Montelukastversusfluticasone: effects on lung function, airway responsiveness and inflammation in moderate asthma

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Abstract
Whether leukotriene receptor antagonists exhibit adequate anti-inflammatory effects in the treatment of asthma is still a controversial issue. The aim of the present study was to perform a direct comparison of the effects of a 4-week treatment with either montelukast (10 mg, once a day) or low-dose inhaled fluticasone (100 µgb.i.d.) on functional and inflammatory parameters in steroid-naïve patients with moderate asthma.Forty patients (forced expiratory volume in one second (FEV1), 60–80% predicted) were studied in a double-blind, randomised, crossover design. Treatment periods were separated by 3–8 weeks of washout. At the beginning and end of each period, FEV1, airway responsiveness to inhaled methacholine (provocative concentration causing a 20% fall in FEV1(PC20)), the level of exhaled nitric oxide (NO) and sputum differential cell counts were determined. Only short-acting β2-agonists were allowed for relief of symptoms.FEV1increased by 0.50±0.07 L (mean±sem) after fluticasone and by 0.37±0.07 L after montelukast (p20by 1.33±0.13 (p−1) by factor 2.1 (p<0.01) and 1.1 (ns).These data indicate a comparable bronchodilator action of montelukast and fluticasone in patients with moderate asthma, but additional attenuation of airway inflammation by fluticasone as detectable through noninvasive methods.