Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Respirology. 2010 May;15(4):683-90. doi: 10.1111/j.1440-1843.2010.01740.x. Epub 2010 Mar 16.
Exercise-induced wheeze (EIW) is common. Several treatment options exist. Patients with low fraction of exhaled nitric oxide (F(E)NO) are unlikely to be steroid-responsive and might benefit from non-steroidal therapies. We assessed: the efficacy of cromoglycate, formoterol and montelukast in patients with EIW and low F(E)NO (<35 ppb) in a randomized cross-over trial, and the efficacy of inhaled corticosteroid in a high F(E)NO (>35 ppb) group.
Patients had EIW and airway hyperresponsiveness (AHR) to mannitol and/or exercise. Those with low F(E)NO (n = 19) received cromoglycate (20 mg inh. bd + before challenge tests), formoterol (12 microg inh. bd + before challenge tests) and montelukast (10 mg p.o. od), each for 2 weeks. Those with high F(E)NO (n = 20) took inhaled fluticasone (500 microg) daily for 4 weeks. Primary end-points were: 50% reduction in maximum FEV(1) %fall (clinical protection) and decrease in AHR to mannitol.
In patients with low F(E)NO, cromoglycate, formoterol and montelukast significantly decreased AHR to mannitol in 63%, 61% and 47% of patients, respectively. In this group, the magnitude of exercise-induced bronchoconstriction (EIB) was significantly reduced with montelukast and formoterol; between-treatment differences were not significant. Of 6/19 with low F(E)NO and EIB, protection occurred in 67% (cromoglycate), 83% (formoterol) and 50% (montelukast), respectively. In the high F(E)NO group, AHR to mannitol and EIB decreased significantly with fluticasone (P < 0.001, P = 0.005, respectively), and protection occurred in 7/8 (88%) with EIB.
In patients with EIW and low F(E)NO, the number of 'responders' to cromoglycate, formoterol and montelukast was similar. In a high F(E)NO population the response to inhaled corticosteroid was highly significant and comparable to previous studies.
运动诱发性喘息（EIW）很常见。有几种治疗选择。呼出一氧化氮分数（F（E）NO）低的患者不太可能对类固醇有反应，可能受益于非甾体治疗。我们评估了在一项随机交叉试验中，在 EIW 和低 F（E）NO（<35ppb）的患者中，色甘酸钠、福莫特罗和孟鲁司特的疗效，以及在高 F（E）NO（>35ppb）组中吸入皮质类固醇的疗效。
患者有 EIW 和对甘露醇和/或运动的气道高反应性（AHR）。那些 F（E）NO 低的患者（n=19）接受色甘酸钠（20mg inh.bd+在挑战试验前）、福莫特罗（12μg inh.bd+在挑战试验前）和孟鲁司特（10mg po.od）治疗，各治疗 2 周。那些 F（E）NO 高的患者（n=20）接受每日吸入氟替卡松（500μg）治疗 4 周。主要终点为：最大 FEV（1）%下降的 50%减少（临床保护）和对甘露醇的 AHR 降低。
在 F（E）NO 低的患者中，色甘酸钠、福莫特罗和孟鲁司特分别使 63%、61%和 47%的患者对甘露醇的 AHR 显著降低。在该组中，孟鲁司特和福莫特罗显著减轻运动诱发性支气管痉挛（EIB）的程度；治疗间差异无显著性。在 19 名 F（E）NO 低且有 EIB 的患者中，保护发生在 67%（色甘酸钠）、83%（福莫特罗）和 50%（孟鲁司特）。在 F（E）NO 高的组中，吸入氟替卡松显著降低对甘露醇的 AHR 和 EIB（P<0.001，P=0.005），并且 88%（7/8）有 EIB 的患者发生保护。
在有 EIW 和低 F（E）NO 的患者中，色甘酸钠、福莫特罗和孟鲁司特的“反应者”数量相似。在 F（E）NO 高的人群中，吸入皮质类固醇的反应非常显著，与之前的研究相当。
