Effect of the addition of montelukast on airway inflammation and remodeling in symptomatic asthma

Background: Cysteinyl leukotrienes are potent pro-inflammatory mediators and bronchoconstrictors involved in the asthmatic process. It is hypothesized that the leukotriene receptor antagonist, montelukast, treating a pathway of inflammation distinct from that of corticosteroids, might confer additional benefit. Objective: To evaluate the effect of montelukast on airway inflammation and remodeling in patients with symptomatic asthma while receiving inhaled corticosteroid (ICS) and long-acting β 2 -agonist (LABA). Methods: Seventy-five persistent asthma were randomized to add-on montelukast 10 mg once daily (n=35) or no add-on (n=40) to maintenance therapy (ICS plus LABA) for 48 weeks. Fractional exhaled nitric oxide (FeNO), quantitative computed tomography, pulmonary function, and asthma quality of life questionnaire (AQLQ) were measured. Results: Compared with maintenance only therapy, add-on montelukast significantly decreased FeNO and improved airflow obstruction and AQLQ score (p 1 was significantly correlated with changes in FeNO (r=-071, p Conclusions: Montelukast add-on therapy in symptomatic asthma reduced eosinophilic inflammation and improved airflow limitation, but not airway wall thickness and may result in significant improvements in asthma control.