Effects of leukotriene receptor antagonist therapy in patients with chronic rhinosinusitis in a real life rhinology clinic setting

Although there is evidence from randomised controlled trials that leukotrie ne receptor antagonists are efficacious in chronic rhinosinusitis there are still little data on their use in every day real life clinical practice. W e report on a pragmatic case series of 32 patients referred from primary ca re with uncontrolled chronic rhinosinusitis (allergic or non-allergic) who have been treated with montelukast in our joint medical/surgical rhinology clinic. Patients' symptoms were scored according to "facial pain", "headach e", "nasal blockage", "nasal discharge", "sense of smell" and "daily activi ty", and measurements of peak inspiratory nasal flow were made, before and after the introduction of montelukast 10mg/day. There were significant (p < 0.05) improvements in subjective scoring for headache, nasal discharge & bl ockage, sense of smell and daily activity but not for facial pain, when mon telukast was added along with other alterations in chronic rhinosinusitis m edication (all receiving intra-nasal corticosteroids). Subgroup analysis of 10 patients, were the addition of montelukast was the only change to medic al therapy, showed significant (p <0.05) improvements in headache, nasal di scharge and blockage and their daily activity. There was no significant imp rovemens in nasal peak inspiratory flow or spirometry. In conclusion, monte lukast may be a useful therapeutic option in addition to standard therapy ( ie intra-nasal corticosteroids or anti-histamines) when treating patients w ith chronic rhinosinusitis in a real life clinical setting.