Spirometry-Adjusted Fraction of Exhaled Nitric Oxide Allows Asthma Diagnosis in Children, Adolescents, and Young Adults.

BACKGROUND: Recently, it has been proved that fractional exhaled nitric oxide (FENO) results are in disagreement with other measurements of asthma control. The objective of this work is to present and validate new lung function/lung inflammation ratios. METHODS: This is a retrospective, cross-sectional study in which we evaluated data from medical documentation of 1,529 pediatric and adolescent subjects and a small number (2% of the studied population) of young adults, who presented symptoms suggestive of asthma (age range 4-24 y). We are the first to analyze results obtained in this manner (before the introduction of controlled medication): FENO, spirometry, specific resistance of the airways, diagnosis of allergic diseases, and allergen sensitization (specific immunoglobulin E results). RESULTS: Cut-off points for the new indicators allowed us to diagnose asthma in the study participants: for FVC/FENO ratio, 0.17 L/ppb; for FEV1/FENO ratio, 0.15 L/ppb; for forced expiratory flow during the middle half of the FVC maneuver (FEF25-75%)/FENO ratio, 0.16 L/s/ppb; for FENO/FVC ratio, 11.00 ppb/L; for FENO/FEV1 ratio, 12.53 ppb/L; and for FENO/FEF25-75% ratio, 11.81 ppb/L/s. Only the ratios described above were closely correlated with the diagnosis of asthma and with one another. They significantly differed between subjects with asthma and healthy subjects as well as between females and males. Only FEF25-75%/FENO and FENO/FEF25-75% values were significant predictors of any sensitization in the studied subjects. We found higher sensitivity than specificity and higher positive predictive value than negative predictive value for FVC/FENO, FEV1/FENO, and FEF25-75%/FENO and found a mirror image for reverse parameters. However, the positive predictive values and negative predictive values were not clearly convincing with respect to diagnostic accuracy in the case of the new parameters proposed. CONCLUSIONS: We propose new lung function/lung inflammation ratios by which it may become possible to diagnose asthma in children and adolescents on the basis of a subject's spirometry and FENO measurements. We believe that our ratios are only supportive of the universally used parameters in the process of diagnosing asthma. (ClinicalTrials.gov registration NCT01805635.).

The role of zinc, copper, plasma glutathione peroxidase enzyme, and vitamins in the development of allergic diseases in early childhood: The Polish mother and child cohort study.

It has been hypothesized that the increase in allergic disorders may, in part, be a consequence of changing diet. The primary aim of this study was to assess the associations between occurrence of atopic dermatitis; food allergy; the incidence of wheeze inhaled glucocorticosteroid use in children during the 1st year of life; and cord blood concentrations of copper, zinc, vitamins (A and E), and glutathione peroxidase activity. We evaluated 240 1-year-old children from the Polish Mother and Child Cohort Study. Women were interviewed during pregnancy to collect demographic and socioeconomic data and medical and reproductive history. Exposure to tobacco constituents was assessed based on questionnaire data. At delivery, umbilical cord blood plasma was sampled. One year after the birth, the child's exposure and health status were examined. In the analyses a multivariable model was used. Higher zinc and copper concentrations in cord blood were associated with increased likelihood of wheezing in 1-year-old children. This effect was seen only among children exposed to tobacco smoke at home. We also showed significantly lower activity of glutathione peroxidase enzyme 3 in umbilical cord blood plasma of children with atopic dermatitis during the 1st year of life. There were no significant associations between vitamin A and E concentrations in plasma and children's health. We showed imbalance in the antioxidant defense system in cord blood, which may lead to development of atopic dermatitis or wheezing in infancy. The association between maternal nutrient status during pregnancy and child's health is complex and interacts with other environmental factors such as tobacco exposure. This study was a part of the clinical trial NCT01861548 registered at ClinicalTrials.gov.

The patents on glucocorticosteroids and selected new therapies for the management of asthma in children: update.

