Effect of montelukast on exhaled leukotrienes and quality of life in asthmatic patients.
OBJECTIVE
In some patients with asthma treated with inhaled corticosteroids, suppression of inflammation is incomplete. This may be because the effect of corticosteroids on cysteinyl-leukotriene (cys-LT) biosynthesis is limited. Montelukast is a cys-LT antagonist that significantly improves asthma control in corticosteroid-treated asthmatic patients. However, not all patients treated with cys-LT antagonists show a clinical improvement.


METHODS
We have studied the effect of treatment for 4 weeks with montelukast (10 mg/d) on exhaled cys-LTs and leukotriene B4 (LTB4), exhaled nitric oxide, asthma quality of life (AQL), and respiratory function in patients with stable asthma.


METHODS
Asthma clinics in general practice.


METHODS
We studied 50 patients (30 men; mean +/- SEM age, 53 +/- 2 years) who were treated with inhaled corticosteroids.


RESULTS
We detected cys-LTs in exhaled breath condensate in 25 of 50 patients; however, in the normal nonasthmatic subjects, cys-LTs were below the limit of detection. After treatment with montelukast, there was a fall in cys-LT concentrations from 14.6 +/- 3.3 to 8.5 +/- 2.6 pg/mL after 2 weeks (p > 0.05) and to 3.9 +/- 1.3 pg/mL after 4 weeks (p < 0.01). Exhaled LTB4 levels were also elevated. After treatment with montelukast, LTB4 levels fell from 33.0 +/- 3.9 to 20.4 +/- 2.5 pg/mL after 2 weeks of treatment (p < 0.05), and to 17.0 +/- 2.2 pg/mL after 4 weeks of treatment (p < 0.01). These changes in exhaled cys-LT and LTB4 were associated with significant improvements in AQL scores.


CONCLUSIONS
It appears that in some patients with stable asthma treated with inhaled corticosteroids, the suppression of inflammation is incomplete. Adding a leukotriene receptor antagonist can provide a complementary effect of controlling inflammation, with a significant improvement in quality of life.
Biernacki
Wojciech A
WA
Department of Thoracic Medicine, Imperial College School of Medicine, National Heart and Lung Institute, Dovehouse St, London SW3 6LY, UK.
Kharitonov
Sergei A
SA
Biernacka
Helen M
HM
Barnes
Peter J
PJ
D000085:Acetates / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D001944:Breath Tests; D003521:Cyclopropanes; D045853:Exhalation; D005194:Family Practice; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D015289:Leukotrienes / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011804:Quinolines / Q000627:therapeutic use*; D013440:Sulfides; D014797:Vital Capacity
D000085:Acetates; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D015289:Leukotrienes; D011804:Quinolines; D013440:Sulfides; C093875:montelukast