title: Leukotriene D4 inhalation challenge for predicting short-term efficacy of montelukast: a pilot study.
abstract: BACKGROUND
  The convenient measure to predict efficacy of leukotriene receptor antagonist is lacking.
  
  
  OBJECTIVE
  To determine if leukotriene D4 inhalation challenge predicts short-term efficacy of montelukast in asthma.
  
  
  METHODS
  In this open-labelled 28-day trial, 45 patients with asthma were allocated to leukotriene-sensitive and leukotriene-insensitive group to receive montelukast monotherapy (10 mg, once daily) based on the positive threshold of leukotriene D4 inhalation challenge test (4.800 nmol). Miscellaneous measurements comprised fractional exhaled nitric oxide, methacholine inhalation challenge, Asthma Control Test and Asthma Quality of Life Questionnaire. Peak expiratory flow was self-monitored throughout the treatment. End point assessments were performed 3 to 5 days after montelukast withdrawal.
  
  
  RESULTS
  Twenty-three patients in leukotriene-sensitive group and 10 leukotriene-insensitive group completed the study. Both groups differed neither in 28-day peak expiratory flow rate nor in maximal weekly peak expiratory flow (both P > 0.05). However, minimal weekly peak expiratory flow was significantly higher in leukotriene-insensitive group throughout the treatment course (all P < 0.05) except for week 1 (P > 0.05). Both groups did not differ statistically in the post-treatment improvement in forced expiratory volume in 1 s (FEV1 ) predicted% prior to inhalation challenge, fractional exhaled nitric oxide or the airway responsiveness to leukotriene D4 or methacholine (all P > 0.05). There was a marked increase in Asthma Control Test score and the symptom score of Asthma Quality of Life Questionnaire in both groups (both P < 0.05). The overall significance of Logistic regression model was unremarkable (P = 0.467).
  
  
  CONCLUSIONS
  Responsiveness to inhaled leukotriene D4 alone might not be sufficient to predict the short-term efficacy of montelukast monotherapy in patients with asthma.
authors: State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China.
authors: Wei-jie
authors: WJ
authors: Guan
authors: Xu
authors: X
authors: Shi
authors: Jin-ping
authors: JP
authors: Zheng
authors: Yi
authors: Y
authors: Gao
authors: Cai-yu
authors: CY
authors: Jiang
authors: Yan-qing
authors: YQ
authors: Xie
authors: Qing-Xia
authors: QX
authors: Liu
authors: Zheng
authors: Z
authors: Zhu
authors: E
authors: E
authors: Guo
authors: Jia-ying
authors: JY
authors: An
authors: Xin-xin
authors: XX
authors: Yu
authors: Wen-ting
authors: WT
authors: Liu
authors: Nan-shan
authors: NS
authors: Zhong
mesh_terms: D000085:Acetates / Q000627:therapeutic use*; D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D001985:Bronchial Provocation Tests; D003521:Cyclopropanes; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D017998:Leukotriene D4 / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011788:Quality of Life; D011804:Quinolines / Q000627:therapeutic use*; D013440:Sulfides; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000085:Acetates; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D017998:Leukotriene D4; C093875:montelukast
keywords: asthma; bronchial provocation test; leukotriene D4; leukotriene-sensitive; montelukast