Despite the continuous increase in the prevalence of asthma in many developing countries, there have been major advances in understanding and managing this disease. The remarkable role of inflammation in asthma is well known. Current asthma guidelines recommend the use of anti-inflammatory drugs and immunotherapy for long-term management of asthma. The management of asthma in children is a challenge because of their inability to express warning signs and seek medical attention in a timely manner. Unlike adults, asthmatic children must rely on their parents or caregivers for the administration of asthma medications. The inability to carry and self-administer asthma drugs may increase the risk of non-compliance. Glucocorticosteroids, the most important drugs for patients with asthma, are associated with an increased level of side effects and compliance issues mostly in children. In an attempt to solve that dilemma, emphasis is being placed on the modification of current management tactics and the introduction of other drugs. This review presents more recent patents for childhood asthma therapies for the management of asthma in children.

The interpretation of exhaled nitric oxide values in children with asthma depends on the degree of bronchoconstriction and the levels of asthma severity.

BACKGROUND: The clinical implications of fractional exhaled nitric oxide (F(ENO)) measurements in childhood asthma are unclear. We aimed to evaluate the relationship between the level of exhaled nitric oxide and pre-bronchodilator FEV1 and the change in FEV1 after bronchodilator in children with asthma. METHODS: This was a retrospective, cross-sectional study. We evaluated data from medical documentation of children with asthma with special attention to F(ENO) results, asthma severity, FEV1 (% predicted), and bronchial reversibility test. RESULTS: Four hundred and five subjects (age 6-18 y) completed the study. Median levels of F(ENO) increased linearly with subjects' age (P = .03). We found a nonlinear trend of pre-bronchodilator FEV1 across 4 quartiles of F(ENO) in episodic and mild asthma; we observed lower pre-bronchodilator FEV1 in children with higher F(ENO), but only up to the F(ENO) value of 35.4 ppb; in children with F(ENO) value > 35.4 ppb, pre-bronchodilator FEV1 was increased. We found a linear increasing trend of change from baseline (after 400 µg of salbutamol) in FEV1 across F(ENO) categories in children with moderate asthma. CONCLUSIONS: Our results suggest a need to measure F(ENO) before as well as after spirometry. Consequently, in children with asthma with bronchial obstruction, we suggest assessing F(ENO) after short-acting ß2 agonists as well. (ClinicalTrials.gov registration NCT00815984.).

Diagnostic value of lung function parameters and FeNO for asthma in schoolchildren in large, real-life population.

BACKGROUND AND OBJECTIVE: To establish a diagnostic value of fractional exhaled nitric oxide (FeNO), interrupter resistance measurement (Rint), specific resistance of the airways (sRaw), spirometric parameters in asthma diagnosis in schoolchildren. METHODS: It was a retrospective, cross-sectional study. We evaluated data from medical documentation of 6,439 children (aged 6-18) with symptoms suggestive of asthma, who attended our Pediatric Allergic Outpatient Clinic. Medical documentation of the patients was analyzed with special attention to the first ever obtained results (before the introduction of controller medication) of: FeNO, Rint, sRaw, spirometry, diagnoses of allergic diseases, and allergen sensitization (specific IgE results). RESULTS: We included 3,612 children in the analysis. Older age, male gender, the presence of allergic rhinitis, sensitization to perennial and seasonal allergens, higher FeNO and Rint, and FEV1 /FVC <80% were significantly associated with asthma. We observed a significant association between FeNO and Rint in the prediction of asthma diagnosis. Optimal cutoff points to differentiate asthmatics from non-asthmatics were established. Thus, Rint >175.4% was defined as asthma-predicting Rint, and FeNO >15.8 ppb was defined as asthma-predicting FeNO. In all study subgroups, sensitivity for asthma-predicting Rint was significantly higher than for asthma-predicting FeNO with an inverse trend in specificity value. CONCLUSION: Our results suggest that asthma-predicting Rint and, to a lesser extent, asthma-predicting FeNO, defined in the present study, could serve as a reliable tool to exclude asthma in schoolchildren. However, our results also indicate a clinically important fact that all lung function parameters or FeNO should be interpreted in the context of age, gender, allergy profile, and the presence of co-morbidities in schoolchildren. Pediatr Pulmonol. 2014; 49:632-640. © 2013 Wiley Periodicals, Inc.

