montelukast and Nasal-Obstruction

Allergic rhinitis is a prevalent disease in developed nations, and its prevalence has been increasing throughout the world. Nasal congestion is the most common and bothersome symptoms of rhinitis. Congestion is associated with sleep-disordered breathing and is thought to be a key cause of sleep impairment in individuals with rhinitis. The end result is a decrease in quality of life and productivity and an increase in daytime sleepiness. Treatment with intranasal corticosteroids has been shown to reduce nasal congestion. Data on sleep-related end points from clinical trials of intranasal corticosteroids indicate that this reduction is associated with improved sleep, reduced daytime fatigue, and improved quality of life. Other therapies, such as montelukast, also have a positive influence on congestion and sleep. This review examines nasal congestion and the associated sleep impairment of allergic rhinitis patients. It explores the adverse effects of disturbed sleep on quality of life and how these conditions can be reduced by therapies that decrease congestion.

Topics: Acetates; Administration, Intranasal; Adrenal Cortex Hormones; Anti-Asthmatic Agents; Cyclopropanes; Fatigue; Humans; Hypersensitivity; Nasal Obstruction; Quality of Life; Quinolines; Rhinitis; Sleep; Sleep Apnea Syndromes; Sleep Stages; Sulfides

It is not unequivocally proven whether a combination of an intranasal corticosteroids (INSs) and a cysteinyl leukotriene receptor antagonist has greater efficacy than INSs in the treatment of seasonal allergic rhinitis (SAR).. Single-center, randomized, open-label study.. Study subjects included 46 participants with SAR. Participants were randomized to receive budesonide (BD; 256 μg) plus montelukast (MNT; 10 mg) (BD + MNT) or BD alone (256 μg) for 2 weeks. Visual analog scale scores for five major symptoms of SAR, nasal cavity volume (NCV), nasal airway resistance (NAR), and fractional exhaled nitric oxide (FeNO) were assessed before and at the end of treatments.. Both treatments significantly improved the five main SAR symptoms from baseline; however, BD + MNT produced significantly greater improvements in nasal blockage and nasal itching compared to BD alone. At baseline, the nasal blockage score was significantly correlated with NCV and NAR (r = -0.473, P = .002 and r = -0.383, P = .013, respectively). After 2 weeks of treatment, BD + MNT significantly improved NCV, but not NAR, to a greater level than BD. The number of patients with FeNO concentration ≥ 30 ppb at baseline was significantly decreased after BD + MNT treatment, but not after BD treatment. Similarly, BD + MNT treatment led to a significantly greater decrease in FeNO concentration than BD treatment.. BD + MNT treatment may have an overall superior efficacy than BD monotherapy for patients with SAR, especially in improvement of nasal blockage, itching, and subclinical lower airway inflammation. Also, NCV and NAR could be used to assess nasal blockage more accurately.. 1b Laryngoscope, 131:E1054-E1061, 2021.

Topics: Acetates; Administration, Intranasal; Adult; Bronchodilator Agents; Budesonide; China; Cyclopropanes; Drug Therapy, Combination; Female; Humans; Leukotriene Antagonists; Male; Nasal Obstruction; Quinolines; Rhinitis, Allergic; Sulfides

Background/aim: The incidence of adenoid hypertrophy is 2%-3% in children. Adenoidectomy is a commonly performed procedure in children that may cause complications such as early or late bleeding (4%-5%), recurrence of adenoid tissue (10%-20%), and postoperative respiratory problems (27%). Therefore, medical therapy alternatives to adenoidectomy are important and must be tried before surgery. In this study, we investigated the efficacy of mometasone furoate, montelukast, and a combination of these drugs in pediatric patients with adenoid hypertrophy who were scheduled for reduction with medical therapy after not being recommended for surgery.Materials and methods: The study included 120 children with adenoid hypertrophy aged between 4 and 10 years. The patients were randomized into 4 separate groups, with 30 in each group. Group 1 received 100 μg of mometasone furoate per day, group 2 received 4/5 mg (for age) montelukast per day, and group 3 received mometasone furoate + montelukast. Medical therapy continued for 3 months in the treatment groups. Group 4, which comprised patients with mild symptoms, received no treatment and was the control group. The pre- and posttreatment adenoid tissue ratios in lateral neck radiographs were recorded in the four groups. Results: When radiologic measurements of adenoid-to-air passage were calculated, an improvement of 21.76% was observed in group 1 after treatment. The rate of improvement was 22.51% in group 2. There was a 21.79% reduction in adenoid size in group 3 after 3 months? treatment and 12.46% in the control group. There were statistically significant differences between pre- and posttreatment values in every single group administered corticosteroids, montelukast, and combined therapy (P < 0.05).Conclusion: According to our results, both montelukast and mometasone furoate therapies were similarly successful in treating adenoid hypertrophy. Combined therapy has no superiority over single-therapy treatment.

