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Effects of Montelukast and Salmeterol on Physical Performance and Exercise Economy in Adult Asthmatics With Exercise-Induced Bronchoconstriction^*

^* From the Department of Lung Medicine (Drs. Steinshamn, Sue-Chu, and Bjermer), University Hospital of Trondheim; and Department of Health and Work Physiology (Dr. Sandsund), SINTEF Health Research, Trondheim, Norway.

Correspondence to: Sigurd Steinshamn, MD, PhD, Department of Lung Medicine, Heart and Lung Institute, University Hospital of Trondheim, N-7006 Trondheim, Norway; e-mail address: sigurd.steinshamn{at}medisin.ntnu.no

Study objectives: To compare the effect of montelukast and the long-acting ß₂-agonist salmeterol on cardiopulmonary exercise economy and physical performance in adult patients with asthma during exercise.

Design and patients: Asthmatic patients (n = 18), aged 18 to 35 years with exercise-induced bronchoconstriction (EIB), using a double-blind, double-dummy cross-over design. Montelukast, 10 mg/d, was compared to inhaled salmeterol, 50 µg bid. The study medication was administered for at least 5 days prior to testing, with a washout period of at least 5 days. Treadmill exercise tests (5.3% inclination, – 15°C ambient temperature) were performed at work loads of 80% of maximal oxygen uptake (O₂max) [6 min], rest (4 min), 60% of O₂max (6 min), and finally step increments until exhaustion.

Measurements and results: We investigated parameters of gas exchange, physical performance, and lung function. After montelukast, the oxygen pulse was higher than after salmeterol, at 80% of O₂max (p = 0.035), and 6 min at 60% of O₂max (p = 0.011). Lung function during exercise, running time to exhaustion, Borg score, lactate levels, O₂max, carbon dioxide elimination, minute ventilation, ventilatory equivalents, respiratory exchange ratio, and heart rate were not significantly different between the two treatments. The maximal postexercise fall in FEV₁ from baseline occurred 2 min after run to exhaustion, and was greater after salmeterol than after montelukast: mean, 16.2% (SD, 11.0) vs 10.0% (SD, 12.2) [p < 0.001].

Conclusions: In adult asthmatics with EIB, montelukast may have a more favorable effect on the oxygen pulse, thus suggesting improved gas exchange during exercise.

Key Words: asthma • exercise economy • exercise-induced bronchoconstriction • gas exchange • lung function • montelukast • physical performance • salmeterol

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