Effect of montelukast compared with inhaled fluticasone on airway inflammation.
BACKGROUND
Inhaled corticosteroids are currently regarded as the gold standard in anti-inflammatory therapy, however, leukotriene receptor antagonists have been ascribed anti-inflammatory properties.


OBJECTIVE
We directly compared the anti-inflammatory effects of inhaled fluticasone propionate (FP, 100 microg Diskus, twice daily) and oral montelukast (MON 10 mg, nocte) in bronchial biopsies of patients with asthma in a double-blind, double-dummy, parallel-group design.


METHODS
Bronchial biopsies, serum and urine samples were collected from 36 atopic asthmatics before and after 8 weeks of treatment. Activated T cells (CD25+), eosinophils (MBP+) and mast cells (tryptase+) were analysed by immunohistochemistry. Serum eosinophil cationic protein (ECP) and IL-5 were analysed by radio and enzyme immunoassay (EIA), respectively. Urinary 9alpha-11beta-PGF2 and leukotriene E4 (LTE4) were measured by EIA.


RESULTS
A comparison of changes from baseline [FP/MON ratio (95% confidence interval)] of activated T cells was not different when subjects were treated with FP compared to treatment with MON [1.00 (0.18-4.86); P=0.924]. Following treatment, mast cells in the FP group were significantly lower than in the group treated with MON [0.39 (0.16-0.97); P=0.041]. There was no difference in the number of eosinophils in the lamina propria following either treatment [0.54 (0.05-2.57); P=0.263]. However, treatment with FP resulted in a significantly greater decrease in serum ECP, compared to treatment with MON [0.37 (0.25-0.71); P=0.002].


CONCLUSIONS
FP appears to be superior to MON as an anti-inflammatory therapy in mild asthmatics.
Overbeek
S E
SE
Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands. s.e.overbeek@erasmusmc.nl
O'Sullivan
S
S
Leman
K
K
Mulder
P G H
PG
Hoogsteden
H C
HC
Prins
J-B
JB
D000085:Acetates / Q000008:administration & dosage*; D000280:Administration, Inhalation; D000284:Administration, Oral; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D003521:Cyclopropanes; D004311:Double-Blind Method; D047150:Eosinophil Cationic Protein / Q000097:blood; D005260:Female; D000068298:Fluticasone; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D015848:Interleukin-5 / Q000097:blood; D020024:Leukotriene Antagonists / Q000008:administration & dosage*; D008168:Lung / Q000503:physiopathology; D008297:Male; D008407:Mast Cells / Q000276:immunology; D008875:Middle Aged; D011804:Quinolines / Q000008:administration & dosage*; D015375:Receptors, Interleukin-2 / Q000276:immunology; D013440:Sulfides; D013601:T-Lymphocytes / Q000276:immunology
D000085:Acetates; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D003521:Cyclopropanes; D015848:Interleukin-5; D020024:Leukotriene Antagonists; D011804:Quinolines; D015375:Receptors, Interleukin-2; D013440:Sulfides; D000068298:Fluticasone; D047150:Eosinophil Cationic Protein; C093875:montelukast