Airway mechanics after withdrawal of a leukotriene receptor antagonist in children with mild persistent asthma: Double-blind, randomized, cross-over study.

Abstract

BACKGROUND:

To determine the response of airway mechanics and the changes in asthma symptoms to stepping down of leukotriene receptor antagonist (LTRA) therapy.

METHODS:

Thirty children (mean age: 7.1 years) with mild, well-controlled, and persistent asthma who took LTRA as maintenance treatment were randomized into a double-blind, placebo-controlled, cross-over study. Each group received an LTRA (montelukast) or placebo daily for 2 weeks, followed by a 1-week washout period, and then the alternate treatment for 2 weeks. Spirometry and impulse oscillation system (IOS) measurements before and after four puffs of salbutamol inhalation, fractional exhaled nitric oxide (FeNO), and the childhood asthma control test (C-ACT) were evaluated at baseline, the end of placebo treatment, and the end of LTRA treatment.

RESULTS:

Changes of FEV1 /FVC (p = .113) and FEV1 (p = .109) from baseline to posttreatment did not differ significantly between the placebo and montelukast groups. In the placebo group, prebronchodilator (pre-) FEV1 /FVC was decreased (83% vs. 86%) and bronchodilator response (BDR) in FEV1 was diminished (10.7% vs. 6.4%) at posttreatment compared with baseline. However, the montelukast group had no significant changes in pre-FEV1 /FVC (p = .865) and BDR in FEV1 (p = .461). In addition, compared with the montelukast group, the placebo group showed no significant changes in Rrs5 (total airway resistance), Rrs5-20 (peripheral airway resistance), FeNO, and symptoms by the C-ACT.

CONCLUSION:

In children with well-controlled mild persistent asthma, changes in spirometry, IOS, FeNO, and C-ACT results did not differ between the placebo and montelukast groups within 2 weeks.

• Authors: Ju Hee Kim, Shinhae Lee, Youn Ho Shin, Eun Kyo Ha, Seung Won Lee, Mi-Ae Kim, Jung Won Yoon, Hey Sung Baek, Sun-Hee Choi, Man Yong Han
• Journal: Pediatric pulmonology (Pediatr Pulmonol) Vol. 55 Issue 12 Pg. 3279-3286 (12 2020) ISSN: 1099-0496 [Electronic] United States
• PMID: 32965787 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 Wiley Periodicals LLC.

Chemical References

• Acetates
• Anti-Asthmatic Agents
• Bronchodilator Agents
• Cyclopropanes
• Leukotriene Antagonists
• Quinolines
• Sulfides
• Nitric Oxide
• montelukast
• Albuterol

Topics

• Acetates (administration & dosage)
• Administration, Inhalation
• Albuterol (administration & dosage)
• Anti-Asthmatic Agents (administration & dosage)
• Asthma (drug therapy, metabolism, physiopathology)
• Bronchodilator Agents (administration & dosage)
• Child
• Cross-Over Studies
• Cyclopropanes (administration & dosage)
• Double-Blind Method
• Female
• Humans
• Leukotriene Antagonists (administration & dosage)
• Male
• Nitric Oxide (metabolism)
• Quinolines (administration & dosage)
• Spirometry
• Sulfides (administration & dosage)
• Withholding Treatment