Buchvald Frederik, Bisgaard Hans
Department of Pediatrics, Rigshospitalet, National University Hospital, Copenhagen, Denmark.
Ann Allergy Asthma Immunol. 2003 Sep;91(3):309-13. doi: 10.1016/S1081-1206(10)63536-3.
Inhaled, long-acting beta2-agonists or antileukotrienes are alternatives as add-on therapy for asthmatic children taking regular inhaled steroids. Any complementary effects would be relevant to the choice between these alternatives. Exhaled nitric oxide (FeNO) may reflect these effects.
To compare the control of FeNO provided by salmeterol or montelukast add-on therapy in asthmatic children undergoing regular maintenance treatment with a daily dose of 400 microg of budesonide.
The study included children with increased FeNO despite regular treatment with budesonide, 400 microg/d, and normal lung function. Montelukast, 5 mg/d, salmeterol, 50 microg twice daily, or placebo was compared as add-on therapy to budesonide, 400 microg, in a randomized, double-blind, double-dummy, crossover study.
Twenty-two children completed the trial. The geometric mean FeNO level was 20 ppb (95% confidence interval [CI], 15-27 ppb) after salmeterol, which was significantly higher than after montelukast (mean, 15 ppb; 95% CI, 11-18 ppb; P = 0.002) and placebo (mean, 15 ppb; 95% CI, 10-21 ppb; P = 0.03). There was no difference in FeNO between the montelukast and placebo groups. Mean forced expiratory volume in 1 second (FEV1) was significantly increased after salmeterol (mean, 2.63 L; 95% CI, 2.34-2.91 L) compared with placebo (mean, 2.48 L; 95% CI, 2.19-2.77 L). Montelukast (mean, 2.57 L; 95% CI, 2.33-2.80 L) was no different than placebo.
The FeNO levels were significantly higher after salmeterol add-on treatment compared with both placebo and montelukast add-on treatment. Salmeterol significantly improved lung function (FEV1) compared with placebo and nonsignificantly compared with montelukast. Montelukast failed to reduce FeNO and improve lung function compared with placebo in this group of children taking regular budesonide, 400 microg.
对于正在接受常规吸入性糖皮质激素治疗的哮喘儿童，吸入长效β2受体激动剂或白三烯拮抗剂可作为附加治疗的选择。任何协同效应都与这些选择之间的抉择相关。呼出一氧化氮（FeNO）可能反映这些效应。
比较沙美特罗或孟鲁司特附加治疗对每日接受400微克布地奈德常规维持治疗的哮喘儿童FeNO的控制情况。
该研究纳入了尽管每日接受400微克布地奈德常规治疗但FeNO仍升高且肺功能正常的儿童。在一项随机、双盲、双模拟、交叉研究中，将孟鲁司特（5毫克/天）、沙美特罗（50微克，每日两次）或安慰剂作为400微克布地奈德的附加治疗进行比较。
22名儿童完成了试验。沙美特罗治疗后FeNO的几何平均水平为20 ppb（95%置信区间[CI]，15 - 27 ppb），显著高于孟鲁司特治疗后（均值，15 ppb；95% CI，11 - 18 ppb；P = 0.002）和安慰剂治疗后（均值，15 ppb；95% CI，10 - 21 ppb；P = 0.03）。孟鲁司特组和安慰剂组之间的FeNO无差异。与安慰剂（均值，2.48升；95% CI，2.19 - 2.77升）相比，沙美特罗治疗后第1秒用力呼气容积（FEV1）显著增加（均值，2.63升；95% CI，2.34 - 2.91升）。孟鲁司特（均值，2.57升；95% CI，2.33 - 2.80升）与安慰剂无差异。
与安慰剂和孟鲁司特附加治疗相比，沙美特罗附加治疗后的FeNO水平显著更高。与安慰剂相比，沙美特罗显著改善了肺功能（FEV1），与孟鲁司特相比改善不显著。在这组每日接受400微克布地奈德治疗的儿童中，与安慰剂相比，孟鲁司特未能降低FeNO水平及改善肺功能。