Pulmonary resection for bronchial polyp after lung transplant in a cystic fibrosis patient.

Many clinical conditions should be considered in the differential diagnosis of life-threatening events in cystic fibrosis patients after a lung graft transplant. We report on a 17-year-old boy who underwent a lobectomy owing to an inflammatory endobronchial polyp complicated by massive airways bleeding 12 months after having had a bilateral sequential lung graft for cystic fibrosis. This unusual complication underscores the requirement for flexible bronchoscopy in patients with recurrent infection at any stage after transplant. Early diagnosis may prevent life-threatening complications.

Fractional exhaled nitric oxide (FeNO) may predict exercise-induced bronchoconstriction (EIB) in schoolchildren with atopic asthma.

BACKGROUND: There is a need for the performance of exercise-induced bronchoconstriction (EIB) tests in the monitoring of childhood asthma control. We aimed to evaluate whether in children with atopic asthma, EIB can be predicted by one or more of the following parameters or by their combination: fractional exhaled nitric-oxide (FeNO), allergy profile, asthma treatment, total IgE serum concentration and eosinophil blood count (EBC). METHODS: It was a retrospective, cross-sectional study. We evaluated data from medical documentation of children with atopic asthma who had performed standardized spirometric exercise challenge test. RESULTS: One hundred and twenty six patients with atopic asthma, aged 5-18, were included in the analysis. There were two groups of patients: the EIB group (n=54) and the no-EIB group (n=72). The median FeNO level prior to exercise in the EIB group was 27.6 vs. 16.3 ppb in the no-EIB group (p=0.002). FeNO level higher than 16 ppb had the highest diagnostic value to confirm EIB. When using the FeNO level of >16 ppb, the sensitivity, specificity, negative predictive and positive predictive values for EIB were 83%, 46.9%, 74.2%, and 60%, respectively. In the EIB group, the degree of FeNO elevation did correlate positively with the absolute fall in FEV(1) (p=0.002; r=0.45). The FeNO value of >16 ppb, EBC value of >350 cell/mm(3) and allergy to house dust mites presented the highest odds ratios of EIB. However, the FeNO value of >16 ppb was the only independent odds ratio of EIB. CONCLUSIONS: Elevated FeNO level increased the odds of EIB in asthmatic schoolchildren, independently of other asthma severity markers and the intensity of anti-asthma therapy. It seems likely that FeNO measurement may act as a screening tool and help to prevent under-diagnosis and under-treatment of exercise-induced bronchoconstriction in schoolchildren with atopic asthma.

The association between fractional exhaled nitric oxide (FeNO) and cat dander in asthmatic children.

BACKGROUND: The aim of our study was to assess risk factors of increased FeNO in asthmatic children with no cat at home. METHODS: It was a retrospective, cross-sectional study. We evaluated data from medical documentation of children with asthma: FeNO results, allergen sensitization, seasonal allergen exposure, FEV(1), allergic rhinitis (AR) diagnosis and cat presence at home. We assessed asthma severity using mean doses of inhaled glucocorticosteroids and a management approach based on control according to the newest guidelines of Global Initiative for Asthma (GINA) throughout the last three months before the measurement of FeNO and spirometry. RESULTS: 316 patients (age 6-18) completed the study. Sensitization to cat dander was associated with the highest median value of FeNO concentration compared to other allergens in our patients (28,4ppb) and co-existing sensitization did not affect FeNO level. Median levels of FeNO increased linearly with patient's age. In asthmatics with AR, the levels of FeNO were increased significantly compared to asthmatics without AR (20.8 vs. 16.3, respectively). We showed that in patients without AR, sensitization to cat allergen was associated with more severe asthma in comparison to other perennial allergy (step 4 vs. other steps according to GINA treatment steps). The above relation was not observed in patients with AR. We did not observe correlation between allergy profile and FEV(1) among patients in neither subgroup nor in general population. CONCLUSIONS: We revealed that sensitization to cat dander was associated with the highest increase of FeNO concentration compared to other allergens in patients not having any cat at home ever. We also observed that in patients without allergic rhinitis, sensitization to cat allergen, compared to other perennial allergy, was associated with more severe asthma.

