Addition of Formoterol or Montelukast to Low-Dose Budesonide: An Efficacy Comparison in Short- and Long-Term Asthma Control

Abstract

Background: Asthma is a chronic inflammatory disease of the airways. Inhaled corticosteroids are very important in anti-inflammatory treatment, but to a great extent they cannot control asthma alone. In addition to corticosteroids, long-acting β₂ agonists and leukotriene antagonists are used for asthma control. Objective: In this study, the effect of the addition of formoterol and montelukast on asthma control in patients with moderately persistent asthma who were symptomatic while using a low dose of inhaled budesonide was compared. Methods: At the beginning of the study, 40 symptomatic patients with moderately persistent asthma used 400 µg/day budesonide for a 4-week training period, and were then divided randomly into two groups, each composed of 20 persons. For the first group’s treatment regime, inhaled formoterol (9 µg) twice a day was added, and for the second group’s treatment regime, one-dose oral montelukast (10 µg) was added. These patients were followed up for 8 weeks. The patients’ peak expiratory flow (PEF) values measured in the morning and at night, changes in PEF, forced expiratory volume in 1 s, asthma symptom score and the symptom-relieving therapy used during the 12-week study period were recorded and evaluated in the clinic at the very beginning and at the end of each period. Results: Before the study, the morning PEF value of the group for whom formoterol was added to budesonide (FB) was 266.3 ± 59.3 liters/min, and in the group for whom montelukast was added to budesonide (MB), it was 262.8 ± 53.8 liters/min (p > 0.05). After the 8-week treatment period, the morning PEF values were found to be 320.5 ± 54.4 liters/min in the FB group and 293.3 ± 52.4 liters/min in the MB group; at the end of the study, it was seen that although there was an increase in morning PEF of 54.2 ± 15.2 liters/min in the FB group, there was an increase of only 30.5 ± 25.3 liters/min in the MB group (p < 0.0001). Before the study, night PEF values were 287 ± 56.6 liters/min in the FB group and 283 ± 48.5 liters/min in the MB group (p > 0.05). At the end of the treatment, the night PEF values were found to be 331.5 ± 56.1 liters/min in the FB group and 310 ± 53.1 liters/min in the MB group. At the end of the study, it was observed that although there was an increase in night PEF of 44.5 ± 23.3 liters/min in the FB group, there was an increase of only 27 ± 24.1 liters/min in the MB group (p < 0.001). Although asthma symptom scores and the use of symptom-relieving drugs showed similarities between the two groups at the beginning of the study, after treatment, the FB group had better results than the MB group with respect to these two parameters (p < 0.0001 for both). It was also seen that the two treatments are tolerated equally well. Conclusion: FB treatment, which causes a considerable improvement in lung function, showed better asthma control than MB treatment in patients with moderately persistent asthma.

Formoterol versus montelukast as add on therapy to low dose budesonide in persistent asthma: effect on lung function

“…13 As per our study, the FB group showed significantly greater improvement in PEF and FEV1. This is in accordance with studies done by Ringdal et al, Ceylan et al 14,15 The fact that mean values of PEF of FB group were significantly greater than that of MB group throughout the study period showed that FB treatment was better than MB treatment in improving lung function right from the first week after the start of the respective treatments. This significant superiority of LABA over LTRA in improving PEF at a much earlier point in the course of treatment was also shown in the 2 week study by Wilson and his colleagues.…”

Human Airway Smooth Muscle Cells Express Eotaxin in Response to Signaling following Mast Cell Contact

“…However, for its clinical significance in the treatment of moderate to severe persistent asthma [30], dexamethasone was used to investigate inhibition of eotaxin protein production in human ASMC and HMC-1 cocultures. Human ASMC pretreated for 24 h at 1 µ M dexamethasone was able to significantly inhibit eotaxin protein production as detected in 24-hour supernatants (fig.…”

Double-Blind, Randomised, Controlled Trial Assessing Controller Medications in Asthma

“…A recent study done by Ceylan et al [33] in patients with moderately persistent asthma, similar in study duration and patient selection, compared formoterol (9 µg) and montelukast (10 mg) added to budesonide 400 µg daily during a follow-up of up to 8 weeks. It showed greater improvement in the group treated with formoterol plus budesonide compared to the group receiving montelukast plus budesonide.…”

“…A study done by Ceylan et al [33] has demonstrated that formoterol causes a considerable improvement in lung function and showed better asthma control than montelukast treatment in patients with moderately persistent asthma.…”