STUDY OBJECTIVES: In some patients with asthma treated with inhaled corticosteroids, suppression of inflammation is incomplete. This may be because the effect of corticosteroids on cysteinyl-leukotriene (cys-LT) biosynthesis is limited. Montelukast is a cys-LT antagonist that significantly improves asthma control in corticosteroid-treated asthmatic patients. However, not all patients treated with cys-LT antagonists show a clinical improvement. DESIGN: We have studied the effect of treatment for 4 weeks with montelukast (10 mg/d) on exhaled cys-LTs and leukotriene B4 (LTB4), exhaled nitric oxide, asthma quality of life (AQL), and respiratory function in patients with stable asthma. SETTING: Asthma clinics in general practice. PATIENTS: We studied 50 patients (30 men; mean +/- SEM age, 53 +/- 2 years) who were treated with inhaled corticosteroids. MEASUREMENTS AND RESULTS: We detected cys-LTs in exhaled breath condensate in 25 of 50 patients; however, in the normal nonasthmatic subjects, cys-LTs were below the limit of detection. After treatment with montelukast, there was a fall in cys-LT concentrations from 14.6 +/- 3.3 to 8.5 +/- 2.6 pg/mL after 2 weeks (p > 0.05) and to 3.9 +/- 1.3 pg/mL after 4 weeks (p < 0.01). Exhaled LTB4 levels were also elevated. After treatment with montelukast, LTB4 levels fell from 33.0 +/- 3.9 to 20.4 +/- 2.5 pg/mL after 2 weeks of treatment (p < 0.05), and to 17.0 +/- 2.2 pg/mL after 4 weeks of treatment (p < 0.01). These changes in exhaled cys-LT and LTB4 were associated with significant improvements in AQL scores. CONCLUSIONS: It appears that in some patients with stable asthma treated with inhaled corticosteroids, the suppression of inflammation is incomplete. Adding a leukotriene receptor antagonist can provide a complementary effect of controlling inflammation, with a significant improvement in quality of life.
STUDY OBJECTIVES: In some patients with asthma treated with inhaled corticosteroids, suppression of inflammation is incomplete. This may be because the effect of corticosteroids on cysteinyl-leukotriene (cys-LT) biosynthesis is limited. Montelukast is a cys-LT antagonist that significantly improves asthma control in corticosteroid-treated asthmatic patients. However, not all patients treated with cys-LT antagonists show a clinical improvement. DESIGN: We have studied the effect of treatment for 4 weeks with montelukast (10 mg/d) on exhaled cys-LTs and leukotriene B4 (LTB4), exhaled nitric oxide, asthma quality of life (AQL), and respiratory function in patients with stable asthma. SETTING: Asthma clinics in general practice. PATIENTS: We studied 50 patients (30 men; mean +/- SEM age, 53 +/- 2 years) who were treated with inhaled corticosteroids. MEASUREMENTS AND RESULTS: We detected cys-LTs in exhaled breath condensate in 25 of 50 patients; however, in the normal nonasthmatic subjects, cys-LTs were below the limit of detection. After treatment with montelukast, there was a fall in cys-LT concentrations from 14.6 +/- 3.3 to 8.5 +/- 2.6 pg/mL after 2 weeks (p > 0.05) and to 3.9 +/- 1.3 pg/mL after 4 weeks (p < 0.01). Exhaled LTB4 levels were also elevated. After treatment with montelukast, LTB4 levels fell from 33.0 +/- 3.9 to 20.4 +/- 2.5 pg/mL after 2 weeks of treatment (p < 0.05), and to 17.0 +/- 2.2 pg/mL after 4 weeks of treatment (p < 0.01). These changes in exhaled cys-LT and LTB4 were associated with significant improvements in AQL scores. CONCLUSIONS: It appears that in some patients with stable asthma treated with inhaled corticosteroids, the suppression of inflammation is incomplete. Adding a leukotriene receptor antagonist can provide a complementary effect of controlling inflammation, with a significant improvement in quality of life.
Authors: Sergei I Ochkur; Cheryl A Protheroe; Wen Li; Dana C Colbert; Katie R Zellner; Hua-Hao Shen; Andrew D Luster; Charles G Irvin; James J Lee; Nancy A Lee Journal: Am J Respir Cell Mol Biol Date: 2013-12 Impact factor: 6.914
Authors: Jason S Debley; Elizabeth S Cochrane; Gregory J Redding; Edward R Carter Journal: Ann Allergy Asthma Immunol Date: 2012-06-26 Impact factor: 6.347
Authors: Richard Einstein; Heather Jordan; Weiyin Zhou; Michael Brenner; Esther G Moses; Stephen B Liggett Journal: Proc Natl Acad Sci U S A Date: 2008-03-24 Impact factor: 11.205
Authors: Arthur F Gelb; Colleen Flynn Taylor; Chris M Shinar; Carlos A Gutierrez; Noe Zamel Journal: Can Respir J Date: 2008 May-Jun Impact factor: 2.409
Authors: Christiane Lex; Angela Zacharasiewicz; Donald N R Payne; Nicola M Wilson; Andrew G Nicholson; Sergei A Kharitonov; Peter J Barnes; Andrew Bush Journal: Respir Res Date: 2006-04-07