Effects of add-on montelukast on airway hyperresponsiveness in patients with well-controlled asthma – a pilot study. (23rd April 2013)

• Record Type: Journal Article
• Authors: Kononowa, Nina; Michel, Sandra; Miedinger, David; Pichler, Christiane E.; Chhajed, Prashant N.; Helbling, Arthur; Leuppi, Jörg D.
• Is Part Of: Journal of drug assessment. Volume 2(2013)
• Page Start: 49
• Page End: 57
• Publication Date: 2013-04-23
• Subjects: Airway inflammation -- Airway hyperresponsiveness -- Asthma -- Asthma control -- Mannitol provocation test -- Methacholine provocation test -- Leukotriene receptor antagonists; AHR, Airway hyperresponsiveness; AQLQ, Asthma Quality of Life Questionnaire; BHR, Bronchial hyperreactivity; BPT, Bronchial provocation test; ECP, Eosinophil cationic protein; FeNO, Fraction of exhaled nitric oxide; FEV1, Forced expiratory volume in one second; ICS, Inhaled corticosteroids; LABA, Long-acting beta-adrenoreceptor agonists; LTRA, Leukotriene receptor antagonist; PD15 FEV1, resp. PD20 FEV1, Mannitol or methacholine dose leading to reduction in FEV1 during a bronchial provocation test, ≥15% or ≥20%, respectively; RDR, Response dose ratio is the percent decrease in FEV1 at the end of challenge divided by the cumulative dose of mannitol or methacholine causing decrease in FEV1; Drugs -- Testing -- Periodicals; 615.1901
• DOI: 10.3109/21556660.2013.791300
• Languages: English
• ISSNs: 2155-6660

Abstract

Abstract: Objective: Control of airway inflammation is the cornerstone of asthma management. The aim of the present pilot study was to assess the effects of a leukotriene receptor antagonist (LTRA) added to a basic treatment of inhaled corticosteroids (ICS) and long-acting beta-agonist (LABA) on airway hyperresponsiveness, inflammation, and quality of life in well-controlled patients with asthma. Research design and methods: Seventeen patients (age 18–65, 11 women) with well-controlled asthma presenting airway hyperresponsiveness to mannitol and methacholine challenge were given add-on montelukast on a stable ICS + LABA for 4 weeks. Quality of life and selected parameters of airway inflammation were measured at baseline and at study end. (ClinicalTrials.gov (NCT01725360)). Results: Adding montelukast to ICS + LABA resulted in an increase in mean FEV1 (+4.5%, p = 0.057), cumulated higher dose of mannitol (+32.5%, p = 0.023) and methacholine (+17.2%, 0.237) in the provocation test, lower airway reactivity with mannitol and methacholine (response dose ratio (RDR) –50.0%, p = 0.024 and –44.3%, p = 0.006, respectively), and improved airway sensitivity to mannitol and methacholine (+12.1%, p = 0.590 and +48.0%, p = 0.129 for PD15 and PD20 FEV1, respectively). Changes in inflammation parameters (blood eosinophil count, serum eosinophil cationic protein, and exhaled nitric oxide) were consistent with these findings. Asthma-related quality of life improved significantly in all domains and overall (from 5.3 at baseline to 6.1 at the final visit, p < 0.001). The main limitation was the absence of a control group. Conclusion: The consistency of the changes in airway hyperresponsiveness and inflammation as well as in quality of life observed with an add-on therapy with montelukast in well-controlled asthma patients during 4 weeks suggests that residual inflammation may represent an area for further improvement of asthma control to be explored in adequately powered randomized controlled trials.