Inhaled corticosteroids may have a beneficial effect on bone metabolism in newly diagnosed asthmatic children.

BACKGROUND: The adverse effect of inhaled corticosteroids (ICS) treatment on bone metabolism in children with asthma is still controversial, and a possible beneficial effect of vitamin D added to ICS on bone turnover is uncertain. OBJECTIVE: We conducted a randomized, double-blind, parallel-group, 6-month trial to assess the effects of a medium and high dose of ICS and a high-dose ICS with vitamin D on bone metabolism in children with newly diagnosed atopic asthma. METHODS: 96 children were equally randomized to 4 groups receiving the following doses of inhaled budesonide [µg/day]: 400 (ICS 400 group), 800 (ICS 800 group), 800 with oral vitamin D (ICS 800 with vit D group), and montelukast as a control (control group). Markers of bone production (osteocalcin, alkaline phosphatase) and bone degradation (amino-terminal cross-linked telopeptide of type I collagen--NTx, carboxy-terminal telopeptides of type I collage), and also concentration of 25-hydroxycholecalciferol (25OH D) and calcium-phosphorus balance (calcium, phosphorus, parathormon-PTH) in serum and/or urine were assessed twice: before and after 6 months of treatment. RESULTS: We obtained a significant decrease in phosphorus and PTH serum levels in ICS 400 and ICS 800 with vit D groups compared to control group, and a significant decrease of NTx urine level in ICS 800 with vit D group. CONCLUSIONS: Medium doses of inhaled corticosteroids exert an advantageous effect on bone metabolism in newly diagnosed asthmatic children. Vitamin D together with a high dose of inhaled corticosteroids has a beneficial effect on both calcium-phosphorus balance and collagen turnover.

The patents on glucocorticosteroids and selected new therapies for the management of asthma in children.

Despite the continuous increase in the prevalence of asthma in the most underdeveloped parts of the world, nowadays, we can generally speak of a better understanding and management of this disease. The remarkable role played by the inflammatory process in asthmatic patients is well known. The aim of most asthma guidelines is to suppress inflammatory process with a combination of anti-inflammatory drugs and immunotherapy. The management of asthma in children is a challenge because of their inability to express warning signs and seek medical attention in a timely manner. Unlike adults, asthmatic children must rely on their parents or caregivers for the administration of asthma medications. This inability to carry and self-administer asthma drugs may increase the risk of non-compliance. Glucocorticosteroids, the most important drugs for patients with asthma, are associated with an increased level of side effects and compliance issues mostly in children. In an attempt to solve that dilemma, emphasis is being placed on the modification of current management tactics and the introduction of other drugs. This review presents more recent patent therapies for the management of asthma in children.

Exercise-induced bronchoconstriction in asthmatic children: a comparative systematic review of the available treatment options.

