Berkman Neville, Avital Avraham, Bardach Elat, Springer Chaim, Breuer Raphael, Godfrey Simon
Institute of Pulmonology, Hadassah University Hospital, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Isr Med Assoc J. 2003 Nov;5(11):778-81.
Leukotriene antagonist therapy in asthmatic patients alleviates symptoms and improves exercise tolerance, however the effect of these drugs on bronchial provocation tests and exhaled nitric oxide levels are less clearly established.
To determine the effect of montelukast treatment on airway hyperresponsiveness to exercise, methacholine and adenosine-5'-monophosphate and on exhaled nitric oxide levels in steroid-naive asthmatics.
Following a 2 week run-in period, 20 mild to moderate asthmatics were enrolled in an open label 6 week trial of oral montelukast-sodium therapy. Bronchial hyperreactivity (exercise, methacholine and adenosine-5'-monophosphate challenges) and exhaled nitric oxide levels were measured before and after the 6 week period.
Montelukast treatment resulted in a significant improvement in exercise tolerance: median delta FEV1 20.0% (range 0-50) prior to treatment vs. 15.0% (range 0-50) post-treatment (P = 0.029). A significant difference was also observed for exhaled NO following therapy: median NO 16.0 ppb (range 7-41) vs. 13.0 (range 4.8-26) (P = 0.016). No change was seen in baseline lung function tests (FEV1, MEF50) or in the bronchial responsiveness (PC20) for methacholine and adenosine-5'-monophosphate.
This study demonstrates that the leukotriene antagonist montelukast-sodium reduces bronchial hyperreactivity in response to exercise and reduces exhaled nitric oxide levels but has little effect on bronchial responsiveness to methacholine and adenosine challenges.
白三烯拮抗剂疗法可缓解哮喘患者的症状并提高运动耐量，然而这些药物对支气管激发试验和呼出气一氧化氮水平的影响尚不太明确。
确定孟鲁司特治疗对初治哮喘患者气道对运动、乙酰甲胆碱和5'-单磷酸腺苷的高反应性以及呼出气一氧化氮水平的影响。
在为期2周的导入期后，20名轻度至中度哮喘患者参加了一项为期6周的口服孟鲁司特钠疗法的开放标签试验。在6周前后测量支气管高反应性（运动、乙酰甲胆碱和5'-单磷酸腺苷激发试验）和呼出气一氧化氮水平。
孟鲁司特治疗使运动耐量有显著改善：治疗前FEV1变化中位数为20.0%（范围0 - 50），治疗后为15.0%（范围0 - 50）（P = 0.029）。治疗后呼出气一氧化氮也有显著差异：一氧化氮中位数为16.0 ppb（范围7 - 41），治疗后为13.0（范围4.8 - 26）（P = 0.016）。乙酰甲胆碱和5'-单磷酸腺苷的基线肺功能测试（FEV1、MEF50）或支气管反应性（PC20）未见变化。
本研究表明，白三烯拮抗剂孟鲁司特钠可降低运动引起的支气管高反应性并降低呼出气一氧化氮水平，但对支气管对乙酰甲胆碱和腺苷激发试验的反应性影响不大。
