Effects of montelukast on subjective and objective outcome measures in preschool asthmatic children

Abstract

It is well accepted that control of airway inflammation is crucial for overall asthma control. Hence, efficient anti-inflammatory therapy is important for disease control. Therefore, we studied the effect of a treatment with montelukast on subjective and objective measures in preschool asthmatic children with insufficient control of airway inflammation, illustrated by increased fractional exhaled nitric oxide (FeNO). Thirty-one preschool children (2.5-5 years) were included in this study. Children with FeNO ! 10 ppb at the first visit received montelukast 4 mg as a first line therapy or an add-on therapy to their baseline treatment (group 1). Therapy was not changed at first visit in children with FeNO < 10 ppb (group 2). Symptom scores, FeNO, lung function (forced oscillation, Rrs8Hz) and airway responsiveness to adenosine 5 0 -monophosphate (AMP) were assessed at visits 1 and 2 eight weeks apart. There was a significant decrease in FeNO (median [interquartile range]; 12.9 [3.7] vs. 7.6 [6.85] ppb, P ¼ 0.011), Rrs8Hz (mean AE SD; 10.03 AE 3.1 vs. 8.72 AE 2.43 hPa.s/L; P ¼ 0.047) and symptom scores (2[2] vs. 1.5[2], P ¼ 0.034) and a significant increase in the provocative AMP dose (2.65 AE 2.1 vs. 4.54 AE 1.05; P ¼ 0.015) in group 1 but not in group 2. First line or add-on treatment of oral montelukast in preschool children with mild to moderate asthma and elevated FeNO, decreased levels of FeNO, improved airway responsiveness to AMP, lung function and symptom scores.Group 1: children with FeNO levels !10 ppb; Group 2: children with FeNO levels <10 ppb. 1 Mean AE standard deviation. 2 Chi-square. ICS, inhaled cortico-steroids.

Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation

“…Elevated FeNO predicted decline in lung function in infants with recurrent wheezing, and the risk of future wheezing in both healthy neonates and wheezy infants [125,126]. FeNO does not seem to correlate well with lung function in early childhood, but it does correlate with BHR [127,128].…”

Diagnosis and management of early asthma in preschool-aged children

“…66 Initiation of openlabel montelukast in preschool-aged children with persistent asthma and fraction of exhaled nitric oxide levels of 10 ppb or greater was associated with a significant decrease in fraction of exhaled nitric oxide levels, along with improvements in BHR to adenosine, lung function (by means of forced oscillation), and symptom scores over an 8-week period. 67 Finally, in recognition that the risk of asthma exacerbations increases significantly in September, a trial of the addition of montelukast or placebo to usual asthma therapy from September 1 to October 15 demonstrated significant reductions in days with worse asthma symptoms (53% less) and unscheduled physician's office visits (78% less) among the montelukast group. 68 In contrast, Weiss et al 69 did not demonstrate an improvement when montelukast was added to standard therapy just before return to school in children 6 to 14 years of age.…”

Bronchiale Provokation im Kindes- und Jugendalter

“…Mehrere Stu dien zeigten eine Korrelation zwischen der AMPProvokationDosis und dem ex halierten Stickstoffmonoxid [16].…”

“…In verschiedenen Studien konnten jedoch gute Erfahrungen mit der Sicherheit und Effektivität des Präparats im bronchialen Provokationstest gesam melt werden [16,25].…”