Improved Case of Bronchial Asthma by Re-administration of Pranlukast from Montelukast: Evaluation of Eosinophilic Inflammation in the Peripheral Airway

Abstract

Background: Pranlukast and Montelukast are Cysteinyl leukotriene receptor antagonists with almost the same pharmacological activity. However, I will describe a case in which these drugs showed different therapeutic effects on clinical symptoms during the daytime and eosinophilic inflammation in the peripheral airway. Methods: A 70-year-old male patient with non-atopic bronchial asthma who was treated with 400 μg/day of Budesonide Turbuhaler® (BUD-TH) changed from Pranlukast (225 mg, twice daily) to Montelukast (10 mg, one tablet before sleeping), resulting in worsening clinical symptoms consisting of sputum and cough in the daytime, mainly at lunch time. Due to the fact that the symptoms did not improve sufficiently, instead of increasing the dose of BUD-TH, we investigated the clinical symptoms and pulmonary functions as well as measured the mean eosinophil count, eosinophil cationic protein (ECP) and eotaxin in the hypertonic saline-induced sputum prior to administration of Pranlukast, and 4 and 8 weeks after the re-administration of Pranlukast from Montelukast. Results: Following the re-administration of Pranlukast, the clinical symptoms disappeared within a few days and pulmonary function improved within 4 weeks. Eosinophils in the induced sputum almost completely disappeared for 4 weeks. The sputum ECP and eotaxin before and 4 weeks after the re-administration of Pranlukast changed from 700 μg/l to 192 μg/l, and 69.9 pg/ml to 30.6 pg/ml, respectively. After 8 weeks, no sputum induction was found. Conclusions: The clinical difference between these two similar antagonists may be caused by the time difference relating to when and how often each drug is administered, suggesting the existence of the lunchtime dip.

Keywords

• asthma
• eosinophil cationic protein (ECP)
• eotaxin
• induced sputum
• Pranlukast