A Study of the Usefulness of Anti-inflammatory Treatment for Mild Intermittent Asthma (Step 1): Budesonide vs. Montelukast

Abstract

Background: Early intervention in adult asthma has been evaluated mostly with regard to symptoms, respiratory function and airway hyperresponsiveness, and has rarely been evaluated with regard to airway inflammation. Further, no clinical data concerning prevention of remodeling by anti-inflammatory therapy have been reported. The anti-inflammatory activities of an inhaled steroid and a leukotriene receptor antagonist were compared using sputum induced by inhaled hyperosmotic NaCl solution, and the usefulness of anti-inflammatory treatment for mild intermittent asthma (step 1) was investigated. Methods: The subjects of the study were patients with mild intermittent asthma (step 1) who had not received steroid treatment and had only been treated with inhaled β2-stimulants as needed. The subjects were divided into two groups : one group received 400 μg/day of budesonide (BUD group ; n = 15) and the other group received 10 mg/day of montelukast (MK group ; n = 12). The anti-inflammatory activities of BUD and MK were compared by examining respiratory function, exhaled nitric oxide (ENO) concentrations, airway hyperresponsiveness (acetylcholine provocation test) and the sputum induced by inhalation of hyperosmotic NaCl solution at three time points, i.e., before, 1 month after, and 6 months after the start of treatment. Results: It was shown that even in mild intermittent asthma (step 1) the levels of ENO and sputum eosinophil ratio were elevated, indicating that airway inflammation was clearly present and that airway hyperresponsiveness was elevated. The effects of BUD and MK in improving ENO and sputum eosinophil ratio were almost the same. However, airway hyperresponsiveness in both groups were not significantly improved after 1 and 6 months of treatment. Conclusions: Anti-inflammatory treatment is necessary even for mild intermittent asthma (step 1). We believe that early intervention with anti-inflammatory drugs is important for the prevention of airway remodeling, exacerbation of disease and progression to intractable asthma. Either of the two types of drugs, low-dose inhaled steroids or leukotriene receptor antagonists, can be selected as anti-inflammatory drugs for mild intermittent asthma.

Keywords

• airway hyperresponsiveness
• airway inflammation
• anti-inflammatory treatment
• early intervention
• exhaled nitric oxide
• induced sputum
• mild intermittent asthma