Cysteinyl leukotrienes (cysLTs) are considered to be important mediators involved in bronchial asthma and the ensuing eosinophilic inflammation. We evaluated the effects of pranlukast, a potent and selective cysLT receptor antagonist, on the clinical course and serum eosinophil cationic protein (ECP) levels of 10 asthmatic patients. A four-week administration of pranlukast increased the morning peak expiratory flow (PEF) (p=0.007) and decreased as-needed /3z-agonist use (p=0.021). Changes in the morning PEF inversely correlated with those in the serum ECP levels (r=-0.80, p=0.0057). These results suggest that cysLTs are important mediators involved in eosinophilic inflammation, a major pathophysiologic feature of bronchial asthma in humans.