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Effect of montelukast compared with inhaled fluticasone on airway inflammation


S. E. Overbeek, Department of Pulmonary Medicine, SV020, Erasmus MC, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.


Background Inhaled corticosteroids are currently regarded as the gold standard in anti-inflammatory therapy, however, leukotriene receptor antagonists have been ascribed anti-inflammatory properties.

Objective We directly compared the anti-inflammatory effects of inhaled fluticasone propionate (FP, 100 μg Diskus, twice daily) and oral montelukast (MON 10 mg, nocte) in bronchial biopsies of patients with asthma in a double-blind, double-dummy, parallel-group design.

Methods Bronchial biopsies, serum and urine samples were collected from 36 atopic asthmatics before and after 8 weeks of treatment. Activated T cells (CD25+), eosinophils (MBP+) and mast cells (tryptase+) were analysed by immunohistochemistry. Serum eosinophil cationic protein (ECP) and IL-5 were analysed by radio and enzyme immunoassay (EIA), respectively. Urinary 9α-11β-PGF2 and leukotriene E4 (LTE4) were measured by EIA.

Results A comparison of changes from baseline [FP/MON ratio (95% confidence interval)] of activated T cells was not different when subjects were treated with FP compared to treatment with MON [1.00 (0.18–4.86); P=0.924]. Following treatment, mast cells in the FP group were significantly lower than in the group treated with MON [0.39 (0.16–0.97); P=0.041]. There was no difference in the number of eosinophils in the lamina propria following either treatment [0.54 (0.05–2.57); P=0.263]. However, treatment with FP resulted in a significantly greater decrease in serum ECP, compared to treatment with MON [0.37 (0.25–0.71); P=0.002].

Conclusions FP appears to be superior to MON as an anti-inflammatory therapy in mild asthmatics.