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Anti-Leukotrienes for Asthma May Mask Airway Inflammation: Presented at CHEST

By Alison Palkhivala
Special to DG News

PHILADELPHIA, PA -- November 9, 2001 -- While anti-leukotriene medication is effective at reducing symptoms of asthma, new research demonstrates it does not put out the fire of inflammation taking place in the lungs.

These findings suggest that anti-leukotriene monotherapy for asthma may not prevent long-term airway deterioration.

The current goals in the management of asthma are twofold: improve symptomatology and reduce airway inflammation in order to prevent the development of fixed airway disease over the long-term. David G Hof, MD, chair of the respiratory therapy department at Saint Luke's Hospital, University of Missouri-Kansas City School of Medicine in Kansas City, Missouri, and colleagues used elevated exhaled nitric oxide (EENO) as a marker of inflammation in order to determine how well anti-leukotrienes reduce airway inflammation in asthma. He presented their findings here this week at the annual meeting of the American College of Chest Physicians (ACCP).

The investigators measured online EENO in individuals, aged 20 to 75, with mild to moderate asthma who were only using leukotriene blockers (montelukast or zafirlucast) as their anti-inflammatory therapy with beta agonist rescue for 12 weeks. All subjects were nonsmokers and free of bronchitis. These results were compared to the EENO scores of 10 nonasthmatic controls who were nonsmokers, had normal methacholine challenges, and had normal lung function.

Although the individuals with asthma had their symptoms well under control, their EENO scores were suggestive of poorly controlled asthma. In other words, the anti-leukotriene medication appeared to effectively control their symptoms without reducing airway inflammation.

"When you looked at exhaled nitric oxide and symptom score, you found that a lot of patients had no symptoms at all but had high nitric oxides," said Dr. Hof. "There was no correlation [between nitric oxide and symptoms], implying that you could have intensive inflammation in your airway progressing onto fixed airways disease, and you don't have any symptoms. You think you're doing great, and it's only after you follow these patients year after year do you see that these patients are deteriorating"

"Long leukotriene blocker therapy may actually mask underlying airway inflammation and cause patients to have deterioration of their lungs even though they're not having any symptoms. … I'm not saying leukotriene blockers shouldn't be used because you can't argue about patients feeling good, but we shouldn't let patients default to only that pill just because they feel good."

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