Comparison of add-on therapy to inhaled fluticasone propionate in children with asthma: Residual volume and exhaled nitric oxide as outcome measures

Abstract

The purpose of this study was to evaluate changes in lung function and fractional exhaled nitric oxide (FeNO) in children with mild to moderate persistent asthma treated with low-dose inhaled steroids but still manifesting significantly increased residual volume (RV). This was a crossover study evaluating lung function and FeNO before and after a 2-week crossover therapy period by adding either montelukast or salmeterol to inhaled fluticasone propionate in 12 children with asthma. Salmeterol increased forced expiratory volume at 1 second (FEV(1)) and decreased RV without effects on eNO. Addition of montelukast produced a statistically significant decrease both for RV (from 191.7 +/- 60.8% to 132.4 +/- 36.1%; p = 0.03) and for eNO (from 14.0 +/- 6.3 ppb to 8. 5+/- 5.0 ppb; p < 0.01). No effect was observed for the montelukast treatment period in FEV(1) and forced expiratory flow at 25-75%. Add-on therapy may reduce RV and decrease levels of FeNO, leading to consideration of a possible anti-inflammatory additive effect that could improve the control of the disease.

Exhaled nitric oxide in childhood allergic asthma management: A randomised controlled trial

“…The production of FeNO by the inducible NO synthase in the lower airways is upregulated in the presence of a type 2 T‐helper cell inflammation and correlates with the sputum eosinophilic count . Previously, it has been shown that FeNO measurement could be helpful in monitoring of anti‐inflammatory treatment, where it appears to act as a response marker to adjusted anti‐inflammatory therapy . Moreover, an increased FeNO level could indicate an uncontrolled eosinophilic inflammation and could be associated with a heightened future exacerbation risk .…”

Effect of inhaled corticosteroid treatment on exhaled breath condensate leukotriene E4 in children with mild asthma

“…20,28 FE NO is the most extensively studied exhaled marker in asthma. 6,7,9,29 We showed that mean FE NO significantly decreased after corticosteroid treatment (Fig. 1).…”

“…29 The analysis of EBC thus offers new perspectives without any risk for the patient. 31,32 In allergic asthma the steering mechanism is assumed to be bronchial inflammation due to mediators released from eosinophil granulocytes and to the polarization of the immune system toward a reaction state dominated by TH 2 -lymphocytes.…”

Oral montelukast compared with inhaled corticosteroid for controlling mild-persistent asthma in Egyptian children and adolescents

“…Verini et al [35] revealed that add-on therapy of montelukast reduced the residual volume and decreased the level of FENO, leading to the consideration of a possible anti-inflammatory additive effect that could improve the control of the disease. This disagreement may be due to the personal variability in the treatment response and the significant variability in the course of the disease [36].…”