Predicting short term response to anti-inflammatory therapy in young children with asthma.

Abstract

BACKGROUND:

Currently available anti-inflammatory treatment for young children with asthma includes inhaled corticosteroids (ICS) and the leukotriene receptor antagonist (LTRA) montelukast.

OBJECTIVE:

To evaluate potential biomarkers of predicting short-term (6-week) response to ICS and LTRAs in children with asthma.

METHODS:

A total of 102 children aged 4 to 7 years with episodic asthma were enrolled in an open labelled single-centre study. Biomarkers and asthma characteristics were evaluated as predictors of treatment. Of 102 patients 45 became symptomatic during observation and were randomised to treatment either to montelukast or fluticasone for 6 weeks.

RESULTS:

Forced Expiratory Volume in one second (FEV1) increased with both treatments: FEV1 at randomisation was 90.2% and after therapy 106.8% with fluticasone vs. 90.8% and 103.7% for montelukast, respectively, showing that montelukast and fluticasone were equally effective in this age group (p = 0.44). Strong correlations to a favourable treatment response were pre-bronchodilatory FEV1 (p < 0.001) and airway reversibility (p = 0.04) at time of randomisation. None of the other biomarkers (methacholine testing, exhaled nitric oxide [eNO], presence of allergy, total Immunoglobulin E [IgE], cumulative specific IgE, eosinophils and parental smoking) were predictive.

CONCLUSION:

Despite the small sample size and the open-label design, the study suggests that the use of pre-bronchodilatory FEV1 and airway reversibility appears to be a good indicator of short-term anti-inflammatory therapy in young children with asthma.

• Authors: Stefan Zielen, Martin Christmann, Magdalena Kloska, Gülben Dogan-Yildiz, Adrian Lieb, Martin Rosewich, Ralf Schubert, Markus A Rose, Johannes Schulze
• Journal: Current medical research and opinion (Curr Med Res Opin) Vol. 26 Issue 2 Pg. 483-92 (Feb 2010) ISSN: 1473-4877 [Electronic] England
• PMID: 20001651 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Acetates
• Androstadienes
• Anti-Asthmatic Agents
• Anti-Inflammatory Agents
• Biomarkers, Pharmacological
• Cyclopropanes
• Quinolines
• Sulfides
• Fluticasone
• montelukast

Topics

• Acetates (therapeutic use)
• Algorithms
• Androstadienes (therapeutic use)
• Anti-Asthmatic Agents (therapeutic use)
• Anti-Inflammatory Agents (therapeutic use)
• Asthma (diagnosis, drug therapy)
• Biomarkers, Pharmacological (analysis)
• Breath Tests
• Child
• Child, Preschool
• Cyclopropanes
• Female
• Fluticasone
• Humans
• Male
• Prognosis
• Quinolines (therapeutic use)
• Sulfides
• Time Factors
• Treatment Outcome