Main results Analysis was by intention to treat. The groups did not differ for frequency of clinical or laboratory adverse events. Conclusion Oral montelukast reduced exercise-induced bronchoconstriction in adults with asthma more than did inhaled salmeterol at 8 weeks of therapy. Commentary Airway hyperresponsiveness to exercise and response to therapy are important and quantifiable indexes of asthma control. Edelman and colleagues expand our understanding of the role of montelukast by comparing it with an inhaled bronchodilator rather than with placebo.
Several issues deserve mention.
First, this trial evaluated and compared the protective effects of montelukast and salmeterol at the end of their dosing intervals. Whether comparable protection against EIB exists earlier in the dosing cycle was not studied. Second, the effect of montelukast in patients with more severe chronic asthma was not investigated. These points aside, this study shows that montelukast had a durable effect in reducing the magnitude of the broncho- constuctive response to provocative exercise challenge. These findings also suggest that the protective effect of salmeterol in EIB decreases after long-term administration.