Response profiles to fluticasone and montelukast in mild-to-moderate persistent childhood asthma

Outcome data are needed to base recommendations for controller asthma medication use in school-aged children. We sought to determine intraindividual and interindividual response profiles and predictors of response to an inhaled corticosteroid (ICS) and a leukotriene receptor antagonist (LTRA). An IC...

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Bibliographic Details
Published in:Journal of allergy and clinical immunology 2006, Vol.117 (1), p.45-52
Main Authors: Zeiger, Robert S., Szefler, Stanley J., Phillips, Brenda R., Schatz, Michael, Martinez, Fernando D., Chinchilli, Vernon M., Lemanske, Robert F., Strunk, Robert C., Larsen, Gary, Spahn, Joseph D., Bacharier, Leonard B., Bloomberg, Gordon R., Guilbert, Theresa W., Heldt, Gregory, Morgan, Wayne J., Moss, Mark H., Sorkness, Christine A., Taussig, Lynn M.
Format: Article
Language:English
Subjects:
Acetates - therapeutic use
Adolescent
Age
Androstadienes - therapeutic use
Asthma
Asthma - drug therapy
Asthma - physiopathology
Asthma control days
asthma control outcomes
Asthma Control Questionnaire
Biological and medical sciences
Child
Cross-Over Studies
Diaries
Double-Blind Method
Drug dosages
exhaled nitric oxide
Female
Fluticasone
fluticasone propionate
Forced Expiratory Volume - drug effects
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Humans
Immunopathology
inhaled corticosteroids
Leukotriene Antagonists - therapeutic use
leukotriene receptor antagonists
Male
Medical sciences
montelukast
Nitric Oxide - analysis
Pediatrics
pulmonary response
Quinolines - therapeutic use
Studies
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Summary:Outcome data are needed to base recommendations for controller asthma medication use in school-aged children. We sought to determine intraindividual and interindividual response profiles and predictors of response to an inhaled corticosteroid (ICS) and a leukotriene receptor antagonist (LTRA). An ICS, fluticasone propionate (100 μg twice daily), and an LTRA, montelukast (5-10 mg nightly, age dependent), were administered to children ages 6 to 17 years with mild-to-moderate persistent asthma using only as-needed bronchodilators in a multicenter, double-masked, 2-sequence, 16-week crossover trial. Clinical, pulmonary, and inflammatory responses to these controllers were evaluated. Improvements in most clinical asthma control measures occurred with both controllers. However, clinical outcomes (asthma control days [ACDs], the validated Asthma Control Questionnaire, and albuterol use), pulmonary responses (FEV 1/forced vital capacity, peak expiratory flow variability, morning peak expiratory flow, and measures of impedance), and inflammatory biomarkers (exhaled nitric oxide [eNO]) improved significantly more with fluticasone than with montelukast treatment. eNO was both a predictor of ACDs ( P = .011) and a response indicator ( P = .003) in discriminating the difference in ACD response between fluticasone and montelukast. The more favorable clinical, pulmonary, and inflammatory responses to an ICS than to an LTRA provide pediatric-based group evidence to support ICSs as the preferred first-line therapy for mild-to-moderate persistent asthma in children. eNO, as a predictor of response, might help to identify individual children not receiving controller medication who achieve a greater improvement in ACDs with an ICS compared with an LTRA.
ISSN:0091-6749
1097-6825
DOI:10.1016/j.jaci.2005.10.012