Can montelukast (Singulair) be used to treat Chronic Obstructive Pulmonary Disease (COPD)?

Montelukast is Not Recommended for COPD Treatment

Montelukast (Singulair) is not recommended for the treatment of Chronic Obstructive Pulmonary Disease (COPD) according to current clinical guidelines. The 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines specifically state that "leukotriene modifiers have not been tested adequately in patients with COPD" 1.

Evidence Against Montelukast in COPD

The most recent and authoritative guidelines on COPD management do not support the use of leukotriene modifiers like montelukast:

• The GOLD 2017 guidelines clearly indicate that leukotriene modifiers lack sufficient evidence for COPD treatment 1.
• Praxis Medical Insights guidelines (2025) do not include montelukast in any recommended treatment algorithm for COPD management 2.
• The British Thoracic Society guidelines focus on established treatments like bronchodilators (LAMAs and LABAs) as first-line therapy rather than leukotriene modifiers 1.

Recommended COPD Treatment Approach

Instead of montelukast, current guidelines recommend the following evidence-based approach:

For Mild COPD:

• Short-acting bronchodilators (SABA) as needed 2
• No drug treatment for asymptomatic patients 1

For Moderate COPD:

• Long-acting muscarinic antagonists (LAMAs) as first-line therapy 2
• LAMAs are superior to long-acting beta-agonists (LABAs) in reducing exacerbation risk 2
• Consider LABA if LAMA not suitable 2

For Severe COPD:

• LAMA/LABA combination therapy 2
• Consider triple therapy (LAMA/LABA/ICS) for patients with continued exacerbations and severe symptoms 2

Limited Research on Montelukast in COPD

While a few small studies have investigated montelukast in COPD, they have significant limitations:

• A 2004 retrospective study of 20 patients suggested some benefit with long-term montelukast, but this was a small, non-randomized study without adequate controls 3.
• A 2003 study showed montelukast may attenuate airway response to hypertonic saline in COPD patients, but this was a specific challenge test rather than evaluation of clinical outcomes 4.
• A 2016 animal study suggested potential benefits in a guinea pig model of COPD, but animal studies cannot be directly translated to human clinical practice 5.

Potential Risks and Considerations

Using medications without strong evidence of benefit in COPD may expose patients to unnecessary risks:

• Montelukast has been associated with neuropsychiatric events in some patients 1.
• Using ineffective treatments may delay implementation of therapies with proven benefits.
• Adding unnecessary medications increases pill burden and potential for drug interactions.

Conclusion

For optimal management of COPD focused on improving morbidity, mortality, and quality of life, clinicians should follow evidence-based guidelines that recommend:

1. Smoking cessation as the most effective intervention to slow disease progression
2. LAMA therapy as first-line pharmacological treatment for moderate to severe COPD
3. Addition of LABA for patients with persistent symptoms
4. Consideration of ICS in specific patients with frequent exacerbations and elevated eosinophil counts
5. Pulmonary rehabilitation for appropriate patients

Montelukast should not be used for COPD treatment given the lack of supporting evidence and availability of more effective, guideline-recommended alternatives.