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Leukotriene Modifier vs Inhaled Corticosteroid in Mild-to-Moderate Asthma^*

Clinical and Anti-inflammatory Effects

^* From the Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Correspondence to: Diahn-Warng Perng, MD, PhD, FCCP, Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Rd, Taipei 11217, Taiwan; e-mail: dwperng{at}vghtpe.gov.tw

Study objective: Evidence for the anti-inflammatory activity of leukotriene receptor antagonists in humans is somewhat limited. There are also no data comparing the anti-inflammatory effects of leukotriene receptor antagonists with those of inhaled corticosteroids. This study was designed to assess the clinical efficacy and anti-inflammatory effects of leukotriene receptor antagonist plus low-dose inhaled corticosteroids compared to those of a high-dose inhaled corticosteroid in patients with mild-to-moderate asthma.

Methods: Forty-nine patients with newly diagnosed asthma were recruited. They were randomly assigned to groups that received, for a 6-week period, either (1) budesonide, 600 µg bid (1,200 µg/d) or (2) budesonide, 200 µg (400 µg/d), and zafirlukast, 20 mg bid. The variables of asthma control were recorded daily. Sputum induction and methacholine provocation tests were performed.

Results: The results indicated that the administration of a low-dose inhaled corticosteroid plus zafirlukast was as effective as that of a high-dose inhaled corticosteroid regarding clinical improvement and anti-inflammatory effects (ie, eosinophil percentage, and eosinophilic cationic protein [ECP] and cysteinyl leukotriene C₄ levels in induced sputum). Nineteen (group 1, 8 patients; group 2, 11 patients) of 49 patients (38.8%) had returned to normal airway responsiveness after treatment. Among these patients, 16 patients (84.2%) had normal ECP levels and 10 patients (52.6%) had normal percentages of eosinophils. ECP level, but not the eosinophil percentage, was significantly associated with symptom scores. The peak expiratory flow rate (PEFR) showed a significant correlation with the provocative concentration of methacholine causing a 20% fall in FEV₁ (PC₂₀) instead of with symptom scores.

Conclusions: The addition of a leukotriene modifier to treatment with low-dose inhaled corticosteroids is equivalent to treatment with high-dose inhaled corticosteroids in patients with newly diagnosed mild-to-moderate asthma. In addition to symptoms and PEFR, the monitoring of ECP and PC₂₀ may be of great value in achieving optimal control of asthma.

Key Words: asthma • induced sputum • inhaled corticosteroid • leukotriene receptor antagonist

This article has been cited by other articles:

				D.-W. Perng, K.-T. Chang, K.-C. Su, Y.-C. Wu, M.-T. Wu, W.-H. Hsu, C.-M. Tsai, and Y.-C. Lee Exposure of Airway Epithelium to Bile Acids Associated With Gastroesophageal Reflux Symptoms: A Relation to Transforming Growth Factor-{beta}1 Production and Fibroblast Proliferation Chest, November 1, 2007; 132(5): 1548 - 1556. [Abstract] [Full Text] [PDF]

				G. P. Currie and D. K.C. Lee Beneficial Antiinflammatory Effects of Leukotriene Receptor Antagonists in Asthma Chest, April 1, 2005; 127(4): 1458 - 1458. [Full Text] [PDF]

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