Adding Montelukast to Inhaled Corticosteroids in Stepwise Approach for Managing Asthma

Study objectives: Asthma is most effectively controlled with inhaled corticosteroids. If there are difficulties in maintaining control, long acting beta2-agonists or a new alternative: leukotriene receptor antagonists can be added to the therapy. In this study we aimed to investigate the effects of montelukast when added to inhaled corticosteroids (ICS).

Methods: Fourteen stable persistent stable asthmatics receiving ICS and salmeterol for at least three months were enrolled in the study. After baseline assessments, salmeterol was ceased for a two- weeks washout period. Then all subject received 10 mg/daily montelukast added to their ICS therapy. Pulmonary functions, symptom scores and exhaled nitric oxide (eNO) levels were recorded under salmeterol therapy, before and after montelukast therapy in 10 patients who completed the study.

Results: A detoriation occurred in pulmonary functions and symptom scores after ceasing salmeterol. Three months after adding montelukast to ICS, there was a nonsignificant improve­ment in FEVj, PEF and eNO, but the improvements in night time symptom scores, bronchodilator consumption and PEF variation were significant (p<0.01).

Conclusion: Adding montelukast to ICS was shown to be effec­tive in controlling asthma. When comparing the study parameters under salmeterol and montelukast, there was not a significant dif­ference in pulmonary functions and eNO levels but montelukast was better in controlling night time symptom scores and PEF vari­ation (p<0.05).