Leukotriene Modifier vs Inhaled Corticosteroid in Mild-to-Moderate Asthma
| Autor: | Reury-Perng Perng, Yu-Chin Lee, Diahn-Warng Perng, Han-Yu Huang |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Pulmonary and Respiratory Medicine
Budesonide Eosinophil cationic protein Leukotriene medicine.medical_specialty Leukotriene receptor medicine.drug_class business.industry Critical Care and Intensive Care Medicine medicine.disease Gastroenterology Internal medicine Anesthesia medicine Corticosteroid Methacholine Zafirlukast Cardiology and Cardiovascular Medicine business medicine.drug Asthma |
| Zdroj: | Chest. 125:1693-1699 |
| ISSN: | 0012-3692 |
| Popis: | Study objective Evidence for the anti-inflammatory activity of leukotriene receptor antagonists in humans is somewhat limited. There are also no data comparing the anti-inflammatory effects of leukotriene receptor antagonists with those of inhaled corticosteroids. This study was designed to assess the clinical efficacy and anti-inflammatory effects of leukotriene receptor antagonist plus low-dose inhaled corticosteroids compared to those of a high-dose inhaled corticosteroid in patients with mild-to-moderate asthma. Methods Forty-nine patients with newly diagnosed asthma were recruited. They were randomly assigned to groups that received, for a 6-week period, either (1) budesonide, 600 μg bid (1,200 μg/d) or (2) budesonide, 200 μg (400 μg/d), and zafirlukast, 20 mg bid. The variables of asthma control were recorded daily. Sputum induction and methacholine provocation tests were performed. Results The results indicated that the administration of a low-dose inhaled corticosteroid plus zafirlukast was as effective as that of a high-dose inhaled corticosteroid regarding clinical improvement and anti-inflammatory effects ( ie , eosinophil percentage, and eosinophilic cationic protein [ECP] and cysteinyl leukotriene C 4 levels in induced sputum). Nineteen (group 1, 8 patients; group 2, 11 patients) of 49 patients (38.8%) had returned to normal airway responsiveness after treatment. Among these patients, 16 patients (84.2%) had normal ECP levels and 10 patients (52.6%) had normal percentages of eosinophils. ECP level, but not the eosinophil percentage, was significantly associated with symptom scores. The peak expiratory flow rate (PEFR) showed a significant correlation with the provocative concentration of methacholine causing a 20% fall in FEV 1 (PC 20 ) instead of with symptom scores. Conclusions The addition of a leukotriene modifier to treatment with low-dose inhaled corticosteroids is equivalent to treatment with high-dose inhaled corticosteroids in patients with newly diagnosed mild-to-moderate asthma. In addition to symptoms and PEFR, the monitoring of ECP and PC 20 may be of great value in achieving optimal control of asthma. |
| Databáze: | OpenAIRE |
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