Hoshino M, et al. - Researchers compared the impact of the addition of either montelukast or tiotropium to inhaled corticosteroids (ICS)/long-acting β₂-agonist (LABA) on airway inflammation and remodeling in persistent asthma. Participants included 87 patients with asthma who were treated with budesonide and formoterol (640/18 μg). They were then patients randomized to one of three treatment groups: oral montelukast (10 mg/day), inhaled tiotropium (5 μg/day), or no add-on to the maintenance therapy for 48 weeks. Findings revealed significantly decreased fractional exhaled nitric oxide (FeNO) and improved airflow obstruction with add-on montelukast vs maintenance therapy, whereas airway dimensions remained unchanged. A significant correlation of changes in FeNO with changes in FEV₁ was observed. In contrast, significantly decreased airway wall area corrected for body surface area (WA/BSA), decreased wall thickness (T/√BSA) and improved airflow obstruction with no change in FeNO were observed with the addition of tiotropium. A significant correlation of changes in WA/BSA and T/√BSA with the change in percentage predicted FEV₁ was observed. In these patients, additive benefits with respect to the pulmonary function and airway inflammation or remodeling could be seen with the addition of either montelukast or tiotropium to ICS/LABA.