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(Chest. 2005;128:1958-1963.)
© 2005 American College of Chest Physicians

Effect of Montelukast on Exhaled Leukotrienes and Quality of Life in Asthmatic Patients*

Wojciech A. Biernacki, MD, PhD; Sergei A. Kharitonov, MD, PhD; Helen M. Biernacka, HND and Peter J. Barnes, MA, DM, DSc

* From the Department of Thoracic Medicine (Drs. Kharitonov and Barnes), Imperial College School of Medicine, National Heart and Lung Institute, London; and St. Gregory’s Medical Practice (Dr. Biernacki and Mrs. Biernacka), Gravesend, UK.

Correspondence to: Peter J. Barnes, MD, DM, DSc, Department of Thoracic Medicine, National Heart and Lung Institute, Imperial College, Dovehouse St, London SW3 6LY, UK; e-mail: p.j.barnes{at}imperial.ac.uk

Study objectives: In some patients with asthma treated with inhaled corticosteroids, suppression of inflammation is incomplete. This may be because the effect of corticosteroids on cysteinyl-leukotriene (cys-LT) biosynthesis is limited. Montelukast is a cys-LT antagonist that significantly improves asthma control in corticosteroid-treated asthmatic patients. However, not all patients treated with cys-LT antagonists show a clinical improvement.

Design: We have studied the effect of treatment for 4 weeks with montelukast (10 mg/d) on exhaled cys-LTs and leukotriene B4 (LTB4), exhaled nitric oxide, asthma quality of life (AQL), and respiratory function in patients with stable asthma.

Setting: Asthma clinics in general practice.

Patients: We studied 50 patients (30 men; mean ± SEM age, 53 ± 2 years) who were treated with inhaled corticosteroids.

Measurements and results: We detected cys-LTs in exhaled breath condensate in 25 of 50 patients; however, in the normal nonasthmatic subjects, cys-LTs were below the limit of detection. After treatment with montelukast, there was a fall in cys-LT concentrations from 14.6 ± 3.3 to 8.5 ± 2.6 pg/mL after 2 weeks (p > 0.05) and to 3.9 ± 1.3 pg/mL after 4 weeks (p < 0.01). Exhaled LTB4 levels were also elevated. After treatment with montelukast, LTB4 levels fell from 33.0 ± 3.9 to 20.4 ± 2.5 pg/mL after 2 weeks of treatment (p < 0.05), and to 17.0 ± 2.2 pg/mL after 4 weeks of treatment (p < 0.01). These changes in exhaled cys-LT and LTB4 were associated with significant improvements in AQL scores.

Conclusions: It appears that in some patients with stable asthma treated with inhaled corticosteroids, the suppression of inflammation is incomplete. Adding a leukotriene receptor antagonist can provide a complementary effect of controlling inflammation, with a significant improvement in quality of life.

Key Words: asthma • cysteinyl-leukotrienes • exhaled breath condensate • leukotriene B4 • leukotriene receptor antagonist






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