This Article Full Text Full Text (PDF) All Versions of this Article: 200208-802OCv1 167/4/528    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Camargo, C. A. Articles by Reiss, T. F. Search for Related Content PubMed PubMed Citation Articles by Camargo, C. A., Jr. Articles by Reiss, T. F.

A Randomized Controlled Trial of Intravenous Montelukast in Acute Asthma

Department of Emergency Medicine, Massachusetts General Hospital, and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Emergency Medicine, Baystate Medical Center, Springfield, Massachusetts; and Respiratory and Allergy, Merck Research Laboratories, Rahway, New Jersey

Correspondence and requests for reprints should be addressed to Stuart A. Green, M.D., Respiratory and Allergy Merck Research Laboratories, 126 East Lincoln Avenue, RY34B-340, Rahway, NJ 07065. E-mail: stuart_green{at}merck.com

Many patients with acute asthma do not respond adequately to currently accepted therapy, including oxygen, ß-agonists, and corticosteroids. Leukotriene receptor antagonists such as montelukast have demonstrated efficacy in chronic asthma, but their efficacy in acute asthma is unknown. In this randomized, double-blind, parallel-group pilot study, adults with moderate to severe acute asthma received standard therapy plus either intravenous montelukast (7 or 14 mg) or matching placebo. A total of 201 patients were randomized, and 194 had complete data available for analysis. There was no difference in FEV₁ response between the 7- and 14-mg montelukast groups. Montelukast improved FEV₁ over the first 20 minutes after intravenous administration (mean percentage change from prerandomization baseline, 14.8% versus 3.6% for the pooled montelukast and placebo treatment groups, respectively; p = 0.007). This benefit was observed at 10 minutes and over 2 hours after intravenous therapy. Patients treated with montelukast tended to receive less ß-agonists and have fewer treatment failures than patients receiving placebo. The tolerability profile for montelukast was similar to that observed for placebo, and no unexpected adverse experiences were observed. We conclude that intravenous montelukast in addition to standard therapy causes rapid benefit and is well tolerated in adults with acute asthma.

Key Words: leukotriene antagonists • injections, intravenous • exacerbation

This article has been cited by other articles:

				C. A. Camargo Jr., G. Rachelefsky, and M. Schatz Managing Asthma Exacerbations in the Emergency Department: Summary of the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Management of Asthma Exacerbations Proceedings of the ATS, August 1, 2009; 6(4): 357 - 366. [Full Text] [PDF]

				Y. Jiang, L. Borrelli, B. J. Bacskai, Y. Kanaoka, and J. A. Boyce P2Y6 Receptors Require an Intact Cysteinyl Leukotriene Synthetic and Signaling System to Induce Survival and Activation of Mast Cells J. Immunol., January 15, 2009; 182(2): 1129 - 1137. [Abstract] [Full Text] [PDF]

				M. Peters-Golden and W. R. Henderson Jr. Leukotrienes N. Engl. J. Med., November 1, 2007; 357(18): 1841 - 1854. [Full Text] [PDF]

				M. Rosewich, M. A. Rose, O. Eickmeier, M. Travaci, R. Kitz, and S. Zielen Montelukast as add-on therapy to {beta}-agonists and late airway response Eur. Respir. J., July 1, 2007; 30(1): 56 - 61. [Abstract] [Full Text] [PDF]

				W. Carroll and W. Lenney Drug therapy in the management of acute asthma Arch. Dis. Child. Ed. Pract., June 1, 2007; 92(3): ep82 - ep86. [Full Text] [PDF]

				C. F. Robertson, D. Price, R. Henry, C. Mellis, N. Glasgow, D. Fitzgerald, A. J. Lee, J. Turner, and M. Sant Short-Course Montelukast for Intermittent Asthma in Children: A Randomized Controlled Trial Am. J. Respir. Crit. Care Med., February 15, 2007; 175(4): 323 - 329. [Abstract] [Full Text] [PDF]

				F. F. Little Treating Acute Asthma with Antibiotics -- Not Quite Yet N. Engl. J. Med., April 13, 2006; 354(15): 1632 - 1634. [Full Text] [PDF]

				Part 10.5: Near-Fatal Asthma Circulation, December 13, 2005; 112(24_suppl): IV-139 - IV-142. [Full Text] [PDF]

