title: Add-on montelukast vs double-dose budesonide in nonasthmatic eosinophilic bronchitis: a pilot study.
abstract: BACKGROUND
  Budesonide at 800 μg/d is generally suggested for treatment of nonasthmatic eosinophilic bronchitis (NAEB). In asthma, adjunctive therapy with montelukast has been shown to confer addictive anti-inflammatory effects to inhaled corticosteroid (ICS). However, whether such effects could be extrapolated to NAEB is not known.
  
  
  OBJECTIVE
  To study the efficacy and tolerability of add-on therapy with montelukast as compared to double-dose ICS in suppressing airway eosinophilia and decreasing cough severity in NAEB.
  
  
  METHODS
  In a randomized controlled trial, 26 nonsmoking, steroid-naïve NAEB patients presenting with chronic cough were treated with 800 μg/d budesonide or 400 μg/d budesonide plus montelukast 10 mg/d for 4 weeks. Cough visual analogue scale (CVAS) and eosinophil differential ratio in induced sputum (Eos) were monitored at baseline, Week 1, 2 and 4. Adverse events during treatment were recorded.
  
  
  RESULTS
  The two groups were comparable in age, gender distribution, cough duration, FEV(1)% predicted, FEV(1)/FEV ratio, baseline CVAS and geometric mean of Eos. Both regimens significantly reduced Eos and CVAS throughout the treatment course, with abrogation of sputum eosinophilia at end of therapy. There was no significant difference between the two groups in reduction of Eos and CVAS at all time points. Both regimens were well tolerated.
  
  
  CONCLUSIONS
  This preliminary study demonstrated that add-on montelukast might be an effective and well tolerated alternative to the generally suggested dose of ICS in treating steroid-naive NAEB, with suppression of eosinophilic inflammation, reduction of cough severity and sparing of ICS doses. (NCT01121016).
authors: Department of Respiratory Medicine, Hangzhou Red Cross Hospital, HuanCheng Dong Rd. 208, Hangzhou 310003, China. skinblack1966@yahoo.com.cn
authors: Chuang
authors: C
authors: Cai
authors: Mu-zhi
authors: MZ
authors: He
authors: Shu-qing
authors: SQ
authors: Zhong
authors: Yan
authors: Y
authors: Tang
authors: Bao-qing
authors: BQ
authors: Sun
authors: Qiao-li
authors: QL
authors: Chen
authors: Nan-shan
authors: NS
authors: Zhong
mesh_terms: D000085:Acetates / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001991:Bronchitis / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D019819:Budesonide / Q000008:administration & dosage*; D002908:Chronic Disease; D003371:Cough / Q000188:drug therapy; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011657:Pulmonary Eosinophilia / Q000188:drug therapy* / Q000503:physiopathology; D011804:Quinolines / Q000008:administration & dosage*; D013440:Sulfides; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000085:Acetates; D001993:Bronchodilator Agents; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D019819:Budesonide; C093875:montelukast