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FEV9.5, symptom score and airways resistance but not bronchodilator responsiveness after
four weeks treatment with 4mg daily of montelukast (Straub, Minocchieri et al. 2005; Straub,
Moeller et al. 2005). In a study of twelve asthmatic children where montelukast reduced
levels of exhaled NO, the four individuals that were heterogeneous at the gene locus of the
leukotriene C4 synthase had a far better response than those who were homozygotes (Whelan,
Blake et al. 2003).
Thirdly, NO has been measured as one factor in comparison studies between montelukast and
IHCS which have all resulted in a greater reduction of levels of NO in the IHCS arm
(Kanniess, Richter et^1.2N2; Peroni, Bodini et aI.2005;Zniger, Szefleret aI.2006). This
coincided with improvements of hyperreactivity (Kanniess, Richter et aL.2002; Peroni, Bodini
et al. 2005), FEVr (Kanniess, Richter et al. 2002; Tniger, Szefler et al. 2006), sputum
eosinophils (Kanniess, Richter et al.2002), asthma control questionnaire and salbutamol use
(7*ige4 Szefler et al. 2006) with both treatments, again greater in the IHCS groups. However,
the other antagonist pranlukast at 450mg per day did not change levels of exhaled NO in 30
adults compared to IHCS but did show improvement in all other parameters measured
(Yamauchi, Tanifuji et al. 20Ol). Comparisons between this drug class and the long actingp2
agonists (LABAs) are described below.
9.S.8 (iii) Long acting p2 agonists
Exhaled NO has been used as an outcome measure when looking at the addition of long
acting p2 agonists (LABAs) to IHCS. Neither eformoterol nor salmeterol have shown any
effect on the exhaled NO when used alone in comparison to either IHCS therapy alone
(Priero, Gutierrez et al.2OO2) or to the combination of IHCS and LABA (Aziz, Wilson et al.
2000; Currie, Syme-Grant et al. 2N3), and no difference where they have been added to
IHCS (Yates, Kharitonov et al. 1997; ke, Jackson et al. 2003). This is despite improvements
in other parameters such as FEV1, adenosine S-monophosphate challenges, sputum and blood
eosinophil counts and serum ECP (Aziz. Wilson et al. 2000; Prieto, Gutierrez et aL 2402;
Currie, Syme-Grant et al. 2003; I-ee, Jackson et al. 2003).
In comparisons between montelukast and LABAs, neither of two studies showed an effect on
the level of exhaled NO (Aziz, Wilson et al. 2000; Wilson, Dempsey et al. 2001). This is
interesting given that in most of the montelukast studies, this medication did result in a
reduction in exhaled NO. The studies here really just confirm that the LABAs do not have
anti -infl ammatory properties.
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