The Effects of Montelukast on Smokers With Asthma - Full Text View

Purpose

The purpose of this study is:

To compare neutrophilia, eosinophilic inflammatory markers and asthma symptom indices between smokers and non-smokers.
To elucidate the mechanism by which cigarette smokers are resistant to corticosteroids.

Condition	Intervention	Phase
Asthmatic Smokers Non-asthmatic Smokers	Drug: Fluticasone Propionate Drug: Montelukast Drug: Salmeterol	Phase 4

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Pharmacodynamics Study Intervention Model: Parallel Assignment Masking: Single Blind (Subject) Primary Purpose: Diagnostic
Official Title:	The Effects of Montelukast on Sputum Cells and Inflammatory Markers in Smokers With Asthma

Resource links provided by NLM:

MedlinePlus related topics: Asthma Steroids

Drug Information available for: Fluticasone propionate Salmeterol Fluticasone Salmeterol xinafoate Montelukast sodium Montelukast

U.S. FDA Resources

Further study details as provided by Inje University:

Primary Outcome Measures:

Sputum Neutrophil Percentages [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
Week 24 sputum neutrophil percentages were measured in active treatment groups.

Secondary Outcome Measures:

Sputum Eosinophil Percentages [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
Secondary endpoints of inflammatory markers (sputum eosinophil percentages at 24 weeks) were measured in active treatment groups
Sputum IL-8 Levels [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
Week 24 sputum IL-8 levels in active treatment groups
Sputum GM-CSF Levels [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
Week 24 sputum GM-CSF levels in active treatment groups were measured.
Sputum IFN-gamma/IL-5 Ratios [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
Week 24 sputum IFN-gamma/IL-5 ratios were determined in active treatment groups.
Sputum Eotaxin Levels [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
Week 24 sputum eotaxin levels in active treatment groups were measured.
Sputum RANTES Levels [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
Week 24 sputum RANTES levels in active treatment groups were measured.

Enrollment:	105
Study Start Date:	February 2007
Study Completion Date:	May 2011
Primary Completion Date:	May 2011 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: 1 Asthmatic smokers treated with combination therapy: Fluticasone propionate dosage - DPI 250 mcg BID for 3 months Salmeterol dosage - DPI 50 mcg BID for 3 months	Drug: Fluticasone Propionate DPI 250 mcg BID for 3 weeks Other Name: inhaled corticosteroid Drug: Salmeterol DPI 50mg BID for 3 weeks Other Name: long-acting beta-agonist
Experimental: 2 Asthmatic smoker treated with Montelukast only: Montelukast dosage: PO 10 mg QHS for 3 months	Drug: Montelukast PO 10 mg QHS for 3 weeks Other Name: leukotriene receptor antagonist
Active Comparator: 3 Non-smoking asthmatics treated with combination therapy: Fluticasone propionate dosage - DPI 250 mcg BID for 3 months Salmeterol dosage - DPI 50 mcg BID for 3 months	Drug: Fluticasone Propionate DPI 250 mcg BID for 3 weeks Other Name: inhaled corticosteroid Drug: Salmeterol DPI 50mg BID for 3 weeks Other Name: long-acting beta-agonist
Active Comparator: 4 Non-smoking asthmatic treated with Montelukast only: Montelukast dosage: PO 10 mg QHS for 3 months	Drug: Montelukast PO 10 mg QHS for 3 weeks Other Name: leukotriene receptor antagonist
No Intervention: 5 Normal controls

Detailed Description:

Many smokers have insufficient control of their symptoms due to inefficacy of ICS in this subpopulation of asthmatics. Cigarette smoking has been shown to stimulate production of cysLTs. CysLTs could activate production of IL-8 for neutrophilia as well as cause eosinophilia in the airway of asthmatics.

LTRAs are felt to be less efficacious than ICS in smokers with asthma. However, LTRA's unique mechanism of action could be particularly efficacious in preventing worsening symptoms and lung function for smokers with asthma. Given this, along with the fact that ICS are less effective in smokers, targeting cysLT could lead to significant clinical benefits for asthmatic smokers.

Data from this study may possibly serve as crucial data for the significant clinical benefits for asthmatic smokers and determination of the mechanism of corticosteroid resistance in smokers with asthma.

Eligibility

Ages Eligible for Study:	18 Years to 45 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

Asthmatics:

clinical history of asthma for at least 1 year
with evidence of reversible airway obstruction,
two documented FEV1 between 60-85%,
PC20 < 4mg/ml by methacholine challenge test
and average baseline β-agonist use of 2 puffs/day

Smokers:

smoke 1/2 to 2 packs a day
with a smoking history of 5-30 pack years

Non-smokers:

Non-smokers will have either never smoked or have stopped smoking cigarettes over 5 years ago

Exclusion Criteria:

positive HCG (for females)
have a respiratory tract infection or need oral corticosteroids within the preceding 6 weeks
history of COPD or respiratory disorder other than asthma
history of psychiatric illness
allergy to fluticasone propionate, salmeterol, montelukast or any of their components
significant, unstable medical condition other than asthma
history of life-threatening asthma exacerbation requiring intubation and mechanical ventilation in the last ten years

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00712335

Locations

Korea, Republic of
Asthma and Allergy Center, Inje University Sanggye Paik Hospital
Seoul, Korea, Republic of, 139-707

Sponsors and Collaborators

Inje University

Investigators

Principal Investigator:

Chang-Keun Kim, MD, PhD

Asthma and Allergy Center, Inje University Sanggye Paik Hospital

More Information

No publications provided

Responsible Party:	Chang-Keun Kim, Dr., Director, Asthma and Allergy Center; Chairman of Pediatrics; Professor of Pediatrics, Inje University
ClinicalTrials.gov Identifier:	NCT00712335 History of Changes
Other Study ID Numbers:	MASK2008
Study First Received:	July 7, 2008
Results First Received:	November 16, 2011
Last Updated:	April 18, 2012
Health Authority:	South Korea: Institutional Review Board

Keywords provided by Inje University:

asthmatics
smokers
inhaled corticosteroids
leukotriene receptor antagonists

Additional relevant MeSH terms:

Asthma
Bronchial Diseases
Respiratory Tract Diseases
Lung Diseases, Obstructive
Lung Diseases
Respiratory Hypersensitivity
Hypersensitivity, Immediate
Hypersensitivity
Immune System Diseases
Salmeterol
Fluticasone
Montelukast
Leukotriene Antagonists
Adrenergic beta-2 Receptor Agonists
Adrenergic beta-Agonists

Adrenergic Agonists
Adrenergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Physiological Effects of Drugs
Bronchodilator Agents
Autonomic Agents
Peripheral Nervous System Agents
Anti-Asthmatic Agents
Respiratory System Agents
Therapeutic Uses
Dermatologic Agents
Anti-Allergic Agents
Anti-Inflammatory Agents

ClinicalTrials.gov processed this record on May 19, 2013