The aim of this article is to critically review the efficacy and safety data from randomized controlled trials (RCTs) using inhaled corticosteroids (ICSs), long- or short-acting beta(2)-adrenoceptor agonists (LABAs, SABAs), parasympatholytics and oral leukotriene receptor antagonists in the management of exercise-induced bronchoconstriction (EIB) in children with persistent asthma (EIA). The studies with sufficient information on patient characteristics and outcomes were chosen using a MEDLINE search. Results from the individual searches were combined and repeated. Studies were also found by reviewing the reference lists of the articles not included in this review. Studies focusing solely on individuals with asthma and other allergic co-morbidities (i.e. a degree of bronchial reversibility) were considered in this review. To make the paper evidence-based, the design and the quality of different studies were assessed employing the Sign criteria (evidence level [EL] and grades of recommendation [GR]). No additional statistical analyses were performed. Most of studies included paediatric patients with underlying EIA. We need to distinguish children with recurrent asthma symptoms in whom EIB is also present (patients with EIA) from asthmatic subjects whose symptoms appear only as a result of exercise (patients with EIB). Further controller treatment is indicated in patients with EIA and further reliever treatment in patients with EIB. ICSs are the first-choice controller drugs for EIA in children with persistent asthma (Sign grade of recommendation [GR]:A). In children with EIA without complete control with ICSs, SABAs (GR:A), leukotriene receptor antagonists (LTRAs) [GR:A] or LABAs (GR:A) may be added to gain control. Treatment with relievers such as SABAs (GR:A), parasympatholytics (GR:B) or, eventually, LABAs (GR:A), administered 10-15 minutes before exercise is the most preferable method of preventing EIB symptoms in children; however, not as monotherapy in children with EIA. The disadvantages and controversy relating to inhaled beta(2)-adrenoceptor agonist use lie in the development of tolerance to their effect when they are used on a regular basis, and the possibility of a resulting underuse of ICSs in patients with EIA. Researchers and guidelines recommend that if any patient requires treatment with a beta(2)-adrenoceptor agonist more than twice weekly, a low dose of ICSs should be administered. Inhaled parasympatholytics may be effective as preventive relievers in some children with EIB or EIA, especially among those with increased vagal activity. LTRAs have a well balanced efficacy-safety profile in preventing the occurrence of EIB symptoms in children. Compared with LABAs, LTRAs produce persistent attenuation of EIB and possess an additional effect with rescue SABA therapy in persistent asthmatic patients with EIA. A disadvantage of LTRAs is a non-response phenomenon. There are still insufficient data on the efficacy-safety profiles of ICS/LABA combination drugs in the treatment of EIA in children to recommend this treatment without caution. Safety profiles of inhaled SABAs, anticholinergics and montelukast in approved dosages seem sufficient enough to recommend use of these drugs in the prevention of EIB symptoms in children. Many researchers agree that treatment of EIA in children should always be individualized.

Tumor necrosis factor inhibitors in pediatric asthma.

Asthma is the most common pulmonary disease in children worldwide. As its prevalence significantly increases from 30% to 50% every 10 years it seems that finding the exact form of treatment is crucial to achieve a long-term-benefit effect. Sometimes it appears hard, especially in case of difficult and severe asthma when a standard therapy is not sufficient. The success of omalizumab inspired further studies which turned the spotlight on other pro-inflammatory cytokines such as TNF-alpha. After the success of anti-TNF-alpha therapy in many other inflammatory diseases such as for instance Crohn's Disease and Rheumatoid Arthritis, there appeared several trials discussing the usage of anti-TNF agents in asthma. The first wave of enthusiasm over positive results in treating asthma patients was blunted by other researches which challenged the benefit of anti-TNF-alpha in asthma. What is more, they warned about serious problems and adverse events related to that kind of treatment. These results hindered further investigation, especially in case of children's population, because of the ambiguity as far as the risks and benefits of the treatment were concerned. Nevertheless, the research on anti-TNF-alpha and asthma underlined a significant polymorphism in asthma phenotypes. It seems likely that a therapy with anti-TNF-alpha should be limited to a small subgroup of patients with a specific phenotype manifested by an increased TNF axis. The purpose of this review article is to discuss some recent patents in anti-TNF-alpha therapy.

Measurement of specific airway resistance decreased the risk of delay in asthma diagnosis in children.

