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Inhaled fluticasone and zafirlukast in persistent asthma

      To the Editor:
      The article by Nathan et al. (
      • Nathan R.A.
      • Bleecker E.R.
      • Kalberg C.
      A comparison of short-term treatment with inhaled fluticasone propionate and zafirlukast for patients with persistent asthma.
      ) is very important in that it demonstrates that even very low doses of inhaled steroids (176 μg of fluticasone administered daily) provide an average benefit in excess to that found with zafirlukast in patients with mild, persistent asthma. However, our experience and that of the existing literature suggest that leukotriene modifiers are most active in various subgroups of patients with asthma, such as those with the aspirin sensitivity-nasal polyps-asthma triad (
      • Barnes P.J.
      Airway pharmacology.
      ). Its role may not be universal in all patients with asthma, but may be applicable in selected patients. With this in mind, it is surprising that the authors presented only their mean data, omitting all data, for instance, which would demonstrate which portion of the zafirlukast group exceeded the mean fluticasone response. Hopefully, they can provide this information.

      References

        • Nathan R.A.
        • Bleecker E.R.
        • Kalberg C.
        A comparison of short-term treatment with inhaled fluticasone propionate and zafirlukast for patients with persistent asthma.
        Am J Med. 2001; 111: 195-202
        • Barnes P.J.
        Airway pharmacology.
        in: Murray J.F. Nadel J.A. Textbook of Respiratory Medicine. W. B. Saunders, Philadelphia, Pennsylvania2000: 285

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