RT Journal Article SR Electronic T1 Montelukast versus fluticasone: effects on lung function, airway responsiveness and inflammation in moderate asthma JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 853 OP 858 DO 10.1183/09031936.02.00244602 VO 20 IS 4 A1 Kanniess, F. A1 Richter, K. A1 Böhme, S. A1 Jörres, R.A. A1 Magnussen, H. YR 2002 UL http://erj.ersjournals.com/content/20/4/853.abstract AB 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 µg b.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. FEV1 increased by 0.50±0.07 L (mean±sem) after fluticasone and by 0.37±0.07 L after montelukast (p<0.001, each), and PC20 by 1.33±0.13 (p<0.001) and 0.15±0.17 (ns) doubling doses, respectively. Correspondingly, percentages of sputum eosinophils were reduced by factor 2.7 (p<0.01) and 1.4 (nonsignificant (ns)), and the levels of exhaled NO (at 50 mL·s−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. Supported by GlaxoSmithKline, D-20354 Hamburg, Germany.