Montuschi Paolo, Mondino Chiara, Koch Pierluigi, Ciabattoni Giovanni, Barnes Peter J, Baviera Giuseppe
Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168 Rome, Italy.
Chest. 2007 Dec;132(6):1876-81. doi: 10.1378/chest.07-1587.
Leukotriene receptor antagonists (LTRAs) reduce fractional exhaled nitric oxide (Feno) concentrations in children with asthma, but the effect of LTRA withdrawal on Feno and lung function is unknown. We aimed to study the effect of treatment and withdrawal of montelukast, a LTRA, on airway inflammation as reflected by Feno and lung function in children with asthma.
A double-blind, randomized, placebo controlled, parallel group study was undertaken in 14 atopic children with mild persistent asthma who were treated with oral montelukast (5 mg/d for 4 weeks) and 12 atopic children with mild persistent asthma who received matching placebo. A follow-up visit was performed 2 weeks after montelukast or placebo withdrawal.
Montelukast reduced Feno concentrations by 17% (p = 0.067), an effect that was more pronounced (35%) [p = 0.0029] when children with seasonal atopy who were exposed to relevant allergens during the treatment phase were excluded from analysis (n = 3). Compared to those at the end of treatment, Feno concentrations were increased 2 weeks after montelukast withdrawal (p = 0.023) concomitant with a reduction in absolute FEV(1) values (p = 0.011), FEV(1) percentage of predicted values (p = 0.006), FEV(1)/FVC ratio (p = 0.002), and forced expiratory flow at 25% to 75% of FVC values (p = 0.021). These changes were not observed in the placebo group.
LTRAs reduce Feno concentrations in children with asthma, and withdrawal can result in increased Feno values and worsening of lung function in children with asthma.
白三烯受体拮抗剂（LTRA）可降低哮喘儿童的呼出一氧化氮分数（Feno）浓度，但停用LTRA对Feno和肺功能的影响尚不清楚。我们旨在研究孟鲁司特（一种LTRA）的治疗和停药对哮喘儿童气道炎症（以Feno和肺功能反映）的影响。
对14名患有轻度持续性哮喘的特应性儿童进行口服孟鲁司特（5mg/d，共4周）治疗，并对12名患有轻度持续性哮喘的特应性儿童给予匹配的安慰剂，进行一项双盲、随机、安慰剂对照、平行组研究。在停用孟鲁司特或安慰剂2周后进行随访。
孟鲁司特使Feno浓度降低了17%（p = 0.067），当排除在治疗阶段接触相关过敏原的季节性特应性儿童（n = 3）后，这一效果更为显著（35%）[p = 0.0029]。与治疗结束时相比，停用孟鲁司特2周后Feno浓度升高（p = 0.023），同时绝对第一秒用力呼气容积（FEV(1)）值降低（p = 0.011）、预测值的FEV(1)百分比降低（p = 0.006）、FEV(1)/用力肺活量（FVC）比值降低（p = 0.002）以及FVC值25%至75%时的用力呼气流量降低（p = 0.021）。安慰剂组未观察到这些变化。
LTRA可降低哮喘儿童的Feno浓度，停药可导致哮喘儿童Feno值升高和肺功能恶化。
