.
• LTRAs can attenuate exercise-induced bronchoconstriction (EIB).