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Steroid naive eosinophilic asthma: anti-inflammatory effects of fluticasone and montelukast
  1. L Jayaram1,
  2. E Pizzichini2,
  3. C Lemière3,
  4. S F P Man4,
  5. A Cartier3,
  6. F E Hargreave1,
  7. M M M Pizzichini2
  1. 1Airways Research Group, Firestone Institute for Respiratory Health, St Joseph’s Healthcare and McMaster University, Hamilton, Ontario
  2. 2NUPAIVA, Universidade Federal de Santa Catarina, Florianopolis, Brazil
  3. 3Hôpital du Sacré-Coeur de Montréal, Montréal, Québec
  4. 4University of Alberta, Edmonton, Alberta
  1. Correspondence to:
    Dr M M M Pizzichini
    NUPAIVA, Hospital Universitário da UFSC, Campus Universitário, Florianopolis, Brazil; mpizzichmatrix.com.br

Abstract

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.

  • asthma
  • eosinophilic asthma
  • montelukast
  • fluticasone
  • anti-inflammatory effect
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Footnotes

  • This study was partially supported by a medical school grant from Glaxo Wellcome Inc; L Jayaram was supported by a Fellowship from Boehringer Ingelheim (Canada) Inc; F E Hargreave is supported by the Father Sean O’Sullivan Research Centre.

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