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Montelukast and bronchial inflammation in asthma: a randomised, double-blind placebo-controlled trial.
Respir Med. 2009 Jul; 103(7):995-1003.RM

Abstract

BACKGROUND

Examination of bronchoalveolar lavage, induced sputum, and peripheral blood indicate that cysteinyl leukotriene receptor blockers decrease inflammatory cells in asthma but these do not examine airway tissue per se.

OBJECTIVES

Our objective was to determine the effect of montelukast, a leukotriene receptor antagonist, on airway tissue inflammatory cells by direct bronchoscopic examination of the bronchial mucosa.

METHODS

Adult subjects with mild asthma (pre-bronchodilator FEV(1)> or =70% predicted; PC(20) of < or =4 mg/mL) were given 10mg/day oral montelukast (N=38) or placebo (N=37) for 6 weeks. Bronchial mucosal eosinophils and mast cells were identified and counted.

RESULTS

Change from baseline in numbers of biopsy EG2+ ("activated") eosinophils was the primary endpoint; numbers of total (chromotrope 2R+) eosinophils and (tryptase+) mast cells were secondary. Unexpectedly, there were many patients with zero EG2+ eosinophils at baseline. There was a within-group decrease in EG2+ cells, from 13.54 cells/mm (at baseline) to 0.79 cells/mm at 6 weeks in the montelukast group (LS mean change; 95% confidence interval=-13.59 [-25.45, -1.74]cells/mm; P<0.05), a change not observed in the placebo group (-1.17 [-13.26, 10.91]cells/mm; NS). The zero-inflated Poisson statistical model demonstrated that montelukast significantly reduced post-treatment EG2+ cells by 80% compared with placebo (95% CI [70.6-86.8%]; P<0.0001). The data for total eosinophils showed similar changes. The reduction in mast cell numbers was 12% (95% CI [7.9, 16.0]; P<0.0001).

CONCLUSION

Direct examination of airway tissue confirms that montelukast decreases the number of eosinophils and mast cells in asthma.

Authors+Show Affiliations

Department of Respiratory Medicine, Royal London Hospital, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19249198

Citation

Ramsay, C F., et al. "Montelukast and Bronchial Inflammation in Asthma: a Randomised, Double-blind Placebo-controlled Trial." Respiratory Medicine, vol. 103, no. 7, 2009, pp. 995-1003.
Ramsay CF, Sullivan P, Gizycki M, et al. Montelukast and bronchial inflammation in asthma: a randomised, double-blind placebo-controlled trial. Respir Med. 2009;103(7):995-1003.
Ramsay, C. F., Sullivan, P., Gizycki, M., Wang, D., Swern, A. S., Barnes, N. C., Reiss, T. F., & Jeffery, P. K. (2009). Montelukast and bronchial inflammation in asthma: a randomised, double-blind placebo-controlled trial. Respiratory Medicine, 103(7), 995-1003. https://doi.org/10.1016/j.rmed.2009.01.019
Ramsay CF, et al. Montelukast and Bronchial Inflammation in Asthma: a Randomised, Double-blind Placebo-controlled Trial. Respir Med. 2009;103(7):995-1003. PubMed PMID: 19249198.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Montelukast and bronchial inflammation in asthma: a randomised, double-blind placebo-controlled trial. AU - Ramsay,C F, AU - Sullivan,P, AU - Gizycki,M, AU - Wang,D, AU - Swern,A S, AU - Barnes,N C, AU - Reiss,T F, AU - Jeffery,P K, Y1 - 2009/02/26/ PY - 2008/11/06/received PY - 2009/01/19/revised PY - 2009/01/19/accepted PY - 2009/3/3/entrez PY - 2009/3/3/pubmed PY - 2010/7/10/medline SP - 995 EP - 1003 JF - Respiratory medicine JO - Respir Med VL - 103 IS - 7 N2 - BACKGROUND: Examination of bronchoalveolar lavage, induced sputum, and peripheral blood indicate that cysteinyl leukotriene receptor blockers decrease inflammatory cells in asthma but these do not examine airway tissue per se. OBJECTIVES: Our objective was to determine the effect of montelukast, a leukotriene receptor antagonist, on airway tissue inflammatory cells by direct bronchoscopic examination of the bronchial mucosa. METHODS: Adult subjects with mild asthma (pre-bronchodilator FEV(1)> or =70% predicted; PC(20) of < or =4 mg/mL) were given 10mg/day oral montelukast (N=38) or placebo (N=37) for 6 weeks. Bronchial mucosal eosinophils and mast cells were identified and counted. RESULTS: Change from baseline in numbers of biopsy EG2+ ("activated") eosinophils was the primary endpoint; numbers of total (chromotrope 2R+) eosinophils and (tryptase+) mast cells were secondary. Unexpectedly, there were many patients with zero EG2+ eosinophils at baseline. There was a within-group decrease in EG2+ cells, from 13.54 cells/mm (at baseline) to 0.79 cells/mm at 6 weeks in the montelukast group (LS mean change; 95% confidence interval=-13.59 [-25.45, -1.74]cells/mm; P<0.05), a change not observed in the placebo group (-1.17 [-13.26, 10.91]cells/mm; NS). The zero-inflated Poisson statistical model demonstrated that montelukast significantly reduced post-treatment EG2+ cells by 80% compared with placebo (95% CI [70.6-86.8%]; P<0.0001). The data for total eosinophils showed similar changes. The reduction in mast cell numbers was 12% (95% CI [7.9, 16.0]; P<0.0001). CONCLUSION: Direct examination of airway tissue confirms that montelukast decreases the number of eosinophils and mast cells in asthma. SN - 1532-3064 UR - https://www.unboundmedicine.com/medline/citation/19249198/Montelukast_and_bronchial_inflammation_in_asthma:_a_randomised_double_blind_placebo_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0954-6111(09)00035-3 DB - PRIME DP - Unbound Medicine ER -