| Response profiles to fluticasone and montelukast in mild-to-moderate persistent childhood asthma. | |
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MedLine Citation:
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PMID: 16387583 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Outcome data are needed to base recommendations for controller asthma medication use in school-aged children. OBJECTIVE: We sought to determine intraindividual and interindividual response profiles and predictors of response to an inhaled corticosteroid (ICS) and a leukotriene receptor antagonist (LTRA). METHODS: An ICS, fluticasone propionate (100 mug twice daily), and an LTRA, montelukast (5-10 mg nightly, age dependent), were administered to children ages 6 to 17 years with mild-to-moderate persistent asthma using only as-needed bronchodilators in a multicenter, double-masked, 2-sequence, 16-week crossover trial. Clinical, pulmonary, and inflammatory responses to these controllers were evaluated. RESULTS: Improvements in most clinical asthma control measures occurred with both controllers. However, clinical outcomes (asthma control days [ACDs], the validated Asthma Control Questionnaire, and albuterol use), pulmonary responses (FEV(1)/forced vital capacity, peak expiratory flow variability, morning peak expiratory flow, and measures of impedance), and inflammatory biomarkers (exhaled nitric oxide [eNO]) improved significantly more with fluticasone than with montelukast treatment. eNO was both a predictor of ACDs (P = .011) and a response indicator (P = .003) in discriminating the difference in ACD response between fluticasone and montelukast. CONCLUSIONS: The more favorable clinical, pulmonary, and inflammatory responses to an ICS than to an LTRA provide pediatric-based group evidence to support ICSs as the preferred first-line therapy for mild-to-moderate persistent asthma in children. eNO, as a predictor of response, might help to identify individual children not receiving controller medication who achieve a greater improvement in ACDs with an ICS compared with an LTRA. |
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Authors:
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Robert S Zeiger; Stanley J Szefler; Brenda R Phillips; Michael Schatz; Fernando D Martinez; Vernon M Chinchilli; Robert F Lemanske; Robert C Strunk; Gary Larsen; Joseph D Spahn; Leonard B Bacharier; Gordon R Bloomberg; Theresa W Guilbert; Gregory Heldt; Wayne J Morgan; Mark H Moss; Christine A Sorkness; Lynn M Taussig; |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of allergy and clinical immunology Volume: 117 ISSN: 0091-6749 ISO Abbreviation: J. Allergy Clin. Immunol. Publication Date: 2006 Jan |
Date Detail:
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Created Date: 2006-01-02 Completed Date: 2006-02-09 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 1275002 Medline TA: J Allergy Clin Immunol Country: United States |
Other Details:
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Languages: eng Pagination: 45-52 Citation Subset: AIM; IM |
Affiliation:
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Department of Pediatrics, University of California-San Diego, San Diego, CA 92111, USA. robert.s.zeiger@kp.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acetates
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therapeutic use* Adolescent Androstadienes / therapeutic use* Asthma / drug therapy*, physiopathology Child Cross-Over Studies Double-Blind Method Female Forced Expiratory Volume / drug effects Humans Leukotriene Antagonists / therapeutic use* Male Nitric Oxide / analysis Quinolines / therapeutic use* |
| Grant Support | |
ID/Acronym/Agency:
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5U10HL064287/HL/NHLBI NIH HHS; 5U10HL064288/HL/NHLBI NIH HHS; 5U10HL064295/HL/NHLBI NIH HHS; 5U10HL064305/HL/NHLBI NIH HHS; 5U10HL064307/HL/NHLBI NIH HHS; 5U10HL064313/HL/NHLBI NIH HHS; M01RR00036/RR/NCRR NIH HHS; M01RR00051/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Acetates; 0/Androstadienes; 0/Leukotriene Antagonists; 0/Quinolines; 10102-43-9/Nitric Oxide; 158966-92-8/montelukast; 90566-53-3/fluticasone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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