Reduction of eosinophilic inflammation in the airways of patients with asthma using montelukast.
OBJECTIVE
Leukotrienes (LTs) are involved in airway eosinophilic inflammation in patients with asthma. We examined the effects of a cysteinyl LT 1-receptor antagonist, montelukast, on sputum eosinophil levels, and the correlation between sputum eosinophils and bronchodilatation in patients with asthma.


METHODS
Double-blind, randomized, crossover study.


METHODS
University hospital and private hospital.


METHODS
Twenty-nine patients with mild-to-moderate asthma.


METHODS
Montelukast, 10 mg, and placebo tablet, once daily, each for 4 weeks.


METHODS
Sputum eosinophils analyzed using hypertonic saline solution-induced sputum and airway hyperresponsiveness to histamine were evaluated before and after treatment. In addition, morning and evening peak expiratory flow (PEF), asthma symptoms, and peripheral blood eosinophil levels were assessed.


RESULTS
The percentage of eosinophils in sputum decreased from 24.6 +/- 12.3% at baseline to 15.1 +/- 11.8% after montelukast treatment, for a change of - 9.5 +/- 12.7% (n = 20). During placebo administration, the percentage of eosinophils fell from 21.3 +/- 12.1% to 21.0 +/- 11.5%, resulting in a decrease of - 0.3 +/- 10.8% (n = 20). There was a statistically significant difference in the change in sputum eosinophil levels between these two periods (p < 0.005). The number of peripheral blood eosinophils also significantly decreased after montelukast treatment (314.1 +/- 237.6/mL) compared with placebo (413.1 +/- 232.1/mL; p < 0.005, n = 21). Although morning and evening PEF values were significantly improved from baseline after montelukast treatment (p < 0.01, n = 20), asthma symptoms and airway responsiveness to histamine were not significantly altered. Furthermore, there was no significant correlation between the decrease in sputum eosinophils and the increase in PEF.


CONCLUSIONS
These results suggest that montelukast has anti-inflammatory effects on the airway in patients with asthma, and that its bronchodilatory effect is not solely dependent on a decrease in airway eosinophilia.
Minoguchi
Kenji
K
First Department of Internal Medicine, Showa University, School of Medicine, Tokyo, Japan.
Kohno
Yasurou
Y
Minoguchi
Hideko
H
Kihara
Norio
N
Sano
Yasuyuki
Y
Yasuhara
Hajime
H
Adachi
Mitsuru
M
D000085:Acetates / Q000494:pharmacology* / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology*; D001980:Bronchi / Q000187:drug effects*; D016535:Bronchial Hyperreactivity / Q000188:drug therapy; D002452:Cell Count; D018592:Cross-Over Studies; D003521:Cyclopropanes; D004311:Double-Blind Method; D004804:Eosinophils / Q000187:drug effects*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D020024:Leukotriene Antagonists / Q000494:pharmacology* / Q000627:therapeutic use; D008875:Middle Aged; D011804:Quinolines / Q000494:pharmacology* / Q000627:therapeutic use; D012129:Respiratory Function Tests; D013183:Sputum / Q000166:cytology; D013440:Sulfides
D000085:Acetates; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; C093875:montelukast