Exercise-induced wheeze: Fraction of exhaled nitric oxide-directed management

Autor: Rochelle Palmay, Richard S. Hewitt, Douglas C. Cowan, Jan O. Cowan, Kate N. Thomas, Carissa Murrell, Samuel J. E. Lucas, Avis Williamson, D. Robin Taylor
Rok vydání: 2010
Předmět:
Zdroj: Respirology. 15:683-690
ISSN: 1440-1843
1323-7799
Popis: Background and objective: Exercise-induced wheeze (EIW) is common. Several treatment options exist. Patients with low fraction of exhaled nitric oxide (FENO) 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 FENO ( 35 ppb) group. Methods: Patients had EIW and airway hyperresponsiveness (AHR) to mannitol and/or exercise.Those with low FENO (n = 19) received cromoglycate (20 mg inh. bd + before challenge tests), formoterol (12 mg inh. bd + before challenge tests) and montelukast (10 mg p.o. od), each for 2 weeks. Those with high FENO (n = 20) took inhaled fluticasone (500 mg) daily for 4 weeks. Primary end-points were: 50% reduction in maximumFEV1%fall(clinicalprotection)anddecrease in AHR to mannitol. Results: In patients with low FENO,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 FENO and EIB, protection occurred in 67% (cromoglycate), 83% (formoterol) and 50% (montelukast),respectively. In the high FENO 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. Conclusions: In patients with EIW and low FENO, the number of ‘responders’ to cromoglycate, formoterol
Databáze: OpenAIRE
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