Effects of leukotriene receptor antagonist therapy in patients with severe rhinitis in a real life clinical setting

Although there is evidence from randomised controlled trials that leukotriene receptor antagonists are efficacious in chronic rhinosinusitis there are still little data on their use in everyday real life clinical practice. We report on a pragmatic case series of 32 patients referred from primary care with uncontrolled chronic rhinosinusitis (allergic or non-allergic) who have been treated with montelukast in our joint medical/surgical rhinology clinic. Patients' symptoms were scored according to "facial pain", "headache", "nasal blockage", "nasal discharge", "sense of smell" and "daily activity", and measurements of peak inspiratory nasal flow were made, before and after the introduction of montelukast 10 mg/day. There were significant (p < 0.05) improvements in subjective scoring for headache, nasal discharge & blockage, sense of smell and daily activity but not for facial pain, when montelukast was added along with other alterations in chronic rhinosinusitis medication (all receiving intra-nasal corticosteroids). Subgroup analysis of 10 patients, were the addition of montelukast was the only change to medical therapy, showed significant (p < 0.05) improvements in headache, nasal discharge and blockage and their daily activity. There was no significant improvements in nasal peak inspiratory flow or spirometry. In conclusion, montelukast may be a useful therapeutic option in addition to standard therapy (i.e. intra-nasal corticosteroids or anti-histamines) when treating patients with chronic rhinosinusitis in a real life clinical setting.