Topics: Acetates; Adenoids; Administration, Intranasal; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Child; Child, Preschool; Cyclopropanes; Drug Therapy, Combination; Female; Humans; Hypertrophy; Male; Mometasone Furoate; Nasal Obstruction; Prospective Studies; Quinolines; Recurrence; Sulfides; Treatment Outcome

The effects of desloratadine-montelukast combination on quality of life (QoL) and nasal airflow of patients with perennial allergic rhinitis (PAR) has not been reported. The objective of this work was investigate the efficacy of desloratadine-montelukast combination on nasal obstruction and health-related quality of life (HRQL) of patients with PAR.. The patients with PAR (n = 40) were assessed using acoustic rhinometry (AcR) and Rhinoconjunctivitis QoL Questionnaire (RQLQ) before therapy. Desloratadine-montelukast fixed-dose combination treatment was applied to every patient once daily. The AcR and RQLQ score were reevaluated at the first and third months; and statistical comparison of pretreatment and posttreatment results was performed.. Nasal symptoms and signs such as itching, sneezing, discharge, congestion, and edema, and color change of turbinates have been decreased after treatment. In AcR, minimum cross-sectional area (MCA) measurements and volume results were increased after the treatment. Correlation was found between the volume results and nasal discharge and/or congestion in right nasal passages. In left nasal passages, statistical relation was observed between the MCA and itching and/or change of turbinate color (p < 0.05). A significant decrease in the overall RQLQ score was determined at the first and third months of therapy. The difference between scores at baseline and end of the first and third months for all domains was statically significant (p < 0.001). The treatment difference in change from the first month to the end of the third month was statistically significant (p < 0.05).. Desloratadine-montelukast combination therapy causes subjective and objective decrease in nasal obstruction, reduces the other symptoms of PAR and improves the disease-specific QoL.

Topics: Acetates; Adult; Cyclopropanes; Drug Combinations; Female; Humans; Leukotriene Antagonists; Loratadine; Male; Middle Aged; Nasal Obstruction; Quality of Life; Quinolines; Rhinitis, Allergic, Perennial; Sulfides; Treatment Outcome; Young Adult

No studies have directly compared the effects of immunotherapy and antileukotrienes due to the long time required to appreciate the clinical effects of immunotherapy. We compared the effect of montelukast (MK) and SLIT added to standard therapy in moderate asthma over 5 years.. Open randomized controlled trial. Patients with moderate asthma (and rhinitis) solely due to birch pollen were randomized to receive either MK (10 mg/d) or birch sublingual immunotherapy (SLIT) in the pollen seasons, in addition to formoterol/fluticasone. All the patients also received salbutamol and cetirizine as rescue medications. Asthma and rhinitis symptoms were recorded on diary cards from February to May at baseline and after 3 and 5 years of study. In-season nasal eosinophils and bronchial hyperresponsiveness were also evaluated.. Thirty-three adult patients were enrolled and 29 completed the study. The groups were homogeneous at baseline. Bronchial and nasal symptom scores were lower at 3 and 5 years compared to baseline in the SLIT group. Bronchial hyperresponsiveness and bronchodilator use decreased significantly in both groups at 5 years, but only in the SLIT group at 3 years. In the SLIT group there was a significant decrease in nasal eosinophils compared to baseline and to the MK group.. In patients with birch pollen-induced moderate asthma and rhinitis, the addition of SLIT provides a greater clinical benefit than that of MK.

Topics: Acetates; Administration, Sublingual; Adolescent; Adult; Aged; Antigens, Plant; Asthma; Betula; Cell Count; Cyclopropanes; Desensitization, Immunologic; Disease Progression; Eosinophilia; Female; Follow-Up Studies; Humans; Leukotriene Antagonists; Male; Middle Aged; Nasal Obstruction; Quinolines; Rhinitis, Allergic, Seasonal; Sulfides

