SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

12/15/04

Comparison of effects of fluticasone and montelukast induced asthma

Summary
Background - Both inhaled corticosteroids (ICS) such as fluticasone (Flut) and leukotriene antagonists (LA) such as montelukast ( Mont ) are used in the treatment of allergic asthma (AA). But how do they compare in inhibiting allergen-induced experimental asthma?

Findings - Palmquist et al of Goteborg Univ in Sweden compared the effects of 8 day course of Flut 250 mcg b.i.d. vs Mont 10 mg/day vs placebo on subsequent allergen inhalational challenge in asthmatics with documented early phase (EAR) and late phase (LAR) bronchospastic response to inhaled allergen. Pretreatment with Mont , but not with Flut, significantly inhibited the EAR (p<0.05). However, pretreatment with Flut was more effective in blocking the LAR (p<0.05 for the difference between Flut effects and those of either Mont or placebo). Flut was also more effective in inhibiting non-immunologic bronchospastic responses to inhaled methacholine.

Reference
Allergy 2005;60:65-70

Editor's Comments
These findings are not too surprising in that it has been known for some time that ICS are more effective in inhibiting LAR than EAR. Since the LAR is now thought to likely play a major role in the chronic manifestations of AA, it makes sense to consider ICS as the primary treatment approach in persistent asthma.

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