An open audit of montelukast, a leukotriene receptor antagonist, in nasal polyposis associated with asthma.
BACKGROUND
Nasal polyposis occurs frequently in patients with intrinsic asthma, especially in those who are aspirin sensitive. It can be difficult to treat effectively, even with surgery and regular topical intranasal corticosteroids many patients are still symptomatic.


OBJECTIVE
To investigate the response to montelukast, a leukotriene D4 receptor antagonist, as an add-on therapy to topical and inhaled corticosteroids in patients, both aspirin sensitive (AS) and aspirin tolerant (AT), with nasal polyposis and asthma.


METHODS
Nasal polyposis symptoms were assessed by visual analogue scales; nasal polyps were assessed by nasendoscopy and via the measurement of nasal volumes by acoustic rhinometry. The nasal airway was assessed by nasal inspiratory peakflow (NIPF). Asthma was monitored using symptom scores and peak expiratory flow measurements. Aspirin sensitivity was assessed by history together with intranasal lysine aspirin challenge. Upper and lower airway nitric oxide measurements were made before and during treatment.


RESULTS
Clinical subjective improvement in nasal polyposis occurred in 64% AT (P < 0.01), patients and 50% AS patients (P > 0.05); asthma improvement in 87% AT and 61% AS patients (P < 0.05 for both). Objective changes in peak flow occurred only in AT patients (P < 0.05). Acoustic rhinometry, nasal inspiratory peak flow and nitric oxide levels did not change significantly in any group, however, correlations were seen between nitric oxide levels and polyp scores and between nitric oxide levels and acoustic rhinometry changes. Improvement on montelukast therapy was not associated with any of the following variables: age, sex, skin prick test positivity, disease duration or aspirin sensitivity. (P > 0.05 for all).


CONCLUSIONS
The findings are consistent with a subgroup of nasal polyps/asthma patients in whom leukotriene receptor antagonists are effective. This is not related to aspirin sensitivity. Further placebo-controlled studies need to be undertaken.
Ragab
S
S
Royal National Throat, Nose and Ear Hospital, London, UK.
Parikh
A
A
Darby
Y C
YC
Scadding
G K
GK
D000085:Acetates / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D001249:Asthma / Q000139:chemically induced / Q000150:complications* / Q000188:drug therapy*; D001760:Bleeding Time; D003521:Cyclopropanes; D005260:Female; D006801:Humans; D007320:Inspiratory Capacity / Q000187:drug effects / Q000502:physiology; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications* / Q000188:drug therapy*; D009569:Nitric Oxide / Q000378:metabolism; D010366:Peak Expiratory Flow Rate / Q000187:drug effects / Q000502:physiology; D011804:Quinolines / Q000627:therapeutic use*; D012680:Sensitivity and Specificity; D012882:Skin Tests; D013440:Sulfides
D000085:Acetates; D018927:Anti-Asthmatic Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D009569:Nitric Oxide; C093875:montelukast; D001241:Aspirin