				J. Zhu, Y.-S. Qiu, D. J. Figueroa, V. Bandi, H. Galczenski, K. Hamada, K. K. Guntupalli, J. F. Evans, and P. K. Jeffery Localization and Upregulation of Cysteinyl Leukotriene-1 Receptor in Asthmatic Bronchial Mucosa Am. J. Respir. Cell Mol. Biol., December 1, 2005; 33(6): 531 - 540. [Abstract] [Full Text] [PDF]

				G. P. Currie, D. K. C. Lee, and P. Srivastava Long-Acting Bronchodilator or Leukotriene Modifier as Add-on Therapy to Inhaled Corticosteroids in Persistent Asthma? Chest, October 1, 2005; 128(4): 2954 - 2962. [Abstract] [Full Text] [PDF]

				A. Casas, F. P. Gomez, B. Dahlen, J. Roca, J. A. Barbera, S-E. Dahlen, and R. Rodriguez-Roisin Leukotriene D4-induced hypoxaemia in asthma is mediated by the cys-leukotriene1 receptor Eur. Respir. J., September 1, 2005; 26(3): 442 - 448. [Abstract] [Full Text] [PDF]

				W. Busse and M. Kraft Cysteinyl Leukotrienes in Allergic Inflammation: Strategic Target for Therapy Chest, April 1, 2005; 127(4): 1312 - 1326. [Abstract] [Full Text] [PDF]

				G. P. Currie and D. K.C. Lee Beneficial Antiinflammatory Effects of Leukotriene Receptor Antagonists in Asthma Chest, April 1, 2005; 127(4): 1458 - 1458. [Full Text] [PDF]

				G. P Currie, G. S Devereux, D. K C Lee, and J. G Ayres Recent developments in asthma management BMJ, March 12, 2005; 330(7491): 585 - 589. [Full Text] [PDF]

				K. Okunishi, M. Dohi, K. Nakagome, R. Tanaka, and K. Yamamoto A Novel Role of Cysteinyl Leukotrienes to Promote Dendritic Cell Activation in the Antigen-Induced Immune Responses in the Lung J. Immunol., November 15, 2004; 173(10): 6393 - 6402. [Abstract] [Full Text] [PDF]

				R. A. Silverman, R. M. Nowak, P. E. Korenblat, E. Skobeloff, Y. Chen, C. M. Bonuccelli, C. J. Miller, and S. G. Simonson Zafirlukast Treatment for Acute Asthma: Evaluation in a Randomized, Double-Blind, Multicenter Trial Chest, November 1, 2004; 126(5): 1480 - 1489. [Abstract] [Full Text] [PDF]

				D K C Lee and S A Green Urinary leukotriene LTE4 levels in non-responders to antileukotriene therapy Thorax, August 1, 2004; 59(8): 727 - 727. [Full Text] [PDF]

				Y. Kanaoka and J. A. Boyce Cysteinyl Leukotrienes and Their Receptors: Cellular Distribution and Function in Immune and Inflammatory Responses J. Immunol., August 1, 2004; 173(3): 1503 - 1510. [Abstract] [Full Text] [PDF]

				R. Buhl and S. G. Farmer Current and Future Pharmacologic Therapy of Exacerbations in Chronic Obstructive Pulmonary Disease and Asthma Proceedings of the ATS, April 1, 2004; 1(2): 136 - 142. [Abstract] [Full Text] [PDF]

				S A Green, M-P Malice, W Tanaka, C A Tozzi, and T F Reiss Increase in urinary leukotriene LTE4 levels in acute asthma: correlation with airflow limitation Thorax, February 1, 2004; 59(2): 100 - 104. [Abstract] [Full Text] [PDF]

				M. J. Tobin Asthma, Airway Biology, and Nasal Disorders in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 265 - 276. [Full Text] [PDF]

				M. S. Jalba, G. J. Rodrigo, C. Rodrigo, C. A. Camargo Jr., M.-P. Malice, S. A. Green, and T. F. Reiss Intravenous Montelukast in Acute Asthma Am. J. Respir. Crit. Care Med., January 1, 2004; 169(1): 130 - 131. [Full Text]

				E. R. McFadden Jr. Acute Severe Asthma Am. J. Respir. Crit. Care Med., October 1, 2003; 168(7): 740 - 759. [Abstract] [Full Text] [PDF]

				J. M. FitzGerald Broadening the Therapeutic Options in Acute Asthma Am. J. Respir. Crit. Care Med., February 15, 2003; 167(4): 488 - 489. [Full Text] [PDF]