Comparison of montelukast versus budesonide in the treatment of exercise-induced bronchoconstriction

Background: Previous studies in which leukotriene-receptor antagonist and c orticosteroids were used have suggested a possible role for these anti-infl ammatory drugs in the prevention of exercise-induced bronchoconstriction, b ut no direct comparisons have been made. Objective: A crossover study was undertaken to compare the ability of both montelukast and budesonide to protect patients from exercise-induced bronch oconstriction. Methods: A total of 20 patients (median age, 17 years; range, 8 to 36 years ), who had clinical exercise-induced bronchoconstriction for 1 year and dec reased FEV1 of at least 20% after exercise on two occasions, were enrolled in this study. To compare the therapies in each patient, we administered, c onsecutively, 10 mg of montelukast once daily at bedtime for 3 days and, la ter, 400 mug of budesonide twice daily for 15 days, or vice versa, with a 1 5-day intervening washout period during which no patient received treatment . Exercise challenges were performed at baseline (no therapy) and after eac h treatment. The percentage of FEV1 declines at 2, 7, and 12 minutes after exercise and the area under the curve (summarizing the extent and modificat ion of FEV1 decreases relative to time) were measured and compared. Results: Both budesonide and montelukast significantly reduced the decrease in FEV, (area under the curve) after exercise with respect to the baseline condition of no therapy (P = 0.0001). Overall, budesonide offered better p rotection (area under the curve) than did montelukast (P = 0.01), particula rly in the short-term evaluation (2 minutes after exercise; P = 0.003); how ever, considerable individual variations in the responses to both budesonid e and montelukast were observed. The degree of protection against decreases in FEV1 ranged from 0% to almost 100% for both treatments. In 16 of 20 pat ients, budesonide therapy offered better protection than did montelukast, a nd in the other 4 patients, montelukast showed better protection than did b udesonide. No side effects of either montelukast or budesonide were detecte d during the study. Conclusions: Treatment with budesonide or montelukast prevents exercise-ind uced bronchoconstriction. Because substantial variation in the response may be present among patients, both drugs should be tested in each patient bef ore long-term therapy is chosen.