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Nitrotyrosine is high in EBC of asthmatic children and could be considered as a noninvasive marker of nitrosative events in the airways.

Effect of montelukast added to inhaled corticosteroids on fractional exhaled nitric oxide in asthmatic children. L. Ghiro, S. Zanconato, O. Rampon, V. Piovan, M. F. Pasquale, E. Baraldi. #ERS Journals Ltd 2002. ABSTRACT: The aim of this prospective, self-controlled, single-blind study was to assess the effect of montelukast added to maintenance therapy with inhaled corticosteroids (ICS) on fractional exhaled nitric oxide (FENO) in asthmatic children.Thirty-five children (age 11.2¡0.4 yrs (mean¡SEM)) with mild-to-moderate persistent asthma treated with low to medium doses of ICS and FENOw20 parts per billion (ppb) were included. The patients were randomly assigned to two groups: 17 patients continued ICS (group C) and 18 had montelukast added to ICS for 3 weeks (group M). FENO measurements were performed in both groups at baseline (T1) and after 3 weeks (T2), and in group M also after 2 weeks of washout. FENO was measured by a chemiluminescence analyser using an on-line method (50 mL?s -1 ) with nitric oxide-free air. The overall mean daily dose of ICS was equivalent to 530¡58 mg?day -1 of beclomethasone in group M and to 564¡55 mg?day -1 of beclomethasone in group C. There were no significant differences in baseline FENO and forced expiratory volume in one second (FEV1) between the two groups. After 3 weeks there was a significant reduction of FENO values in patients of group M (T1 52.2¡7.8 ppb, T2 36.1¡4.6 ppb) but no significant changes in group C (T1 43.5¡6.0 ppb, T2 47.8¡9.4 ppb). In group M after 2 weeks of montelukast withdrawal, FENO rose to baseline values (55.6¡8.7 ppb).In conclusion, after montelukast treatment there is a fractional exhaled nitric oxide reduction in asthmatic children receiving maintenance therapy with inhaled corticosteroids. This suggests an anti-inflammatory effect of montelukast additive to that of inhaled corticosteroids. Fractional exhaled nitric oxide (FENO) has been proposed as a simple and noninvasive marker of airway inflammation in asthmatic patients [1]. Several studies have demonstrated that FENO in asthmatics is reduced by corticosteroid therapy [1,2], and that changes in FENO due to steroid dose changes precede the improvement or worsening in asthma symptoms and lung function [1]. Recently FENO was demonstrated to be useful in predicting loss of control in asthmatic subjects when inhaled corticosteroids (ICS) were withdrawn [3], with a positive predictive value similar to that obtained using sputum eosinophils and airway hyperresponsiveness, but with the advantage that FENO is an easier-to-measure, real-time parameter. This evidence suggests that FENO measurement reflects control of asthma and may help the physician in modulating anti-inflammatory therapy [1].The cysteinyl leukotrienes (Cys-LT) C4 and E4 play a key role in the pathophysiology of asthma [4]. The leukotriene receptor antagonists (LTRAs) that have recently been developed selectively block the binding of Cys-LT to the CysLT1 receptor, which has been identified as the receptor through which most their actions...

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