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| |  Adding Montelukast to Inhaled Corticosteroids Reduces Risk of Excessive Airway Narrowing in Patients With Allergic Asthma: Presented at ATS By Cathy Yarbrough SAN DIEGO -- May 19, 2009 -- Adult patients with allergy-induced asthma treated inhaled corticosteroids (ICS) can benefit from the addition of montelukast, researchers stated here at the American Thoracic Society (ATS) 2009 International Conference. On May 17, Zuzana Diamant, MD, Erasmus Medical Center, Rotterdam, and Charlotte Suppli Ulrik, MD, Hvidovre Hospital, Copenhagen, Denmark, reported the results of a randomised, double-blind study comparing the effects of ICS plus montelukast with ICS plus a matching placebo to determine whether the addition of montelukast would lower the dose-response plateau to inhaled methacholine. The study included 31 patients (14 men, 17 women), aged 19 to 50 years, who had mild to moderate allergic asthma and a twice-documented response plateau to inhaled methacholine. Patients were randomly assigned to receive once-daily montelukast 10 mg or placebo, each in addition to ICS. Every 4 weeks, the researchers administered bronchial challenge tests with doubling doses of methacholine (0.03-256 mol). After 12 weeks of treatment, the montelukast/ICS-treated patients had significantly improved in both FEV1 and PD20 (dose of methacholine that resulted in 20% reduction of FEV1). Compared with the placebo group, the montelukast group had a significantly decreased maximal response plateau to methacholine (mean difference 9.1%; 95% confidence interval [CI], 3.7-15.5; P < .005) and improved FEV1 decline (2.1% for montelukast vs 0.8% for placebo; P < .05). The mean change in PD20 was 13.6 mol in the montelukast group and 0.3 mol in the placebo group (P < .001). Mean baseline FEV1 was 84% (range, 71%-100%) of the predicted value, and mean baseline PD20 was 0.99 mol methacholine (range, 0.12-3.26 mol). The mean maximum decline in FEV1 was 27.3% in the montelukast group and 31.1% in the placebo group. Together, ICS and montelukast can reduce the patient's risks of experiencing excessive airway narrowing and severe asthma attacks, the researchers concluded. [Presentation title: Effect of Add-On Montelukast to Inhaled Corticosteroids on Excessive Airway Narrowing in Adult Asthmatics. Abstract A2416]
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