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Improvement of aspirin-intolerant asthma by montelukast, a leukotriene antagonist. A randomized, double-blind, placebo-controlled trial

Improvement of aspirin-intolerant asthma by montelukast, a leukotriene antagonist. A randomized, double-blind, placebo-controlled trial
Improvement of aspirin-intolerant asthma by montelukast, a leukotriene antagonist. A randomized, double-blind, placebo-controlled trial
Leukotriene antagonists block the proinflammatory actions of leukotrienes (LT) and have been introduced as new treatments for asthma. Conventional therapy with glucocorticosteroids does not inhibit the biosynthesis of leukotrienes. We therefore tested whether addition of the leukotriene receptor antagonist montelukast was of therapeutic benefit in a group of aspirin-intolerant patients with asthma of whom 90% already were treated with moderate to high doses of glucocorticosteroids. Under double-blind conditions, 80 aspirin-intolerant patients with asthma were randomized to receive 4 wk oral treatment of either 10 mg of montelukast or placebo once daily at bedtime. Pulmonary function was measured as forced expiratory volume in 1 s (FEV1) once a week in the clinic and daily as morning and evening peak expiratory flow rate (PEFR). Asthma symptoms and use of rescue bronchodilator were also recorded daily.
Asthma specific quality of life (QoL) was assessed before and after the treatments. The group receiving montelukast showed a remarkable improvement of their asthma, whereas the group given placebo showed no change. Thus, from equal baseline values, the mean difference between the groups over the 4-wk treatment period was 10.2% for FEV1 and 28.0 L for morning PEFR (p for both < 0.001). The improved pulmonary function in the group receiving montelukast occurred at the same time as 27% less bronchodilator was used (p < 0.05), and it was associated with fewer asthma symptoms than in the group given placebo, including 1.3 nights more of sleep per week and 54% fewer asthma exacerbations (p < 0.05). There was also an improvement in asthma-specific QoL (p < 0.05). The therapeutic response to montelukast was consistent across patients with different baseline characteristics and did not correlate with baseline urinary LTE4. Addition of a leukotriene receptor antagonist such as montelukast improves asthma in aspirin-intolerant patients over and above what can be achieved by glucocorticosteroids.
asthma therapy, leukotriene modifiers, glucocorticosteroids, airway inflammation
1073-449X
9-14
Dahlén, Sven-Erik
9e18ae23-c6a1-413c-93fe-203949a4dcda
Malmstrom, Kerstin
30720c21-2732-4542-aef5-6046d1d15c66
Nizankowska, Ewa
29680f35-b6b1-4601-ac80-f2fe6c0fbd43
Dahlén, Barbro
9a1ebc34-9a8e-46a3-9933-fda2cbdd4ab9
Kuna, Piotr
0982046a-9893-4920-842d-49f032302edc
Kowalski, Marek
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Lumry, William R.
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Picado, César
cf4213cb-724d-41f1-a722-8d3214ae8d36
Stevenson, Donald D.
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Bousquet, Jean
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Pauwels, Romain
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Holgate, Stephen T.
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Shahane, Aditi
25a78127-8885-4e16-a584-efc05f619c62
Zhang, Ji
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Reiss, Theodore F.
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Szczeklik, Andrew
b14277fb-e4f6-4f37-9bfa-29effd8163cf
Dahlén, Sven-Erik
9e18ae23-c6a1-413c-93fe-203949a4dcda
Malmstrom, Kerstin
30720c21-2732-4542-aef5-6046d1d15c66
Nizankowska, Ewa
29680f35-b6b1-4601-ac80-f2fe6c0fbd43
Dahlén, Barbro
9a1ebc34-9a8e-46a3-9933-fda2cbdd4ab9
Kuna, Piotr
0982046a-9893-4920-842d-49f032302edc
Kowalski, Marek
e05772b8-1253-4d5f-baa7-53279c09bcd5
Lumry, William R.
ab89d8a7-ce98-4330-b71b-ff5e292353a5
Picado, César
cf4213cb-724d-41f1-a722-8d3214ae8d36
Stevenson, Donald D.
9735b918-7d90-4ef6-a836-e2a25e9a3f19
Bousquet, Jean
8065d130-faa7-4c8e-bf40-8d2899980c21
Pauwels, Romain
6bf0b103-586b-43cb-83ab-65e95b30a5f7
Holgate, Stephen T.
2e7c17a9-6796-436e-8772-1fe6d2ac5edc
Shahane, Aditi
25a78127-8885-4e16-a584-efc05f619c62
Zhang, Ji
6997e0a9-db00-418c-b5ce-17cf7056bc29
Reiss, Theodore F.
80d85cd8-45f5-4294-a4a4-35755ff8865b
Szczeklik, Andrew
b14277fb-e4f6-4f37-9bfa-29effd8163cf

