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Efficacy of Montelukast as Complementary Therapy to Fixed Associations ICS/LABA in Asthmatic Patients with Concomitant Rhinitis

CHU Vésale, Montigny-Le-Tilleul, Belgium

PURPOSE: Asthma and allergic rhinitis are often associated. The concept of "one airway, one disease" emphasizes the presence of persistent inflammation throughout the upper and lower airways in patients with associated asthma and rhinitis. This suggests that management strategies should target both airways. In a 2-month real-life study conducted in Belgium evaluating the efficacy of montelukast 10 mg added to fixed associations [FA], we sub-analyzed the evolution of asthma patients with concomitant rhinitis.

METHODS: 294 asthmatic patients, symptomatic despite regular treatment with FA (budesonide/formoterol 160/4.5 2 inh. bid, salmeterol/fluticasone diskus DPI 50/250 1 inh. bid or salmeterol/fluticasone MDI 25/125 2 puffs bid) were recruited. At inclusion, patients were required to be symptomatic according to the standardized Juniper’s asthma control questionnaire. The patients’ assessments were recorded at inclusion and after 2 months of add-on therapy with montelukast 10mg.

RESULTS: Among the 143 asthma patients reporting concomitant rhinitis at inclusion (49% of all patients included), the mean total asthma symptom score decreased significantly on montelukast (11.4 versus 5.5 on a 0-36 scale; p<0.001), with a significantly greater mean decrease (p<0.001) in the 86 patients also reporting an improvement in rhinitis (decrease of 6.9 in symptom score) compared with those reporting no improvement (decrease of 4.3 in symptom score). 83% of the 143 patients reported a global improvement in their symptoms.

CONCLUSION: Asthmatic patients with concomitant rhinitis who remain symptomatic on fixed associations may benefit from montelukast as a complementary treatment. In addition to a significant decrease in asthma symptoms, the majority of patients reported an improvement in rhinitis and global symptoms. Moreover, improvement in rhinitis was associated with a greater asthma improvement.

CLINICAL IMPLICATIONS: Treating rhinitis improved global asthma control. Montelukast, a leukotriene-receptor antagonist, controlling an airway inflammation pathway distinct from that of ICS, may confer additional benefits by acting both on nasal and bronchial inflammation.

DISCLOSURE: R. Peché, Educational grant from Merck Sharp and Dohme