Comparative efficacy and anti-inflammatory profile of once-daily therapy with leukotriene antagonist or low-dose inhaled corticosteroid in patients with mild persistent asthma

J Allergy Clin Immunol. 2002 Jan;109(1):68-74. doi: 10.1067/mai.2002.120559.


Background: Current guidelines advocate the use of preventative anti-inflammatory therapy for mild persistent asthma.

Objective: We compared the efficacy and anti-inflammatory profiles of a leukotriene receptor antagonist and a low dose of inhaled corticosteroid in patients with mild persistent asthma.

Methods: Twenty-one adult patients with mild asthma received 4 weeks of either once-daily inhaled hydrofluoroalkane triamcinolone acetonide (450 microg/day ex-actuator dose) or oral montelukast (10 mg/day) in a randomized, placebo-controlled, single-blinded crossover study. Measurements were made before and after 2 and 4 weeks of each treatment.

Results: At the endpoint (after 4 weeks), triamcinolone and montelukast had improved the primary outcome (provocative dose of methacholine required to produce a 20% fall in FEV(1)) in comparison with placebo (P <.05), there being no difference between the treatments (1.09-fold; 95% CI 0.73 to 1.63). Triamcinolone was better than placebo or montelukast for effects on all other surrogate inflammatory markers (P <.05), including exhaled nitric oxide, blood eosinophils, serum eosinophil cationic protein, plasma intracellular circulating adhesion molecule 1, and plasma E-selectin. Both treatments improved (P <.05) morning and evening peak flow, nighttime beta2-agonist use, and symptoms in comparison with placebo, though triamcinolone was better than montelukast (P <.05) with regard to peak flow. Triamcinolone produced suppression (P <.05) of overnight urinary cortisol/creatinine and serum osteocalcin.

Conclusion: Once-daily inhaled corticosteroid and leukotriene antagonist improved the primary outcome variable of bronchial hyperresponsiveness to a similar degree.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetates / administration & dosage*
  • Administration, Inhalation
  • Adolescent
  • Adult
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Bronchial Hyperreactivity / drug therapy
  • Cross-Over Studies
  • Cyclopropanes
  • Drug Administration Schedule
  • Female
  • Humans
  • Leukotriene Antagonists / administration & dosage*
  • Leukotriene Antagonists / adverse effects
  • Male
  • Middle Aged
  • Quinolines / administration & dosage*
  • Single-Blind Method
  • Sulfides
  • Triamcinolone / administration & dosage*


  • Acetates
  • Cyclopropanes
  • Leukotriene Antagonists
  • Quinolines
  • Sulfides
  • Triamcinolone
  • montelukast