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Montelukast improves regional air-trapping due to small airways obstruction in asthma

¹ Division of Pulmonary, Critical Care Medicine and Hospitalists, ² Thoracic Radiology Section, Dept of Radiology, and ³ Division of Biomathematics, Dept of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.

CORRESPONDENCE: M. R. Zeidler, David Geffen School of Medicine at the University of California, Los Angeles, Division of Pulmonary, Critical Care Medicine and Hospitalists, CHS 37-131, 10833 Le Conte Ave., Los Angeles, CA 90095-1690, USA. Fax: 1 3102065088. E-mail: mzeidler{at}mednet.ucla.edu

Keywords: Methacholine, montelukast, quantitative thoracic computed tomography of asthma, small airways

Received: January 13, 2005
Accepted October 24, 2005

Quantitative image analysis of high-resolution computed tomography (HRCT) performed at residual volume, before and after methacholine, is a sensitive method of detecting small airways involvement in asthma and response to therapy targeted to the small airways. Since an oral anti-leukotriene reaches the small airways via the circulation, the present authors hypothesised that treatment with montelukast would lead to improved small airway patency.

A double-blind crossover study compared the effect of montelukast versus placebo for 4 weeks in 16 mild-to-moderate steroid-naïve asthmatics. Small airways function was evaluated by HRCT at residual volume before and after methacholine to assess regional air-trapping and airways hyperresponsiveness, as well as by physiological studies of small airways.

Montelukast treatment resulted in significantly less regional air-trapping on HRCT on the pre-methacholine images when compared with placebo, as well as improvement in total quality of life scores and symptom sub-scores. However, montelukast treatment had no effect on increases in regional air-trapping on HRCT in response to methacholine. No differences were noted in global measures of small airways physiology between placebo and montelukast.

In conclusion, distal airways disease improves in asthmatic subjects treated with montelukast. This improvement can be detected with high-resolution computed tomography, but not with conventional physiological studies.

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