During the course of development of montelukast, a cysteinyl leukotriene receptor 1 antagonist, for treatment of seasonal allergic rhinitis, a double-blind, non-inferiority study was carried out to evaluate the efficacy and safety of montelukast 5mg and 10mg compared with pranlukast 450mg, which has a similar mechanism of action.. Montelukast 5mg, 10mg or pranlukast 450mg and the corresponding placebo were orally administered to patients with seasonal allergic rhinitis three times a day for 2 weeks. Non-inferior efficacy of montelukast 5mg and 10mg to pranlukast 450mg was investigated by the change from the baseline in the composite nasal symptoms scores over the 2-week treatment period.. Montelukast 5mg, 10mg once daily and the pranlukast 450mg/day showed significant improvements in the change from the baseline in the composite, daytime and nighttime nasal symptom scores, and the improvement lasted for 2 weeks. Montelukast 5mg and 10mg were non-inferior to pranlukast 450mg in the change from the baseline in the composite nasal symptoms scores. The incidence rates of adverse experiences and drug-related adverse experiences were not significantly different among the three treatment groups.. The results indicate that administration of montelukast 5mg and 10mg once daily are potent alternatives for the treatment of seasonal allergic rhinitis and demonstrated that the efficacy and the safety profiles are comparable with pranlukast 450mg/day.

Topics: Acetates; Adult; Chromones; Cyclopropanes; Double-Blind Method; Female; Humans; Leukotriene Antagonists; Male; Middle Aged; Nasal Obstruction; Quinolines; Rhinitis, Allergic, Seasonal; Severity of Illness Index; Sleep Initiation and Maintenance Disorders; Sneezing; Sulfides; Treatment Outcome

The safety and efficacy of intranasal corticosteroids for the treatment of allergic rhinitis is well documented in the literature. Additionally, an expert panel has concluded that intranasal corticosteroids are the first line of therapy when obstruction is a major component of rhinitis. Montelukast is a leukotriene receptor antagonist recently approved for the treatment of seasonal allergic rhinitis (SAR).. This randomized, double-blind, double-dummy, parallel-group study was conducted to compare the effectiveness of a 15-day course of intranasal fluticasone propionate 200 microg, once daily (FP200QD), to oral montelukast 10 mg, once daily (MON10QD), in relieving daytime and nighttime nasal symptoms associated with SAR.. The intent-to-treat (ITT) analysis population consisted of 705 eligible males and females (> or = 15 years) with SAR randomized to either FP200QD (N = 353) or MON10QD (N = 352). The primary efficacy endpoint was the mean change from baseline in subject-rated daytime total nasal symptom scores (the sum of four individual scores: nasal congestion, itching, rhinorrhea, and sneezing), evaluated via visual analog scales, and averaged over weeks 1 to 2. Secondary endpoints included the four daytime individual nasal symptom scores, the nighttime total, and individual nasal symptom scores (each evaluated on a four-point scale from 0 to 3).. Statistically significant differences favoring FP200QD over MON10QD were observed for the mean change from baseline in daytime total nasal symptom scores (P < 0.001), daytime individual nasal symptom scores (P < 0.001), nighttime total (P < 0.001), and all individual nasal symptom scores (P < or = 0.002) over the 15-day treatment period. FP200QD and MON10QD were both well tolerated.. The results of this well controlled study demonstrated that FP200QD was consistently superior to MON10QD with regard to every efficacy endpoint evaluated, including daytime and nighttime nasal congestion, in subjects with SAR.

Topics: Acetates; Administration, Intranasal; Administration, Oral; Adult; Androstadienes; Anti-Allergic Agents; Cyclopropanes; Female; Fluticasone; Humans; Leukotriene Antagonists; Loratadine; Male; Nasal Obstruction; Pruritus; Quinolines; Rhinitis, Allergic, Seasonal; Sneezing; Sulfides

Both domiciliary and laboratory measures of nasal function have been used to evaluate treatment response in allergic airways disease; however, these measures have not been compared.. To determine the relationship of domiciliary measures (daily symptoms, peak inspiratory nasal flow, and nasal oral index) and laboratory measures (rhinomanometry, acoustic rhinometry) in assessing treatment response with topical steroids and specific inflammatory mediator blockage.. Twenty-one patients with seasonal allergic rhinitis and asthma were enrolled into a single-blind, placebo-controlled, crossover study comparing 2 weeks of 1) 400 microg inhaled plus 200 microg intranasal budesonide once daily and 2) 10 mg montelukast plus 10 mg cetirizine once daily. Before each treatment, patients received 7 to 10 days of placebo period. Laboratory measurements were made of nasal resistance by posterior rhinomanometry, and nasal volume between 0 and 5 cm by acoustic rhinometry after both placebo and active treatment periods. Daily domiciliary recordings were made of allergic rhinitis nasal symptoms scores and peak nasal and oral inspiratory flow rate (enabling the calculation of a nasal/oral index) throughout the study.. There were significant (P < 0.05) improvements for all allergic rhinitis symptoms with both therapies, after factoring for pollen count. Spearman's rank correlation for comparison among nasal symptoms and the objective responses were: nasal inspiratory flow rate (R = -0.50, P = 0.02); nasal/oral index (R = -0.55 P = 0.01); rhinomanometry (R = 0.24, P = 0.30); and acoustic rhinometry (R = -0.21, P = 0.36).. Both treatments were effective in managing allergic rhinitis symptoms, and patients' symptoms were more closely associated with domiciliary measurements of nasal flow than laboratory measurements of nasal function.

