Singulair

I started back on to singulair after my last lot of blimin virus's. My peak flow never changes from 450 unless i've exercised, it can go up to 500. So its pretty good.

I only ever suffer with my asthma when i've cold a chest infection. When i think back to when i was on singulair ( i came off it 2 years ago as they think it may of caused my stomach ulcer...i don't think it did!!) i never got bad chest infections. Only until i was off the singulair. I'd be interested to find out whether it will help me in the future if (god forbid) i get a chest infection again. Especially if its an anti inflammatory. Has anybody had the same experience. I will say though i haven't had hayfever at all!!! GREAT :)

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  • I've actually read on the singulair website that one of the side effects while testing the drug is a sore throat, ears & a chest infection. Very strange especially cos its an anti inflammatory. Oh well works for me!! :)

  • Hi Julie,

    Good to hear that you feel that Singulair might be doing you some good!

    The inflammatory cascade, the sequence of chemical changes that occurs in our bodies when we get inflammation, is a very complex one involving dozens, if not hundreds, of different chemicals. Different parts of the cascade are activated by different triggers, so, for example, the inflammation that occurs in response to infection is slightly different to that caused by allergy.

    Montelukast (Singulair) and zafirlukast (Accolate) work to try to block the action of a specific group of inflammatory chemicals, the leukotrienes. These chemicals tend to be produced in response to allergic stimuli (in some people) rather than other inflammation-causing stimuli such as infection or trauma. So these drugs can be very effective in asthmatics who mainly suffer from allergic asthma. They wouldn't be expected to have much of an effect on the sort of inflammation associated with infection.

    The inflammatory cascade and the functions of all the different chemicals involved are not fully understood (at least not by me, and I don't think by anyone!). There has been work done on finding drugs to target the inflammatory response seen in severe sepsis, as the chemicals produced are part of what causes Multi Organ Dysfunction Syndrome in severe sepsis. However, studies haven't consistently shown benefit for any particular drug in this situation. There are a few clearly defined situations in severe infection where steroids have been shown to be of benefit if given early enough, for example in bacterial meningitis, but this has to be done cautiously and only in very clearly defined situations, since steroids are a bit of a 'sledgehammer' drug and, as everyone knows, have an immunosuppressive effect as well as an anti-inflammatory effect.

    One also has to bear in mind that in a lot of cases, especially in more mild infections that haven't lead to severe sepsis, the inflammatory response is actually a positive adaption to infection. It increases blood flow to the infected area and recruits white blood cells, the infection fighting cells, to the area - allowing our bodies to fight the infection more effectively. Inflammation in response to infection only becomes a problem when there is another condition (such as asthma) which is aggrevated by it, or when a severe inflammatory response in severe sepsis starts having a toxic effect on other parts of the body.

    This seems to have become a lot longer and more convoluted than I was anticipating, and I'm sorry if it is not very clear! I seem to be half asleep this morning which is not conducive to remembering the details of things I learnt a long time ago! Anyway I hope this goes some way to explaining why the leukotriene antagonists such as montelukast can be effective in inflammation associated with allergy but not in inflammation associated with infection.

    Personally, I take montelukast, and I don't feel it has much, if any, direct effect on my asthma. However, it does help my allergies - I get perineal allergic rhinitis (hayfever etc) and generalised allergic reactions - and this has a knock-on effect in improving my asthma symptoms. I don't get much, if anything, in the way of side effects from it so I'm sticking with it!

    Hope this helps a little - please feel free to ask any questions and I will do my best to answer without confusing you and myself any more!

    Take care

    Em H

  • WOW Gosh Emily thanks for the info. Makes sense now. I did browse the net but it didn't give me much info.

    It must be helping my asthma as it more or less stays at 450, although i've just checked it and it 480. So i have a good peak flow daily. Or is it because since my attack i've been more paranoid about my asthma and check my peak flow about 4 times a day!! Never checked it prior the attack. Its definately helped my hayfever, i haven't had it at all this year.

    I will say i totally agree with the steroid result. My chest only got bad cos i didn't start taking steroids until well into my cough. I have an emergency supply so that at the start of a virus i need to start taking them. Hopefully this will help clear my chest quicker and more effectively.

    Its interesting to see how drugs work though, especially when you take them. Its nice to know what they do and why!! Its strange how singulair helps some and not others though.

    Thanks again your reply was very much appreciated x

  • I think the reason why Singulair works for some and not others is that asthma is a multifactorial disease; in fact, it's not just one disease at all. What we call asthma is the end symptoms and signs of a problem that can be caused by a number of different factors.

    For some it might be the leukotrienes that are responsible for most of their symptoms, and drugs like Singulair might work well. For others, it might be predominantly IgE that is causing the problem, and Xolair would potentially work well. There are many other immune system and inflammatory cells and chemicals that have been potentially implicated in causing asthma in some people, and there are some studies ongoing to try to specifically target other individual parts of the immune system.

    The trouble is that there is currently no reliable way to separate out asthmatics into groups according to what is causing their symptoms, so it's just a case of trying these drugs and seeing what works. Studies that look at drugs that target very specific parts of the immune response, like Singulair and Xolair, tend to come up with not particularly impressive results - because the studies are often done on large groups of people with asthma of all different types and the subjects are not selected as having 'IgE mediated asthma' or 'leukotriene mediated asthma' (because we don't really know how to do this).

    I personally think that I, and possibly others who have severe asthma, am lucky enough to have *two* different types of asthma going on at once. I do have allergic asthma (leukotriene mediated? IgE mediated? something else? who knows) which probably accounts for at least some of my day to day symptoms. However, I don't believe allergy accounts for my sudden 'Type II brittle' type attacks... although what does account for them, I'm not sure.

    I think over the next few years we'll be seeing a lot more effort to classify asthma into one of several catagories and treat it specifically and appropriately, rather than relying on 'sledgehammer' drugs like steroids, which damp down most of the immune and inflammatory response and consequentially cause much more in the way of side effects. Let's hope so, anyway!

    Em H

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