A comparison of the effects of oral montelukast and inhaled salmeterol on response to rescue bronchodilation after challenge

Objectives: To compare the effects of addition of montelukast or salmeterol to inhaled corticosteroids (ICS) on the response to rescue beta2-agonist use after exercise-induced bronchoconstriction. Methods: A double-blind, placebo-controlled study was performed at 16 centers in the United States. Patients with asthma ( n=122, ages 15–58) whose symptoms were uncontrolled on low-dose inhaled fluticasone and who had a history of exercise-induced worsening of asthma were randomized to receive either montelukast (10 mg once daily), salmeterol (50 μg twice daily), or placebo for 4 weeks. Standardized spirometry after exercise challenge and beta2-agonist rescue was performed at baseline, week 1 and 4. Results: Maximum achievable forced expiratory volume in 1 s (FEV 1) percent predicted after rescue beta2-agonist improved in the montelukast (+1.5%) and placebo (+1.2%) groups at 4 weeks, but diminished in the salmeterol (−3.9%) group ( P