Combination Regimens

In 194 patients with moderate-to-severe acute asthma (FEV₁, 47% of predicted), Camargo and coworkers did a randomized, double-blind study of standard therapy plus intravenous montelukast (7 or 14 mg) versus standard therapy plus placebo. Responses to 7 mg and 14 mg of montelukast were equivalent. Patients treated with montelukast experienced a greater increase in FEV₁ than did patients receiving placebo (14.8% versus 3.6%). Benefit was observed at 10 minutes and continued for 2 hours. Adverse effects were not observed. The authors conclude that the addition of intravenous montelukast to standard therapy causes rapid benefit in patients with acute asthma and is well tolerated. An editorial commentary by FitzGerald accompanies this article.

In 28 patients with mild asthma, O'Sullivan and coworkers determined whether adding montelukast (10 mg at night) would have an additional effect over inhaled fluticasone propionate (100 µg twice a day) on airway inflammation. Patients received inhaled fluticasone propionate plus montelukast for 8 weeks, and were then crossed over to the alternate treatment for another 8 weeks. After 8 weeks there were no differences in percent-predicted FEV₁ or the dose of histamine producing a 20% decrease in FEV₁. Both treatment arms achieved equivalent decreases in T cells, CD45RO+, mast cells, activated eosinophils in bronchial biopsies, and percentage area stained for interferon- ${gamma}$ or interleukin-4. The authors conclude that the addition of a leukotriene receptor antagonist, montelukast, did not significantly after the airway inflammatory response in patients with mild asthma as compared with treatment with inhaled fluticasone propionate alone.

To determine whether the addition of a leukotriene receptor antagonist is beneficial in patients being treated with an optimal dose of inhaled glucocorticoid alone or inhaled glucocorticoid combined with a long-acting ß₂-agonist, Currie and coworkers did a double-blind controlled trial in 22 patients with mild-to-moderate asthma. Compared with a 2-week run-in consisting of a combination of fluticasone propionate (250 µg) and salmeterol (50 µg), delivered as 1 puff twice daily, the addition of montelukast (10 mg daily) achieved a reduction in inflammatory mediators, although lung function was not affected. Compared with the fluticasone–salmeterol run-in, the addition of montelukast decreased blood eosinophils, decreased exhaled nitric oxide, decreased the recovery time after adenosine monophosphate challenge, and increased the threshold of adenosine monophosphate. The authors conclude that the addition of montelukast to an inhaled glucocorticoid (alone or in combination with a long-acting ß₂-agonist) produced a decrease in surrogate markers of inflammation without having a beneficial effect on lung function.

Citations 1-4 of 4 total displayed.

Effects of Montelukast on Surrogate Inflammatory Markers in Corticosteroid-treated Patients with Asthma

Graeme P. Currie, Daniel K. C. Lee, Kay Haggart, Caroline E. Bates, and Brian J. Lipworth
Am. J. Respir. Crit. Care Med. 167: 1232 -1238. First published online as doi:10.1164/rccm.200209-1116OC [Abstract] [Full text]

Effect of the Addition of Montelukast to Inhaled Fluticasone Propionate on Airway Inflammation

Siobhán O'Sullivan, Martijn Akveld, Conor M. Burke, and Leonard W. Poulter
Am. J. Respir. Crit. Care Med. 167: 745 -750. First published online as doi:10.1164/rccm.200208-783OC [Abstract] [Full text]

Broadening the Therapeutic Options in Acute Asthma

J. Mark FitzGerald
Am. J. Respir. Crit. Care Med. 167: 488-489. [Full text]

A Randomized Controlled Trial of Intravenous Montelukast in Acute Asthma

Carlos A. Camargo, Jr., Howard A. Smithline, Marie-Pierre Malice, Stuart A. Green, and Theodore F. Reiss
Am. J. Respir. Crit. Care Med. 167: 528 -533. First published online as doi:10.1164/rccm.200208-802OC [Abstract] [Full text]

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