Montelukast added to fluticasone propionate does not alter inflammation or outcomes

Summary 

Background

Airway inflammation is a key pathological feature of asthma which underlies its clinical presentation.

Objectives

To examine whether adding a leukotriene modifier to an inhaled corticosteroid produces further clinical and/or anti-inflammatory benefits in patients symptomatic on short-acting β₂-agonists.

Methods

Patients uncontrolled on short-acting β₂-agonists were treated for 12 weeks with either fluticasone propionate (100mcg BD) or fluticasone propionate (100mcg BD) and montelukast (10mg QD) in a randomized, double-blind, parallel group study. Bronchoscopy with endobronchial biopsy and bronchoalveolar lavage (BAL) was performed before and after treatment to compare effects on airway inflammation.

Results

Of 103 subjects enrolled, 89 subjects completed treatment and 82 subjects had matched pair biopsy samples. Submucosal eosinophil counts, the primary endpoint, and asthma control improved to similar extents after both treatments (p≤0.008). Both treatments significantly reduced submucosal mast cell, CD3+, CD4+, CD8+ and CD25+ cell counts. Submucosal mast cell reduction was greater in the fluticasone propionate plus montelukast group. There were no differences between treatments in BAL markers of inflammation or thickness of sub-epithelial collagen.

Conclusions

Low-dose fluticasone propionate significantly improves clinical disease control and reduces airway inflammation in asthma patients uncontrolled with short-acting β₂-agonists without further improvement when montelukast is added to low-dose fluticasone propionate.

Keywords: Asthma, Airway inflammation, Eosinophils, Bronchoscopy, Fluticasone propionate, Montelukast