Dahlén, Sven-Erik, Malmstrom, Kerstin, Nizankowska, Ewa, Dahlén, Barbro, Kuna, Piotr, Kowalski, Marek, Lumry, William R., Picado, César, Stevenson, Donald D., Bousquet, Jean, Pauwels, Romain, Holgate, Stephen T., Shahane, Aditi, Zhang, Ji, Reiss, Theodore F. and Szczeklik, Andrew (2002) Improvement of aspirin-intolerant asthma by montelukast, a leukotriene antagonist. A randomized, double-blind, placebo-controlled trial. American Journal of Respiratory and Critical Care Medicine, 165 (1), 9-14.

Record type: Article

Abstract

Leukotriene antagonists block the proinflammatory actions of leukotrienes (LT) and have been introduced as new treatments for asthma. Conventional therapy with glucocorticosteroids does not inhibit the biosynthesis of leukotrienes. We therefore tested whether addition of the leukotriene receptor antagonist montelukast was of therapeutic benefit in a group of aspirin-intolerant patients with asthma of whom 90% already were treated with moderate to high doses of glucocorticosteroids. Under double-blind conditions, 80 aspirin-intolerant patients with asthma were randomized to receive 4 wk oral treatment of either 10 mg of montelukast or placebo once daily at bedtime. Pulmonary function was measured as forced expiratory volume in 1 s (FEV1) once a week in the clinic and daily as morning and evening peak expiratory flow rate (PEFR). Asthma symptoms and use of rescue bronchodilator were also recorded daily.
Asthma specific quality of life (QoL) was assessed before and after the treatments. The group receiving montelukast showed a remarkable improvement of their asthma, whereas the group given placebo showed no change. Thus, from equal baseline values, the mean difference between the groups over the 4-wk treatment period was 10.2% for FEV1 and 28.0 L for morning PEFR (p for both < 0.001). The improved pulmonary function in the group receiving montelukast occurred at the same time as 27% less bronchodilator was used (p < 0.05), and it was associated with fewer asthma symptoms than in the group given placebo, including 1.3 nights more of sleep per week and 54% fewer asthma exacerbations (p < 0.05). There was also an improvement in asthma-specific QoL (p < 0.05). The therapeutic response to montelukast was consistent across patients with different baseline characteristics and did not correlate with baseline urinary LTE4. Addition of a leukotriene receptor antagonist such as montelukast improves asthma in aspirin-intolerant patients over and above what can be achieved by glucocorticosteroids.

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More information

Published date: 2002
Keywords: asthma therapy, leukotriene modifiers, glucocorticosteroids, airway inflammation

Identifiers

Local EPrints ID: 27011
URI: http://eprints.soton.ac.uk/id/eprint/27011
ISSN: 1073-449X
PURE UUID: 1962fefb-b0cc-483c-b828-dcee862bb267

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Date deposited: 25 Apr 2006
Last modified: 27 Apr 2022 08:45

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Contributors

Author: Sven-Erik Dahlén
Author: Kerstin Malmstrom
Author: Ewa Nizankowska
Author: Barbro Dahlén
Author: Piotr Kuna
Author: Marek Kowalski
Author: William R. Lumry
Author: César Picado
Author: Donald D. Stevenson
Author: Jean Bousquet
Author: Romain Pauwels
Author: Aditi Shahane
Author: Ji Zhang
Author: Theodore F. Reiss
Author: Andrew Szczeklik

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