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Steroid naive eosinophilic asthma: anti-inflammatory effects of fluticasone and montelukast

¹ Airways Research Group, Firestone Institute for Respiratory Health, St Joseph’s Healthcare and McMaster University, Hamilton, Ontario
² NUPAIVA, Universidade Federal de Santa Catarina, Florianopolis, Brazil
³ Hôpital du Sacré-Coeur de Montréal, Montréal, Québec
⁴ University of Alberta, Edmonton, Alberta

Correspondence to:
Correspondence to:
Dr M M M Pizzichini
NUPAIVA, Hospital Universitário da UFSC, Campus Universitário, Florianopolis, Brazil; mpizzich{at}matrix.com.br

Background: Inhaled corticosteroids and leukotriene receptor antagonists reduce airway eosinophilia and have been used as first line anti-inflammatory therapy for mild persistent asthma.

Methods: A multicentre, randomised, placebo controlled, parallel group study was performed to compare the anti-inflammatory effects of fluticasone propionate and montelukast as measured by sputum eosinophils in 50 adults with symptomatic steroid naive asthma and sputum eosinophilia of 3.5%.

Results: Eighteen patients received low dose fluticasone (250 µg/day), 19 received montelukast (10 mg/day), and 13 were given placebo for 8 weeks. Fluticasone treatment resulted in a greater reduction in sputum eosinophils (geometric mean (SD) 11.9 (2.3)% to 1.7 (5.1)%) than montelukast (10.7 (2.3)% to 6.9 (3.8)%; p = 0.04) or placebo (15.4 (2.4)% to 7.8 (4.2)%; p = 0.002), and improvement in FEV₁ (mean (SD) 2.6 (0.9) l to 3.0 (0.9) l) than montelukast (2.8 (0.7) l to 2.8 (0.9) l; p = 0.02) or placebo (2.4 (0.8) l to 2.4 (0.9) l; p = 0.01). Treatment with fluticasone suppressed sputum eosinophilia within a week while montelukast only attenuated it. The effect of montelukast was maximal at 1 week and was maintained over 4 weeks. The effect of fluticasone was maintained over 8 weeks while that of montelukast was not.

Conclusions: Montelukast is not as effective as low dose fluticasone in reducing or maintaining an anti-inflammatory effect in steroid naïve eosinophilic asthma.

Keywords: asthma; eosinophilic asthma; montelukast; fluticasone; anti-inflammatory effect

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				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]