SELECTED ARTICLES FROM THE RECENT LITERATURE 2003

12/18/03

Acute effect of leukotriene antagonists on airway function in acute asthma

Summary
Orally administered leukotriene antagonists such as montelukast (Mont) are used commonly in the maintenance treatment of persistent asthma. However, previous studies have shown that Mont ingestion can be followed by improved pulmonary function within one hour. Therefore, Cylly et al compared the effect of adding oral Mont 10 mg vs added placebo to treatment with IV prednisolone 1 mg/kg vs placebo alone in a randomized, single-blind study of 70 patients with acute asthma. Following this intervention, each patient immediately received aerosol treatment with 100 mcg of terbutaline, a beta agonist, divided in 3 doses over one hour. They found that the PEFR of those treated with prednisolone plus Mont group was greater than the prednisolone plus placebo group but not significantly so. However, those treated with prednisolone plus Mont required less rescue use of inhaled beta agonists than patients in the other 2 groups.

Reference
Respir Med 2003;97:533-6

Editor's Comments
These findings suggest a modest and not very impressive beneficial effect of adding Mont to IV steroids in acute asthma. Even those effects may not be closely relevant to the usual community practice where larger doses of IV steroids are given over the first 24 hours of treatment of acute asthma. Also, one cannot always rely on the consistent absorption of oral medications in individuals with acute asthma who may occasionally even have vomiting after a prominent coughing episode.

<-- BACK