Topics: Acetates; Administration, Inhalation; Administration, Intranasal; Adult; Airway Resistance; Anti-Allergic Agents; Anti-Inflammatory Agents; Asthma; Budesonide; Cetirizine; Cross-Over Studies; Cyclopropanes; Female; Glucocorticoids; Histamine H1 Antagonists; Humans; Leukotriene Antagonists; Male; Nasal Obstruction; Quinolines; Rhinitis, Allergic, Seasonal; Rhinomanometry; Rhinometry, Acoustic; Sulfides

Nasal obstruction is one of the most bothersome symptoms of allergic rhinitis (AR) affecting sleep-related quality of life in AR patients. Although several treatments were tested to control nasal obstruction, some patients with moderate to severe AR do not respond to current treatments, including the combined administration of different types of anti-allergic medicine. Thus, new options for AR treatment are needed. This study aimed to evaluate the effects of combined treatment with a novel inhibitor of hematopoietic prostaglandin D synthase (HPGDS), TAS-205, and different types of anti-allergic medicine on nasal obstruction in AR. Firstly, we demonstrated that TAS-205 selectively inhibited prostaglandin D

Topics: Acetates; Animals; Anti-Allergic Agents; Cell Line; Cyclopropanes; Disease Models, Animal; Drug Synergism; Drug Therapy, Combination; Enzyme Inhibitors; Guinea Pigs; Humans; Intramolecular Oxidoreductases; Lipocalins; Male; Morpholines; Nasal Mucosa; Nasal Obstruction; Ovalbumin; Piperidines; Prostaglandin D2; Pyrroles; Quality of Life; Quinolines; Rats; Rhinitis, Allergic; Sulfides; Terfenadine

Different drugs from various pharmacological classes were compared for their ability to protect against the nasal effects of acute allergen challenge in a guinea pig model. In the model, sneezing and nose rubbing were recorded after an initial allergen challenge in guinea pigs previously sensitized to egg albumin. Four days later the same guinea pigs were re-challenged a second time when anesthetised. In these anaesthetized animals, nasal airway pressure, pulmonary inflation pressure and cellular infiltration into nasal lavage fluid were measured. The drug tested were autacoid antagonists (mepyramine--3mg/kg, cetirizine--3mg/kg and montelukast--10mg/kg), L-NAME (10 or 20mg/kg), heparin (20mg/kg) and dexamethasone (20mg/kg) given either intraperitoneally or intravenously; all were given shortly before challenge. Sneezing induced by allergen challenge was statistically significantly reduced by mepyramine, cetirizine and dexamethasone whereas only cetirizine reduced nose rubbing. Changes in nasal airway pressure due to allergen exposure were reduced by cetirizine, montelukast, L-NAME, and heparin, but not by mepyramine, nor dexamethasone. In the presence of L-NAME, nasal airway pressure actually changed in the opposite direction. Cellular infiltration, as assessed by cytometry in nasal lavage fluid 60min after acute allergen challenge, was reduced by montelukast and heparin but not by antihistamines, L-NAME nor dexamethasone. This pattern of effects of the drugs, given by doses and routes previously described in the literature as being effective was not completely consistent with expected responses. The lack of effect of dexamethasone probably reflects the fact that it was given acutely whereas in the clinic chronic administration is used. The two antihistamines were not identical in their actions, presumably reflecting the fact that cetirizine has therapeutic actions not entirely confined to blockade of H1 receptors. Montelukast has not been reported to have major effects on sneezing and itching in the clinic but reduces nasal obstruction (lower nasal airway pressure or nasal patency). Montelukast's effects on cellular infiltration indicate the possible involvement of leukotrienes. Heparin has actions on inflammatory cell infiltration. This could explain its profile of reducing both cellular infiltration, and increased nasal airway pressure.

Topics: Acetates; Acute Disease; Animals; Cetirizine; Cyclopropanes; Dexamethasone; Disease Models, Animal; Guinea Pigs; Heparin; Histamine H1 Antagonists; Male; Nasal Obstruction; NG-Nitroarginine Methyl Ester; Ovalbumin; Pyrilamine; Quinolines; Rhinitis, Allergic, Seasonal; Sneezing; Sulfides