[Polyposis nasi--improvement in quality of life by the influence of leukotrien receptor antagonists].
BACKGROUND
Sulfido-Leukotrienes are important inflammatory mediators of bronchial asthma, intolerance of acetylsalicylic acid (ASA), polyposis nasi and allergic rhinitis. Receptorantagonists like Montelukast constitute a well-established asthma- and ASA intolerance-therapy. The aim of our study was to evaluate changes in patients Health-Related-Quality-of-Life (HRQL) during Montelukast-monotherapy of nasal polyposis.


METHODS
The study was performed in a prospective, double blind and placebo-controlled matter. The study included 30 patients of our ENT outpatient's dept. (77 % male, mean age 49 yrs), suffering from nasal polyposis grade II to IV. Polyps were endoscopically graded, nasal Eosinophilic Cationic Protein (ECP) was measured, and HRQL-score was taken prior to and four weeks after Montelukast-(0 - 0 - 10 mg) compared to placebo. An established HRQL-questionnaire - including 25 items, summarized in 6 symptom-groups - was used. Given was a symptom-score of 1 (not troubled) to 4 (extremely troubled).


RESULTS
Patients treated with Montelukast improved their nasal symptoms (Delta HRQL-score 0.58 +/- 0.94, P < 0.01), practical problems (Delta HRQL-score 0.42 +/- 0.71, P < 0.05), headaches (Delta HRQL-score 0.38 +/- 0.56, P < 0.05), non-nasal symptoms (Delta HRQL-score 0.35 +/- 0.92, P < 0.05), sleep (Delta HRQL-score 0.26 +/- 0.71) and emotional problems (Delta HRQL-score 0.18 +/- 0.75). Intranasal ECP (Delta 210.67 ng/ml +/- 332.68) and polyp grading (Delta 0.72 +/- 1.77) tended to improve as well, but did not reach statistical significance. Patients treated with placebo revealed no significant changes neither in HRQL-score, ECP, nor polyp grading.


CONCLUSIONS
Montelukast-therapy of nasal polyposis significantly improved patient's HRQL in 4 out of 6 symptom-groups. Measuring HRQL proofed to constitute a more sensitive tool than looking at eosinophilic parameters of inflammation or polyp size.
Pauli
C
C
Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde der Ludwig-Maximilians-Universität München, Klinikum Grosshadern.
Fintelmann
R
R
Klemens
C
C
Hilgert
E
E
Jund
F
F
Rasp
G
G
Hagedorn
H
H
Kramer
M F
MF
D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use*; D003521:Cyclopropanes; D003627:Data Interpretation, Statistical; D004311:Double-Blind Method; D047150:Eosinophil Cationic Protein / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000378:metabolism; D009298:Nasal Polyps / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy*; D010919:Placebos; D011446:Prospective Studies; D011788:Quality of Life; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D012680:Sensitivity and Specificity; D013440:Sulfides; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D000085:Acetates; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D010919:Placebos; D011804:Quinolines; D013440:Sulfides; D047150:Eosinophil Cationic Protein; C093875:montelukast