PURPOSE: To study the effect of inhaled Fluticasone verses Montelukast as treatment of persistent asthma.
METHODS: 100 patients, diagnosed with Asthma, of age >18 years, having FEV1 between 50% − 80% and increase in FEV1 by 15% after inhalation of two puffs of Salbutamol were included in the study. Patients were divided into two groups and followed for 8 weeks. Group I included 50 patients and were given fluticasone (88 mg) bid through MDI and a placebo capsule in evening. Group II included 50 patients and were given oral Montelukast 10 mg and two puffs of placebo through MDI. The primary measure of efficacy for each drug was the mean percentage of morning FEV1 from baseline to endpoint and secondary efficacy endpoints included mean change at end point, morning and evening PEF, asthma symptom score, daily rescue salbutamol use.
RESULTS: In-group I mean percentage change of FEV1, PEF (morning), PEF (evening) and symptoms from baseline to endpoint were 12.98%, 6.39%, 4.57% and 44.73% compared to the change of 4.91%, 0.93%, 1.19% and 78.38% in-group II respectively. Mean percentage change in Rescue Salbutamol (puffs/day) used was 64.83% in group I and 58.60 in group II.
CONCLUSION: It was found that Fluticasone is more effective than Montelukast in increasing FEV1. Also Fluticasone increased morning and evening PEFR significantly more than Montelukast .The combined day asthma symptom score was also reduced more by fluticasone then with montelukast .Patients on Fluticasone also used less number of rescue sabutamol puffs/day compared to montelukast.
CLINICAL IMPLICATIONS: Low dose Fluticasone was more effective than Montelukast at improving long term asthma control .Thus Fluticasone is more effective than Montelukast as first line maintenance therapy for persistent asthma.
DISCLOSURE: Pratibha Dogra, None.