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Published ahead of print on August 15, 2002, doi:10.1164/rccm.200206-509OC

Am. J. Respir. Crit. Care Med., Volume 166, Number 9, November 2002, 1212-1217

A more recent version of this article appeared on November 1, 2002
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Submitted on June 4, 2002
Accepted on August 12, 2002

Effects of montelukast and budesonide on airway responses and airway inflammation in asthma

Richard Leigh1*, Dilini Vethanayagam1, Makoto Yoshida1, Richard M Watson1, Tracy Rerecich1, Mark D Inman1, and Paul M O'Byrne1

1 St. Joseph's Healthcare - McMaster University, Asthma Research Group, Firestone Institute for Respiratory Health and Department of Medicine, Hamilton, Ontario, Canada

* To whom correspondence should be addressed. E-mail: rleigh{at}mcmaster.ca.

Inhaled corticosteroids are effective anti-inflammatory therapy for asthma; however they do not completely abolish allergen-induced airway inflammation. Leukotriene modifiers attenuate both early and late allergen responses, and have anti-inflammatory properties. We reasoned that treatment with budesonide and montelukast in combination might provide greater anti-inflammatory effects than either drug alone, and the purpose of this study was to compare the effects of treatment with budesonide and montelukast, alone or in combination, on outcome variables following allergen inhalation. Ten asthmatic subjects with dual responses after allergen inhalation were included in this randomized, double blind, crossover study. Outcomes included early and late asthmatic responses, changes in airway responsiveness and sputum eosinophilia, measured before and after challenge. Treatment with montelukast attenuated the maximal early asthmatic response compared to placebo (p<0.001) and budesonide (p=0.002). Both budesonide and montelukast, alone and in combination, attenuated the maximal late asthmatic response compared to placebo (p<0.01). Budesonide and montelukast, alone and in combination, afforded protection against allergen-induced airway hyperresponsiveness (p<0.05), although budesonide treatment effect was greater than that of montelukast (p<0.05). Treatment with budesonide and montelukast, alone and in combination, also attenuated allergen-induced sputum eosinophilia. Thus, montelukast and budesonide attenuated allergen-induced asthmatic responses, airway hyperresponsiveness, and sputum eosinophilia, although combination treatment did not provide greater anti-inflammatory effects than either drug alone.
Key words: asthma; allergen-challenge; bronchial hyperresponsiveness; airway inflammation; glucocorticosteroids; cysteinyl leukotrienes




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