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Effect of Montelukast and Fluticasone Propionate on Airway Mucosal Blood Flow in Asthma

Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Miami School of Medicine, Miami, Florida

Correspondence and requests for reprints should be addressed to Adam Wanner, M.D., Division of Pulmonary and Critical Care Medicine, University of Miami School of Medicine, P.O. Box 016960 (R-47), Miami, FL 33101. E-mail: awanner{at}miami.edu

Asthma is associated with an increase in airway blood flow (aw), presumably as a manifestation of airway inflammation. We therefore determined the effect of the antiinflammatory agents montelukast (ML) and fluticasone propionate (FP) on aw in 12 patients with mild intermittent asthma. Using a double-blind approach, aw along with FEV₁ and max₅₀ were determined before and after a 2-week treatment period with either ML (10 mg/day), FP (440 µg/day), or 10 mg of ML plus 440 µg of FP daily, separated by 2-week washout periods. Mean (± SEM) aw ranged from 68 ± 4.2 to 71.8 ± 5.9 µl · minute^–1 · ml^–1 anatomic dead space before the treatment periods. ML, FP, and ML plus FP decreased mean aw by 21.5, 20.8, and 26.9%, respectively (p < 0.05 for all). No significant difference was observed among the three regimens. FEV₁ and max₅₀ were not changed by any of the treatments. We conclude that at the dosages used, ML and FP are equipotent in reducing aw in patients with mild asthma, and that the magnitude of the response is not greater if the two drugs are combined. The results also suggest that the vascular effects of these agents can be assessed independent of their effects on airway function.

Key Words: airway inflammation • asthma • bronchial circulation • glucocorticosteroids • leukotriene modifiers

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