Factors that facilitate the asthma diagnosis in children are still being investigated. We attempted to assess the duration of a delay in asthma diagnosis in children, and we examined the previously identified risk factors of its occurrence together with the pulmonary function test results such as spirometry and specific airway resistance (sR(aw)) and sought to determine how the measurement of sR(aw) contributes to asthma diagnosis in children. This study was a part of the Asthma Prevention Study in Poland, which focused on increasing early detection of asthma in a community-based cohort. Data were collected using a questionnaire during regular doctor visits. Childrens' medical documentation from the time period between birth and the visit was analyzed. Participants with the duration of an undiagnosed asthma above the upper quartile range of this variable were defined as having a delayed asthma diagnosis. The independent risk factors of the delayed asthma diagnosis included the absence of atopy, allergic rhinitis symptoms, asthma/allergy in a family, and living in the single-parent families. The whole-body plethysmography performed simultaneously with the spirometry revealed the underestimation of reversibility of bronchial obstruction in 16.4% of participants. This underestimation of reversibility of bronchial obstruction was the only modifiable, independent risk factor of the delayed asthma diagnosis in children. Measurement of sR(aw) contributes significantly to asthma diagnosis in children at risk of the delayed asthma diagnosis.

Sexual and reproductive health knowledge in cystic fibrosis female patients and their parents.

INTRODUCTION: The changing outcomes for young cystic fibrosis (CF) patients means that reproductive health issues have become an integral part of CF management. AIM: The aim of this study was to investigate the knowledge and experiences of reproductive and sexual health issues in women with CF and to investigate the knowledge and reproductive health attitudes of their parents. MAIN OUTCOME MEASURES: Assessment of reproductive and sexual health knowledge in female CF patients and their parents. METHODS: A questionnaire study directed to 120 Polish women with CF aged 16 years and older and their parents. RESULTS: Sixty-four patients and their parents responded to the questionnaire. Sixty-eight percent of the patients started sexual intercourse at a mean age of 19.2 years. Eighty-four percent of all sexually active women reported that they did not use any form of contraception. Only 32.8% of women understood the problems connected with their own and male fertility in CF. Popular scientific publications and other CF patients were identified as the most important source of information. Only 23% of parents understood the problems connected with female fertility in CF; 44% of parents thought that man with CF had normal fertility. Seventy-five percent of the women and 40% of the parents felt that sexual health discussions should begin between age 12 and 14 years with a CF doctor and the mother. CONCLUSIONS: Our study showed that significant knowledge gaps exist regarding fertility issues in both CF patients and CF parents. Women with CF have some general knowledge about sexual issues but insufficient knowledge to have a safe sexual life. The results helped us to develop the educational program for CF patients.

Antileukotriene treatment in children with asthma--new patents.

Leukotrienes, and especially cysteinyl leukotrienes have been shown to be involved in many processes that play a role in asthma pathophysiology: eosinophil recruitment, the most characteristic processes of asthma pathogenesis, increased mucosal secretion, which impairs the normal process of airway clearance and favors the development of mucus plugs, mucosal edema, caused by increased vascular permeability and bronchoconstriction, leading to smooth muscle hypertrophy. Latest progress in the understanding of chronic asthma pathology events underline the leukotriene synthesis pathway enzymes and different leukotriene receptors as potential targets of asthma treatment in children. Agents inhibiting the production of leukotrienes or agents antagonising their receptor's action, attract attention. Studies on molecular mechanisms of leukotrienes action have led to the development and patents of potential drugs including new 5-lipoxygenase inhibitors, 5-lipoxygenase-activating protein (FLAP) inhibitors, leukotriene B4 receptor antagonists, or nanoparticulate leukotriene receptor antagonist formulations.

Effect of different antiasthmatic treatments on exercise-induced bronchoconstriction in children with asthma.

