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Update in Pulmonary Diseases
1999-2000 Series: Update Sessions from ACP-ASIM's 1999 Annual Session
Margaret Ring Gillock, Editor, and David Cramer, MD, Co-Editor
In choosing the articles to include in this Update, I turned to primary care physicians from Nassau County Medical Center in New York, ACP Journal Club Editor Brian Haynes, and internists from the community. Not only is a wealth of new information available about a broad range of therapy topics, but many recent studies have discussed new diagnostic methods. The articles chosen can be divided into four categories: asthma and chronic obstructive pulmonary disease; pulmonary infections, including pulmonary tuberculosis; interstitial and occupational lung diseases; and pulmonary embolism, solitary pulmonary nodules, and lung carcinoma. I focus on three articles from each of these areas. For a list of related readings on the topics discussed here, see the Appendix.
Asthma and Chronic Obstructive Pulmonary Disease
Oral Montelukast Treatment Is Effective for Patients with Mild Exercise-Induced Asthma
Leff JA, Busse WW, Pearlman D, et al. Montelukast, a leukotriene-receptor antagonist, for the treatment of mild asthma and exercise-induced bronchoconstriction. N Engl J Med. 1998; 339:147-52.
In a randomized, controlled trial of 110 nonsmoking patients with mild asthma (age range, 15 to 45 years), Leff and colleagues evaluated the ability of montelukast, a leukotriene-receptor antagonist, to protect against exercise-induced bronchoconstriction. All patients were given placebo in a single-blinded fashion for the first week and were then randomly assigned to receive 10 mg of montelukast or matching placebo once daily at bedtime for 12 weeks. Exercise challenges and methacholine challenges were performed on different days during the baseline period and 4, 8, and 12 weeks after treatment began.
The degree of protection against bronchoconstriction afforded by montelukast therapy at week 12 was significantly greater than that afforded by placebo. Montelukast therapy was associated with significant improvement in the following: area under the curve for the percentage decrease in forced expiratory volume in 1 second …
