Montelukast Is a Better Controller in Obese Atopic Asthmatics
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Sherry Farzan, MD, Sundas Khan, MD, Claudia Elera, Meredith Akerman, MS

The concomitant rise in the prevalence of asthma and obesity has suggested an association between the two.  Two phenotypes of obesity-associated asthma exist; early-onset atopic and late-onset non-atopic asthma. Animal and human studies suggest involvement of leptin and leukotrienes in inflammatory pathways. We hypothesized that montelukast is a more effective controller of early-onset atopic asthma in overweight/obese (O) compared to normal (N) weight asthmatics.


Mild to moderate persistent early-onset asthmatics on inhaled corticosteroids (ICS) were randomized in a double-blind controlled manner to receive montelukast (M) or placebo (P).  Treatment with M was compared to P at week 24 for the primary outcome measure, Asthma Control Test (ACT) scores, and secondary outcome measures (spirometric measures, exhaled nitric oxide, total ICS dose, serum leptin and urinary leukotriene E4).  Mean difference was calculated as M group minus P group with corresponding 95% confidence intervals.


The two treatment groups were comparable at baseline. At week 24, the O group, but not the N group, treated with M demonstrated a significantly higher ACT score than P (25.0 vs. 15.7 respectively, p<0.01).  ACT score differed significantly between M and P groups (24.5 vs. 18.1 respectively, p<0.01), overall, but not for any other clinical or laboratory parameters assessed. There were no significant interactions between treatment group and weight subgroup for any parameters of interest.


Montelukast is a more effective controller medication among obese atopic early-onset compared to normal weight asthmatics. These data underscore the need to elucidate the underlying mechanism and individualize the management of obesity-associated asthma.