Steroid naive eosinophilic asthma: anti-inflammatory effects of fluticasone and montelukast.
BACKGROUND
Inhaled corticosteroids and leukotriene receptor antagonists reduce airway eosinophilia and have been used as first line anti-inflammatory therapy for mild persistent asthma.


METHODS
A multicentre, randomised, placebo controlled, parallel group study was performed to compare the anti-inflammatory effects of fluticasone propionate and montelukast as measured by sputum eosinophils in 50 adults with symptomatic steroid naive asthma and sputum eosinophilia of > or =3.5%.


RESULTS
Eighteen patients received low dose fluticasone (250 mug/day), 19 received montelukast (10 mg/day), and 13 were given placebo for 8 weeks. Fluticasone treatment resulted in a greater reduction in sputum eosinophils (geometric mean (SD) 11.9 (2.3)% to 1.7 (5.1)%) than montelukast (10.7 (2.3)% to 6.9 (3.8)%; p = 0.04) or placebo (15.4 (2.4)% to 7.8 (4.2)%; p = 0.002), and improvement in FEV(1) (mean (SD) 2.6 (0.9) l to 3.0 (0.9) l) than montelukast (2.8 (0.7) l to 2.8 (0.9) l; p = 0.02) or placebo (2.4 (0.8) l to 2.4 (0.9) l; p = 0.01). Treatment with fluticasone suppressed sputum eosinophilia within a week while montelukast only attenuated it. The effect of montelukast was maximal at 1 week and was maintained over 4 weeks. The effect of fluticasone was maintained over 8 weeks while that of montelukast was not.


CONCLUSIONS
Montelukast is not as effective as low dose fluticasone in reducing or maintaining an anti-inflammatory effect in steroid naive eosinophilic asthma.
Jayaram
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L
Airways Research Group, Firestone Institute for Repiratory Health, St Joseph's Healthcare and McMaster University, Hamilton, Ontario.
Pizzichini
E
E
Lemière
C
C
Man
S F P
SF
Cartier
A
A
Hargreave
F E
FE
Pizzichini
M M M
MM
D000085:Acetates / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001249:Asthma / Q000188:drug therapy*; D003521:Cyclopropanes; D004311:Double-Blind Method; D004804:Eosinophils / Q000187:drug effects; D005260:Female; D000068298:Fluticasone; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D010349:Patient Compliance; D011657:Pulmonary Eosinophilia / Q000188:drug therapy*; D011804:Quinolines / Q000008:administration & dosage* / Q000009:adverse effects; D013183:Sputum / Q000166:cytology; D013440:Sulfides; D016896:Treatment Outcome
D000085:Acetates; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D000068298:Fluticasone; C093875:montelukast