PT  - JOURNAL ARTICLE
AU  - L Jayaram
AU  - E Pizzichini
AU  - C Lemière
AU  - S F P Man
AU  - A Cartier
AU  - F E Hargreave
AU  - M M M Pizzichini
TI  - Steroid naive eosinophilic asthma: anti-inflammatory effects of fluticasone and montelukast
AID  - 10.1136/thx.2004.021634
DP  - 2005 Feb 01
TA  - Thorax
PG  - 100--105
VI  - 60
IP  - 2
4099  - http://thorax.bmj.com/content/60/2/100.short
4100  - http://thorax.bmj.com/content/60/2/100.full
SO  - Thorax2005 Feb 01; 60
AB  - 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.