Effect of montelukast on exhaled leukotrienes and quality of life in asthmatic patients.

Abstract

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: Wojciech A Biernacki, Sergei A Kharitonov, Helen M Biernacka, Peter J Barnes
• Journal: Chest (Chest) Vol. 128 Issue 4 Pg. 1958-63 (Oct 2005) ISSN: 0012-3692 [Print] United States
• PMID: 16236841 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Acetates
• Anti-Asthmatic Agents
• Cyclopropanes
• Leukotrienes
• Quinolines
• Sulfides
• montelukast

Topics

• Acetates (therapeutic use)
• Anti-Asthmatic Agents (therapeutic use)
• Asthma (drug therapy, physiopathology, psychology)
• Breath Tests
• Cyclopropanes
• Exhalation
• Family Practice
• Female
• Forced Expiratory Volume
• Humans
• Leukotrienes (analysis)
• Male
• Middle Aged
• Quality of Life
• Quinolines (therapeutic use)
• Sulfides
• Vital Capacity