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Increase in urinary leukotriene LTE₄ levels in acute asthma: correlation with airflow limitation

Merck Research Laboratories, Rahway, NJ, USA

Correspondence to:
Correspondence to:
Dr S A Green
Director, Respiratory & Allergy, Merck Research Laboratories, 126 East Lincoln Avenue, RY34B-340, Rahway, NJ, USA; stuart_green{at}merck.com

Background: Leukotrienes play a key role in the pathophysiology of chronic asthma. Activation of leukotriene pathways is accompanied by rises in detectable urinary levels of leukotriene E₄ (LTE₄). The relationship between urinary LTE₄ levels and factors associated with acute asthma has not been determined.

Methods: Adults aged 15–54 years presenting with moderate to severe acute asthma were evaluated at emergency departments in 16 US sites. Forced expiratory volume in 1 second (FEV₁) was measured during the first 60 minutes after arrival and at specified times until discharge or admission. Urine samples for measurement of LTE₄ levels were obtained either on arrival at the study site and/or before discharge. Patients were seen 2 weeks later for follow up, at which time repeat FEV₁ measurements and urine samples for LTE₄ were obtained.

Results: One hundred and eighty four patients were evaluated; LTE₄ results from both the acute and follow up periods were available for analysis in 146. Urinary LTE₄ levels were increased during asthma exacerbations compared with levels obtained 2 weeks later (geometric means 111.7 and 75.6 pg/mg creatinine, respectively, mean percentage change -32.3; 95% confidence interval (CI) for the mean percentage change -39.6 to -24.3, p<0.001). The correlation between improvement in FEV₁ and decline in LTE₄ over the 2 week interval was significant (p<0.001, r = 0.43).

Conclusions: Activation of leukotriene pathways in acute asthma is correlated with the degree of airflow obstruction, and resolution of the asthma exacerbation is associated with a reduction in leukotriene levels.

Keywords: asthma; urinary leukotrienes; montelukast

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