Bambuterol versus Montelukast in Patients with Chronic Asthma
Keywords:Bambuterol, Montelukast sodium, Moderate persistent asthma, Pulmnory function tests
Background: Asthma is a common chronic inflammatory disorder of the airways. This feature of asthma has implications for the diagnosis, management, and potential prevention of the disease. Although many drug classes are used for long-term control of asthma, the response is variable due to multifactorial reasons. This study was designed to evaluate the preventive effect of bambuterol or montelukast sodium in chronic asthmatics.
Subjects and methods: Open-label clinical trial was utilized, in which 40 patients with moderate persistent asthma were randomized into two groups; the first group comprises 20 patients, treated with bambuterol (20 mg orally once daily) for 4 weeks and the second group comprises 20 patients, treated with montelukast sodium (l0mg orally once daily) for 4 weeks. Frequency of asthma symptoms (chest tightness, coughing and wheezing), pulmonary function tests (PFTs) and pulse oximetry (SpO2) were recorded at baseline and at the end point (after 4 weeks). The patients' use of asthma drugs and their symptoms were evaluated at each visit.
Results: The symptoms of asthma, PFT values and SpO2 were significantly improved in the two groups at the end of the study compared to the first visit (p < 0.05). In conclusion, both bambuterol and montÂelukast sodium showed significant improvement in asthma symptoms, pulmonary function test values and pulse oximetry after 4-week therapy, however, bambuterol showed more significant improvement in PFT values compared to montelukast.
Busse WW, Lemanske RF Jr. Asthma. N Engl J Med. 2001; 344(5):350â€“62.
Cohn L, Elias JA, Chupp GL. Asthma: mechanisms of disease persistence and progression. Annu Rev Immunol. 2004; 22:789â€“815.
Maddox L, Schwartz DA. The pathophysiology of asthma. Annu. Rev. Med. 2002; 53: 477-498.
Hay DW, Trophy TJ, Undem BJ. Cysteinyl leukotrienes in asthma: old mediators up to new tricks. Trends Pharmacol. Sci. 1995; 16(9):304-309.
Shield MD., Brown V, Stevenson EG., Fitch PS., Schock BC et al. Serum eosinophilic cationic protein and blood eosinophil counts for the prediction of the presence of airways inflammation in children with wheezing. Clin. Exp. Allergy1999; 29: 1382-1389.
Strauch E., Moske O, Thomas S, Storm Van's Gravesande K, Ihorst, G et al. A randomized controlled trial on the effect of montelukast on sputum eosinophil cationic protein in children with corticosteroid-dependent asthma. Pediatr. Res. 2003. 54: 198-203.
Mechiche H. Naline E, Candenas L, Pinto, P.M., Birembault P et al. Effects of cysteinyl leukotrienes in small human bronchus and antagonist activity of montelukast and its metabolites. Clin. Exp. Allergy 2003; 33: 887-894.
Reiss TF, Sorkness CA, Stricker W, Botto A, Busse WW et al. Effects of montelukast (MK-0476); a potent cysteinyl leukotriene receptor antagonist, on bronchodilation in asthmatic subjects treated with and without inhaled corticosteroids. Thorax 1997a; 52: 45-48.
Villaran C, O'Neill SJ, Helbling A. Montelukast versus salmeterol in patients with asthma and exercise-induced bronchoconstriction. Montelukust/Salmeterol Exercise Study Group. J. Allergy Clin. Immunol. 1999; 104: 547-553.
Reiss TF, Chervinsky P, Dockhorn RJ, Shingo S, Seidenberg B et al. Montelukast, a once daily leukotriene receptor antagonist in the treatment of chronic asthma: a multi-center randomized, double-blind trial. Arch. Intern. Med. 1998; 158:1213-1220.
Krawiec ME, Jarjour NJ. Leukotriene receptor antagonists. Semin. Respir. Crit.Care Med. 2002; 23: 399-410.
Sitar DS. Clinical pharmacokinetics of bambuterol. Clin Pharmacokinet. 1996; 31:246-56.
Rosenborg J, Larsson P, Nyberg L. Pharmacokinetics of bambuterol during oral administration of plain tablets and solution to healthy adults. Br J Clin Pharmacol 2000; 49:199-206.
Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention: NHLBI/WHO Workshop Report: Bethesda: National Institutes of Health, National Heart, Lung and Blood Institute; 2002. Publication No. 02-3659.
Boskabady MH, Fasihfar M. Correlation between symptom score, reversibility of pulmonary function tests and treatment response in asthma. Iran. J. Allergy Asthma Immunol. 2003; 2 (2): 61-67.
Holgate ST. The cellular and mediator basis of asthma in relation to natural history. Lancet 1997; 350 (Suppl. 2): SII5-SII9.
Pavord ID, Ward R, Woltmann G, Wardlaw AI, Sheller JR et al. Leukotriene C4 induces TGF-beta1 production in airway epithelium via p38 kinase pathway. Am J Respir Cell Mol Biol. 2006; 34:101-7.
Reiss TF, White R, Noonan G, Korenblat P, Hess J et al. Montelukast (MK-0467), a CysLT 1 receptor antagonist improves the signs and symptoms of asthma over one year of treatment. Eur. Respir. J. 1997b; 10 (Suppl. 25): 437S-438S.
Reiss TF, Chervinsky P, Edwards T. Montelukast (MK-0467), a CysLT 1 receptor antagonist, improves asthma outcomes over a 3-month treatment period. Am. J. Respir. Crit. Care Med. 1997c; 155: A662.
- Bisgaard H, Zielen S, Garcia-Garcia ML, Johnston SL, Gilles L, Menten J, Tozzi AC, Polos P, et al. Montelukast reduces asthma exacerbations in 2. to 5-year-old children with intermittent asthma. Am. J. Respir. Crit. Care Med. 2005; 171 (4): 315-322.
Barnes PJ, Chung KF, Page C. Inflammatory mediators of asthma: an update. Pharmacol. Rev. 1998; 50: 515-596.
Keam SJ, Lyseng-Williamson KA, Goa KL. Pranlukast: a review of its use in the management of asthma. Drugs 2003; 63: 991-1019.
Fritscher LG, Rodrigues MT, Zamel N, Chapman KR. The effect of montelukast on exhaled nitric oxide of alveolar and bronchial origin in inhaled corticosteroid-treated asthma. Respir Med. 2009; 103(2):296-300.
SchÃ¤per C, Noga O, Koch B, Ewert R, Felix SB et al. Anti-inflammatory properties of montelukast, leukotriene receptor antagonist in patients with asthma and nasal polyposis. J Investig Allergol Clin Immunol. 2011; 21(1):51-58.
Xue L, Barrow A, Fleming VM, Hunter MG, Ogg G et al. Leukotriene E4 activates human Th2 cells for exaggerated proinflammatory cytokine production in response to prostaglandin D2. J. Immunol. 2012; 188(2):694-702.
Majak P, Rychlik B, Pu1aski L, B1auz A, Agnieszka B et al. Montelukast treatment may alter the early efficacy of immunotherapy in children with asthma. J Allergy Clin Immunol. 2010; 125(6):1220-1227.
Svensson LA. Bambuterol, a bronchodilator prodrug with sustained action, enhances delivery of active drug to the lung. Agents Actions Suppl. 1988; 23:271-276.
Waldeck B. Beta-adrenoceptor agonists and asthma-100 years of development. Eur J Pharmacol. 2002; 445:1-12.
Svensson LA. Mechanism of action of bambuterol: a beta-agonist prodrug with sustained lung affinity. Agents Actions Suppl. 1991; 34:71-78.
- Chou YL, Wu CC, Wang HW. Effects of bambuterol and terbutaline on isolated ratâ€™s tracheal smooth muscle. Eur Arch Otorhinolaryngol. 2010; 267(8):1305-11.
Larsen K, Schmekel B. Tremor in healthy volunteers after bambuterol and terbutaline CR-tablets. Eur J Clin Pharmacol. 1993; 45: 303â€“305.
Persson G, Baas A, Knight A, Larsen B, Olsson H. One month treatment with the once daily oral Î²2-agonist bambuterol in asthmatic patients. Eur Respir J. 1995; 8: 34â€“39.
Petrie GR, Chookang JY, Hassan WU, et al. Bambuterol: effective in nocturnal asthma. Respir Med. 1993; 87:581-5.
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