BACKGROUND: Exercise-induced bronchoconstriction occurs in a large proportion of children with asthma, limiting everyday activities important for their physical and social development. OBJECTIVE: The purpose of this randomized, double-blind, placebo-controlled study was to compare the ability of different patterns of antiasthmatic treatment, recommended in childhood asthma, to protect patients from exercise-induced bronchoconstriction. METHODS: Children 6 to 18 years of age with atopic asthma were randomized to a 4-week, placebo-controlled, double-blind trial. Patients were randomly allocated to receive daily 200 microg budesonide (twice daily, 100 microg per dose) + 9 microg formoterol (twice daily, 4.5 microg per dose; n = 20); 200 microg budesonide + 5 or 10 mg montelukast (once daily at bedtime; n = 20); 5 or 10 mg montelukast (n = 20); 200 microg budesonide (n = 20); or placebo (n = 20). A standardized treadmill exercise challenge was performed before and after treatment. RESULTS: Exercise-induced bronchoconstriction, reflected by area under the curve for the FEV1 values from exercise over the 20-minute period and by maximum percent fall in FEV1 after exercise, was significantly diminished after 4 weeks in all active treatment groups, and compared with placebo. Exercise-induced bronchoconstriction protection improved more significantly in the budesonide + montelukast and montelukast groups compared with other therapeutic options. CONCLUSION: These data indicate differences in effects on exercise-induced bronchoconstriction between therapeutic options recommended in childhood asthma. Control of childhood asthma with exercise-induced bronchoconstriction can be obtained by using regular controller treatment.

A randomized, double-blind trial of the effect of anti-asthma treatment on lung function in children with asthma.

BACKGROUND: Pulmonary function tests (PFTs) and especially spirometry measures are useful tools in evaluating early response to treatment of asthma in children mainly due to their worldwide availability. The aim of our study was to determine the effects of anti-asthma treatment in children, equally on FEV(1), FEF25-75%, R(int) and SR(aw) values. METHODS: Children 6-18 years of age with moderate atopic asthma were randomized to 4-week, placebo-controlled, double-blind trial. Patients were randomly allocated to receive 200 microg budesonide (B) (n=29), 5 or 10 mg (according to age) montelukast (M) (n=29), 200 microg B + 5 or 10 mg M (n=29), 200 microg B + 9 microg formoterol (F) (n=29) or placebo (n=27). FEV(1,) FEF25-75%, R(int), SR(aw) were measured before and after treatment. RESULTS: R(int), SR(aw), FEV(1) improved significantly in all active treatment groups while FEF25-75% improved significantly only in BM group and M group. Combination therapy, showed significantly greater effects on R(int) than monotherapy: BM group compared to B group (P=0.01) and M group (P=0.03) and BF group compared to B group (P=0.01) and M group (P=0.04). CONCLUSION: This study shows that using single parameter for monitoring asthma can be misleading. Using combination of lung function techniques provides better assessment of treatment. Results of our study confirm this hypothesis. The best effect on large and small airways was achieved with combined anti-inflammatory therapy.

Effects of montelukast treatment on clinical and inflammatory variables in patients with cystic fibrosis.

BACKGROUND: In cystic fibrosis (CF), the inflammatory process contributes to progressive lung tissue damage. Cysteinyl leukotrienes have been found in the sputum of patients with CF at high concentrations sufficient to cause potent biological effects. OBJECTIVE: To evaluate the effect of anti-inflammatory treatment with montelukast sodium in patients with CF. METHODS: Twenty-six patients aged 6 to 18 years were recruited to this 20-week, randomized, double-blind, placebo-controlled, crossover trial. Patients received montelukast or placebo for 8 weeks in addition to their regular CF treatment. Before and after treatment, findings from spirometry, whole-body plethysmography, and the clinical wheezing and cough scales were evaluated. At the same time, serum and sputum samples were obtained for the measurement of eosinophil cationic protein, interleukin 10 (IL-10), IL-8, and myeloperoxidase levels. RESULTS: Twenty-three patients completed the study. Compared with placebo use, montelukast treatment significantly improved forced expiratory volume in I second, peak expiratory flow, and forced expiratory flow between 25% and 75% and significantly decreased cough and wheezing scale scores (P < .001 for all). There were no significant changes in vital capacity, thoracic gas volume, airway resistance, and residual volume after treatment. Compared with placebo use, montelukast treatment decreased serum and sputum levels of eosinophil cationic protein and IL-8, decreased sputum levels of myeloperoxidase, and increased serum and sputum levels of IL-10 (P < .001 for all). CONCLUSIONS: Montelukast may have measurable anti-inflammatory properties in patients with CF.