The effect of montelukast on bronchial provocation tests and exhaled nitric oxide levels in asthmatic patients.
BACKGROUND
Leukotriene antagonist therapy in asthmatic patients alleviates symptoms and improves exercise tolerance, however the effect of these drugs on bronchial provocation tests and exhaled nitric oxide levels are less clearly established.


OBJECTIVE
To determine the effect of montelukast treatment on airway hyperresponsiveness to exercise, methacholine and adenosine-5'-monophosphate and on exhaled nitric oxide levels in steroid-naive asthmatics.


METHODS
Following a 2 week run-in period, 20 mild to moderate asthmatics were enrolled in an open label 6 week trial of oral montelukast-sodium therapy. Bronchial hyperreactivity (exercise, methacholine and adenosine-5'-monophosphate challenges) and exhaled nitric oxide levels were measured before and after the 6 week period.


RESULTS
Montelukast treatment resulted in a significant improvement in exercise tolerance: median delta FEV1 20.0% (range 0-50) prior to treatment vs. 15.0% (range 0-50) post-treatment (P = 0.029). A significant difference was also observed for exhaled NO following therapy: median NO 16.0 ppb (range 7-41) vs. 13.0 (range 4.8-26) (P = 0.016). No change was seen in baseline lung function tests (FEV1, MEF50) or in the bronchial responsiveness (PC20) for methacholine and adenosine-5'-monophosphate.


CONCLUSIONS
This study demonstrates that the leukotriene antagonist montelukast-sodium reduces bronchial hyperreactivity in response to exercise and reduces exhaled nitric oxide levels but has little effect on bronchial responsiveness to methacholine and adenosine challenges.
Berkman
Neville
N
Institute of Pulmonology, Hadassah University Hospital, Hebrew University-Hadassah Medical School, Jerusalem, Israel. neville@hadassah.org.il
Avital
Avraham
A
Bardach
Elat
E
Springer
Chaim
C
Breuer
Raphael
R
Godfrey
Simon
S
D000085:Acetates / Q000008:administration & dosage*; D000241:Adenosine; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D001985:Bronchial Provocation Tests; D016085:Bronchoconstrictor Agents; D002648:Child; D003521:Cyclopropanes; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D016210:Methacholine Chloride; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D011804:Quinolines / Q000008:administration & dosage*; D013147:Spirometry; D013440:Sulfides; D016896:Treatment Outcome; D014665:Vasodilator Agents
D000085:Acetates; D018927:Anti-Asthmatic Agents; D016085:Bronchoconstrictor Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D014665:Vasodilator Agents; D016210:Methacholine Chloride; D009569:Nitric Oxide; D000241:Adenosine; C093875:montelukast