Leukotrienes are important inflammatory mediators in both chronic asthma and acute exacerbations. Well-known for their benefits in the management of chronic asthma, leukotriene receptor antagonists haven't been tested in acute asthma.
Ramsay et al randomized 87 adults admitted to the hospital for asthma exacerbations to receive daily montelukast 10 mg or placebo for 4 weeks, along with other standard therapies. Peak expiratory flow the morning after the first dose of montelukast was improved by 160 L/min, which was 57 L/min more than placebo. By the time of discharge, the montelukast group's advantage was down to 41 L/min and was no longer stat.significant, and by 4 weeks their peak flows were essentially identical. There was no stat.significant difference in FEV1 or residual volume between groups; these and peak flow were the only outcomes measured. More patients in the montelukast group got aminophylline and magnesium infusions, which accounted for some of the measured improvement in peak flow over placebo.
Ramsay CF et al. Oral montelukast in acute asthma exacerbations: a randomised, double-blind, placebo-controlled trial. Thorax 2011;66:7-11. FREE FULL TEXT