No effect of montelukast on asthma‐like symptoms in elite ice hockey players

Background: Controlled clinical trials on the effects of leukotriene antagonists on asthma‐like symptoms, bronchial hyperresponsiveness and airway inflammation have not been performed in elite athletes. Methods: In 2001, we examined 88 of 102 (86%) players from three junior, national league ice hockey teams in Helsinki. Athletes were included in the intervention if they reported at least two exercise‐induced bronchial symptoms (wheeze, cough, shortness of breath) weekly during the previous month on a previously validated respiratory‐symptom questionnaire. Sixteen male ice hockey players fulfilled the study criteria. A double‐blind, randomized, cross‐over, placebo‐controlled study included 4‐week active treatment (10 mg oral montelukast, bedtime), 1‐week washout period, and 4‐week placebo treatment. Before entering the study, all patients were clinically examined, skin prick tested, filled in a respiratory symptom questionnaire, performed a spirometry and a histamine challenge test, and gave induced sputum samples. Exhaled NO was measured. These measures were repeated after both treatment periods. During the treatment the athletes kept daily diary on lower respiratory tract symptoms on a scale from 0 (no symptoms) to 10 (most severe symptoms), morning peak expiratory flow (PEF), training amount, and use of study medication. Primary end‐point was daily lower respiratory tract symptom score. Results: Montelukast had no effect on daily lower respiratory symptom scores, spirometry parameters [forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, PEF], bronchial hyperresponsiveness, sputum eosinophil or neutrophil cell counts, exhaled NO measurements, or morning PEF. Nine subjects were atopic in skin prick test, but their results did not differ from the nonatopic subjects. Conclusion: A leukotriene antagonist, montelukast, was of no benefit in the treatment of asthma‐like symptoms, increased bronchial hyperresponsiveness or a mixed type of eosinophilic and neutrophilic airway inflammation in highly‐trained ice hockey players.