Leukotriene receptor antagonists: Efficacy and safety in children with asthma

Becker, Allan B.

doi:10.1002/1099-0496(200008)30:2<183::aid-ppul17>3.0.co;2-m

Cited by 17 publications

(5 citation statements)

References 23 publications

(18 reference statements)

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“…37 Asthma symptoms improve after administration of a cysLT receptor antagonist. 38 Thus the reason for SHS worsening these diseases may also be due to a ''double hit'' of cysLTs.…”

Section: Discussionmentioning

confidence: 99%

Effect of secondhand cigarette smoke, RSV bronchiolitis and parental asthma on urinary cysteinyl LTE4

Kott

Salt

McDonald

et al. 2008

Pediatric Pulmonology

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Cysteinyl leukotrienes promote airway inflammation, bronchoconstriction and mucus hypersecretion. Cigarette smoking and respiratory syncytial virus (RSV) bronchiolitis are known to increase urinary cysteinyl leukotriene E4 (uLTE4), the end product of the cysteinyl leukotriene biosynthetic pathway. We tested the following hypotheses: (1) Secondhand smoke (SHS) exposure increases uLTE4 in well infants and in those hospitalized for RSV bronchiolitis; (2) Length of hospital stay for those with RSV bronchiolitis correlates with uLTE4; and (3) Infants with parent(s) with asthma will have higher uLTE4. Parental asthma for infants hospitalized with RSV bronchiolitis (n = 79) and Well babies (n = 31) was determined by questionnaire. Urine was analyzed for LTE4, cotinine, and creatinine. SHS exposure was determined by cotinine to creatinine ratio. Chi square, or t-tests were used to determine significant differences between two groups. A three-way analysis of variance compared the effects of SHS exposure and parental asthma on uLTE4 in Well versus RSV babies. Independent variables predicting length of hospital stay were determined by stepwise multiple regression. High SHS exposure and RSV significantly increased uLTE4. The SHS induced increase in uLTE4 was seen in infants with no parental asthma but not in those with parental asthma. Length of hospital stay positively correlated with uLTE4. We concluded that SHS exposure may increase the severity of bronchiolitis in RSV-infected infants by enhancing production of cysLTs in infants with no parental asthma.

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“…37 Asthma symptoms improve after administration of a cysLT receptor antagonist. 38 Thus the reason for SHS worsening these diseases may also be due to a ''double hit'' of cysLTs.…”

Section: Discussionmentioning

confidence: 99%

Effect of secondhand cigarette smoke, RSV bronchiolitis and parental asthma on urinary cysteinyl LTE4

Kott

Salt

McDonald

et al. 2008

Pediatric Pulmonology

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“…Improvement in airway hyperresponsiveness and overall asthma control were both clearly evident for the group randomized to scheduled budesonide. Since that time, leukotriene receptor antagonists (LTRAs) have documented efficacy as asthma controller therapy in both pediatric and adult populations(15-19). …”

Section: Introductionmentioning

confidence: 99%

Phenotypic predictors of long-term response to inhaled corticosteroid and leukotriene modifier therapies in pediatric asthma

Knuffman

Sorkness

Lemanske

et al. 2009

Journal of Allergy and Clinical Immunology

104

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Background In children with mild-moderate persistent asthma, identification of phenotypic predictors to guide selection of a controller regimen is essential. Objective Identify phenotypic characteristics retaining predictive value for the difference in treatment responses between twice daily fluticasone and once-daily montelukast. Methods Data from the Pediatric Asthma Controller Trial (PACT) were assessed with multivariate analysis. Outcomes included the change in asthma control days (ACDs), FEV1, peak expiratory flow and time to first asthma exacerbation measured over a one-year treatment period. Results The mean age was 9.6 +/- 2.1 years, 60% were male, 50% had a parental history of asthma and 78% had positive aeroallergen skin prick tests. The mean %-predicted pre-bronchodilator FEV1 was 97.8 +/-12.9, median PC20 was 0.93 mg/ml and median exhaled nitric oxide (eNO) was 25.2 ppb. A history of parental asthma best predicted the expected treatment benefit with fluticasone compared to montelukast in terms of gain in ACDs (adjusted p=0.02) and time to first exacerbation (adjusted p=0.05). Elevated baseline eNO predicted the differential treatment response for fluticasone regarding the gain in ACDs (adjusted p=0.01). Prior inhaled corticosteroid (ICS) use (adjusted p=0.01) and low PC20 (adjusted p=0.03) each predicted the expected treatment benefit with fluticasone over montelukast regarding time to first exacerbation. No phenotypic characteristics predicted treatment benefits for montelukast over fluticasone for either outcome. Conclusions Physicians treating children with parental history of asthma, elevated eNO, low PC20, or history of ICS use can expect the best long-term outcomes with ICS therapy, as compared to treatment with leukotriene receptor antagonists.

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“…The leukotriene receptor antagonists appear to be well tolerated in children even with daily use for up to 6 months. [77] The leukotriene receptor antagonist montelukast has been studied for the treatment of exercise-induced bronchoconstriction in patients with mild asthma and EIA in a randomized controlled trial. [78] The study included participants ≥15 years of age, with a median age in the active and placebo arm of 25 years.…”

Section: Leukotriene Modifiersmentioning

confidence: 99%

Exercise-Induced Asthma in Children

Massie

2002

Pediatric Drugs

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Exercise-induced asthma (EIA) is a relatively common problem in children, but may not be recognized because children either do not report their symptoms, or avoid activities that cause it. Clarifying the diagnosis of EIA, in particular separating EIA from other causes of exertional dyspnea, is essential. Treating EIA in children is challenging because of the nature of their physical activities, which are often not planned, and may be prolonged. Keeping children active is an important goal to ensure healthy physical and social development. Many children with EIA are well managed with an inhaled short-acting beta(2)-adrenoceptor agonist before exercise or if symptoms develop. The approach to more troublesome EIA depends on whether the child has persistent asthma and requires better prevention, or the EIA is an isolated clinical problem. The options for treatment also depend on the timing, frequency, and duration of activity that induces EIA. Options include the addition of a cromone, a leukotriene modifier, an inhaled corticosteroid, or switching to use a long-acting beta(2)-adrenoceptor agonist. The use of warm-up exercises has been shown to be helpful by using the refractory period but is not practical for most children with EIA. A final consideration for successful management of EIA in children is that the delivery of medication needs to be age-appropriate.

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Leukotriene receptor antagonists: Efficacy and safety in children with asthma

Cited by 17 publications

References 23 publications

Effect of secondhand cigarette smoke, RSV bronchiolitis and parental asthma on urinary cysteinyl LTE4

Effect of secondhand cigarette smoke, RSV bronchiolitis and parental asthma on urinary cysteinyl LTE4

Phenotypic predictors of long-term response to inhaled corticosteroid and leukotriene modifier therapies in pediatric asthma

Exercise-Induced Asthma in Children

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