SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

10/13/04

Montelukast protects against nasal aspirin challenge in patients with aspirin-induced asthma

Summary
Background - There is generally an increased production of cysteinyl leukotrienes (Cys LT) in patients with aspirin intolerant asthma (AIA). Although treatment with leukotriene antagonists (LA) such as montelukast (Mont) generally improve asthmatic symptoms in AIA, the effect of such drugs on associated upper respiratory symptoms is less well defined.

Findings - Lee et al of the Univ. of Dundee in Scotland evaluated the effect of treatment with varying doses of Mont (10 mg, 40 mg) vs. placebo on responses to nasal lysine aspirin challenge in a double blind, crossover approach in 12 patients with well-characterized AIA.

They found that the mean maximal decrease in peak nasal inspiratory flow rates (PNIF) following nasal aspirin challenge was significantly greater after placebo pre-treatment (-45%) than after pre-treatment with either 10 mg (-34%) or 40 mg (-32%) of Mont. The subjects' subjective assessment showed a marked increase in aspirin-induced nasal congestion following placebo pre-treatment but not after Mont pre-treatment.

There was no difference in the patterns of aspirin challenge induced decreases in FEV-1 following placebo vs. Mont pre-treatment.

Conclusion - Mont pre-treatment partially protects against the nasal congestion induced by nasal aspirin challenge in AIA patients with no significant difference between the protective effects of Mont 10 mg vs. Mont 40 mg.

Reference
Eur Respir J 2004;24:226-30

Editor's Comments
I have discussed this report with an expert in AIA. He pointed out that the upper airway response to nasal aspirin challenge on AIA patients is quite complex mediation by histamine and prostanoids as well as by LT. The choice of nasal congestion as the major outcome measurement in the study described above would put the focus more on LT-induced vasodilatation than on histamine effects (sneezing, rhinorrhea, ocular effects). Thus, it is not surprising that Mont pre-treatment will partially decrease aspirin challenge induced nasal obstruction.

 

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