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Dose reduction of inhaled corticosteroids under concomitant medication with montelukast in patients with asthma

Pulmonary Research Institute, Hospital Großhansdorf, Center for Pneumology and Thoracic Surgery, Großhansdorf, Germany

CORRESPONDENCE: F. Kanniess, Pulmonary Research Institute, Hospital Großhansdorf, Center for Pneumology and Thoracic Surgery, Wöhrendamm 80, D-22927, Großhansdorf, Germany. Fax: 49 4102601379. E-mail: f.kanniess@pulmoresearch.de

Keywords: airway hyperresponsiveness, airway inflammation, leucotriene receptor antagonist, lung function, methacholine, steroid reduction

Received: December 19, 2001
Accepted June 30, 2002

Supported by an educational grant from MSD, Munich, Germany

The present study aimed at comparing the effects of a dose reduction of inhaled corticosteroids on lung function, indirect measures of airway inflammation and clinical scores during treatment with a leucotriene receptor antagonist.

In 50 patients (mean forced expiratory volume in one second (FEV₁) 94% predicted), steroid doses (800 µg beclomethasone dipropionate) were first reduced to 50% and then to 25%, for 6 weeks each. One group received a placebo and the other group received montelukast (10 mg).

The first reduction did not cause significant effects. During the second, FEV₁ and peak expiratory flow decreased in both groups (p<0.001). Daytime symptoms were not altered with placebo but were reduced by montelukast (p<0.05). Night-time symptoms were slightly elevated with placebo (p<0.05) but not montelukast, as well as the use of supplemental salbutamol. Changes in provocative concentration of methacholine causing a 20% fall in FEV₁ (PC₂₀), sputum eosinophils and exhaled nitric oxide were mostly nonsignificant for both placebo and montelukast.

These data demonstrate that a 75% reduction in the dose of steroid given to patients with asthma led to a deterioration in lung function not prevented by montelukast, whereas changes in clinical state seemed to favour montelukast treatment. It therefore appears that potential effects of montelukast, in the presence of low-dose steroids, could not be attributed to single indices of lung function or airway inflammation.

This article has been cited by other articles:

				S Joos, A Miksch, J Szecsenyi, B Wieseler, U Grouven, T Kaiser, and A Schneider Montelukast as add-on therapy to inhaled corticosteroids in the treatment of mild to moderate asthma: a systematic review Thorax, May 1, 2008; 63(5): 453 - 462. [Abstract] [Full Text] [PDF]