Response profiles to fluticasone and montelukast in mild-to-moderate persistent childhood asthma
Response profiles to fluticasone and montelukast in mild-to-moderate persistent childhood asthma
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DOI：
10.1016/j.jaci.2005.10.012
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发表时间：
2006-01-01
影响因子：
14.2
通讯作者：
Taussig, LM
中科院分区：
文献类型：
--
作者：
Zeiger, RS;Szefler, SJ;Taussig, LM
背景：需要结果数据作为学龄儿童控制哮喘药物使用建议的基础。目的：我们试图确定吸入皮质类固醇 (ICS) 和白三烯受体拮抗剂 (LTRA) 的个体内和个体间反应概况和预测因子。方法：ICS、丙酸氟替卡松（100 微克，每天两次）和 LTRA、孟鲁司特（每晚 5-10 毫克，年龄）在一项多中心、双盲、2个序列、为期16周的交叉试验中，仅根据需要使用支气管扩张剂，对6至17岁患有轻度至中度持续性哮喘的儿童进行治疗。临床。对这些控制器的肺部反应和炎症反应进行了评估。结果：两种控制器的大多数临床哮喘控制措施均得到改善。然而，与孟鲁司特治疗相比，氟替卡松治疗的临床结果（哮喘控制天数 [ACD]、经过验证的哮喘控制问卷和沙丁胺醇的使用）、肺部反应（FEV1/用力肺活量、峰值呼气流量变异性、早晨峰值呼气流量和阻抗测量）和炎症生物标志物（呼出一氧化氮 [eNO]）的改善显着更多。 eNO 既是 ACD 的预测因子 (P = .011)，又是区分氟替卡松和孟鲁司特之间 ACD 反应差异的反应指标 (P = .003)。结论：ICS 比 LTRA 更有利的临床、肺部和炎症反应提供了基于儿科的团体证据，支持 ICS 作为儿童轻至中度持续性哮喘的首选一线治疗。 eNO 作为反应的预测因子，可能有助于识别未接受控制药物的个别儿童，与 LTRA 相比，ICS 使 ACD 获得更大改善。
Background: Outcome data are needed to base recommendations for controller asthma medication use in school-aged children.Objective: We sought to determine intraindividual and interindividual response profiles and predictors of response to an inhaled corticosteroid (ICS) and a leukotriene receptor antagonist (LTRA).Methods: An ICS, fluticasone propionate (100 mu g 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.Results: 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 (FEV1/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.Conclusions: 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.