Comparison of oral montelukast and inhaled fluticasone in the treatment of asthma associated with chronic rhinopolyposis: a single-blind, randomized, pilot study

Abstract

Background: Rhinopolyposis is considered to be a non-immunoglobulin E-mediated inflammatory condition of the nose and sinuses, often associated with chronic rhinitis and asthma. Inhaled corticosteroids are currently the most commonly used anti-inflammatory agents for the chronic treatment of asthma and rhinopolyposis. Recently, montelukast, a selective cysteinyl leukotriene receptor antagonist indicated for the prophylaxis and treatment of asthma, has been shown to be effective in controlling rhinopolyposis and related symptoms. Objective: The aim of this study was to compare the short-term clinical efficacy of montelukast with that of fluticasone propionate in patients with asthma associated with rhinopolyposis. Methods: In this prospective, single-blind, randomized, pilot study, 12 out-patients with asthma associated with rhinopolyposis were given oral montelukast (10 mg once daily) or inhaled fluticasone propionate (intranasal suspension 50 μg and spray 250 μg twice daily). At baseline and after 30 days of treatment, the patients completed an asthma and rhinitis questionnaire and underwent nasal endoscopy, pulmonary function tests, and bronchial provocation testing. Results: Of the 12 study patients (9 men, 3 women), 7 were randomized to the montelukast group and 5 to the fluticasone group. There were no significant differences in baseline characteristics between the 2 treatment groups. After treatment, improvements in nasal and respiratory symptoms and nasal endoscopy results were found in 6 patients, 3 in each treatment group. No significant differences in the peak expiratory flow rate, forced expiratory volume in 1 second, or bronchial hyperresponsiveness changes after treatment were observed between the 2 groups. Conclusions: Our preliminary data show a comparable effect on respiratory and nasal symptoms and pulmonary function test results between oral montelukast and inhaled fluticasone in this small patient population, suggesting that leukotriene-receptor antagonists might be considered an alternative to inhaled corticosteroids in the treatment of asthma associated with rhinopolyposis.