Short-term effects of montelukast in stable patients with moderate to severe COPD

Abstract

This study aims to investigate the possibility of additional value of leukotriene receptor antagonist (LTA) on dyspnea score, arterial blood gases (ABG), pulmonary function tests (PFTs), and quality of life (St. George QoL) in chronic obstructive pulmonary disease (COPD) patients. In this randomized, prospective, single-blind, and controlled study, 117 non-reversible COPD patients defined by global initiative for chronic obstructive lung disease (GOLD) criteria were randomized to receive ipratropium bromide, formoterol and montelukast (n:58, montelukast group) or ipratropium bromide and formoterol (n:59, control group) after a 2-week run-in period. There was no significant demographic difference between the two groups (P>0.05). Baseline ABG, PFT, visual analoque scores (VAS), and QoL scores were obtained and at first month and second month, PFT, VAS, and QoL scores were repeated and ABG was obtained at second month and the values were compared with baseline values. As the result of the comparison, there was significant increase in vital capacity, FVC, FEV1, VAS, and PaO2 parameters (P<0.05), and a significant decrease in the QoL scores (P<0.05) in the montelukast group. These parameters did not show any difference in the control group (P>0.05). Sputum samples that could be obtained in 24 of the COPD patients were evaluated and in the montelukast group, there was a decrease in neutrophilic activity after treatment (n:13) (P:0.059). These results suggest that LTA that is used additionally in routine treatment protocol can produce additive improvement on PFT, dyspnea score and especially QoL in patients with stable COPD and for these reasons, LTA may be taken into account when there is need for an additional anti-inflammatory treatment in COPD patients.

Leukotrienes C4 and D4 sensitize human neutrophils for hyperreactivity to chemoattractants

“…All of those have been implicated in the pathogenesis of airway hyperresponsiveness, damage and remodeling [18][19][20][21]. If operative in vivo, this mechanism may explain the therapeutic activity of CysLT 1 R antagonists, such as montelukast, in diseases such as COPD [22,23] and certain types of bronchial asthma, in which the neutrophil is thought to be the primary offender [24].…”

International Union of Basic and Clinical Pharmacology. LXXXIV: Leukotriene Receptor Nomenclature, Distribution, and Pathophysiological Functions

“…There are only a few studies of the clinical effects of LTRAs in COPD. For example, lung function improvement has been observed with zafirlukast in smokers with COPD (Cazzola et al, 2000;Nannini and Flores, 2003) Furthermore, a retrospective study of patients with moderate to severe COPD, reported that montelukast use improved patient's functional scores (shortness of breath, sputum production, wheezing, and nocturnal symptoms), use of drugs (oral and inhaled corticosteroids, inhaled bronchodilators, and supplemental oxygen), number of visits to the emergency department as well as the number and duration of hospitalizations for acute exacerbations (Rubinstein et al, 2004), and QL (Celik et al, 2005). However, further clinical studies are required to judge the real impact of LTRAs in COPD therapy or at least in a subset of patients with COPD (Usery et al, 2008).…”

EMPADE Study: Evaluation of Medical Prescriptions and Adverse Drug Events in COPD Patients Admitted to Intensive Care Unit

“…Adding theophylline, leukotriene antagonists or antihistamines in routine treatment protocol seem to ameliorate respiratory symptoms [21], improve PFT, dyspnea score and QOL in stable COPD [22], accordingly these agents were utilized wherever necessary. Oral tablets/capsules were preferred dosage form; however, it is highly recommended that physicians prescribe inhalers more than tablets/ capsules.…”