Montelukast added to fluticasone propionate does not alter inflammation or outcomes

Djukanović, Ratko, Wilson, Susan J., Moore, Wendy C., Koenig, Steven M., Laviolette, Michel, Bleecker, Eugene, Davis, W. Bruce, Doherty, Dennis E., Olivenstein, Ronald, Israel, Elliot, Kavuru, Mani, Kleerup, Eric, Reilly, Donna S., Yancey, Steven, Edwards, Lisa D., Stauffer, John L., Dorinsky, Paul M. and Jarjour, Nizar N. (2010) Montelukast added to fluticasone propionate does not alter inflammation or outcomes. Respiratory Medicine, 104, (10), 1425-1435. (doi:10.1016/j.rmed.2010.04.004). (PMID:20709517).


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Background: Airway inflammation is a key pathological feature of asthma which underlies its clinical presentation.

Objectives: To examine whether adding a leukotriene modifier to an inhaled corticosteroid produces further clinical and/or anti-inflammatory benefits in patients symptomatic on short-acting ?2-agonists.

Methods: Patients uncontrolled on short-acting ?2-agonists were treated for 12 weeks with either fluticasone propionate (100 mcg BD) or fluticasone propionate (100 mcg BD) and montelukast (10 mg QD) in a randomized, double-blind, parallel group study. Bronchoscopy with endobronchial biopsy and bronchoalveolar lavage (BAL) was performed before and after treatment to compare effects on airway inflammation.

Results: Of 103 subjects enrolled, 89 subjects completed treatment and 82 subjects had matched pair biopsy samples. Submucosal eosinophil counts, the primary endpoint, and asthma control improved to similar extents after both treatments (p ? 0.008). Both treatments significantly reduced submucosal mast cell, CD3+, CD4+, CD8+ and CD25+ cell counts. Submucosal mast cell reduction was greater in the fluticasone propionate plus montelukast group. There were no differences between treatments in BAL markers of inflammation or thickness of sub-epithelial collagen.

Conclusions: Low-dose fluticasone propionate significantly improves clinical disease control and reduces airway inflammation in asthma patients uncontrolled with short-acting ?2-agonists without further improvement when montelukast is added to low-dose fluticasone propionate.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1016/j.rmed.2010.04.004
ISSNs: 0954-6111 (print)
Keywords: asthma, airway inflammation, eosinophils, bronchoscopy, fluticasone propionate, montelukast
Subjects: Q Science > QR Microbiology > QR180 Immunology
R Medicine > RB Pathology
R Medicine > RC Internal medicine
Divisions : University Structure - Pre August 2011 > School of Medicine > Infection, Inflammation and Repair
ePrint ID: 183683
Accepted Date and Publication Date:
October 2010Published
Date Deposited: 03 May 2011 15:03
Last Modified: 31 Mar 2016 13:37

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