Comparative effect of triamcinolone, nedocromil and montelukast on asthma control in children: A randomized pragmatic study.
Asthma severity can be judged by measurements of symptoms, lung function, and medication requirements. The objective was to compare the effect of a 4-wk monotherapy with low-dose triamcinolone, montelukast and nedocromil on asthma control, lung function, eosinophil blood count, and bronchial hyper-reactivity in children with mild to moderate asthma allergic to dust mite. Two hundred fifty-six children, aged 6-18 yr, with mild to moderate asthma, participated in an 8-wk study. This was a three-arm, randomized no blinding or placebo pragmatic trial comparing the effect of triamcinolone acetonide (400 microg/day), inhaled nedocromil and montelukast sodium on clinical parameters of asthma [score, forced expiratory volume in 1 s (FEV(1))], PC20H, and eosinophil blood count. Two hundred forty-six children completed the study. After 4 wk of treatment with triamcinolone and montelukast, FEV(1) and PC20H significantly increased, and mean total symptoms score and mean number of eosinophil count in serum significantly decreased. Triamcinolone had a stronger effect on PC20H than montelukast. Nedocromil improved total asthma symptoms score and lung function. There was a reduction in the daytime and night-time symptom scores after treatment with all three drugs. Triamcinolone and montelukast had a stronger effect on asthma symptoms than nedocromil. There were statistically significant differences in reduction of nocturnal asthma symptoms between the triamcinolone and nedocromil groups (p < 0.001) and between montelukast and nedocromil (p = 0.001) groups, but not between the triamcinolone and montelukast groups. There was a reduction in beta-agonists use after treatment with all three drugs, with the strongest effect of triamcinolone. The study showed the strongest effect of low-dose inhaled steroids on clinical symptoms, lung function, bronchial hyper-reactivity and eosinophil blood count when compared to other asthma medications.
The M Curie Hospital, Department of Pediatrics and Allergy, Zgierz, Poland. interna@wss.zgierz.pl
Iwona
I
Stelmach
Pawel
P
Majak
Joanna
J
Jerzynska
Wlodzimierz
W
Stelmach
Piotr
P
Kuna
D000085:Acetates / Q000008:administration & dosage*; D000280:Administration, Inhalation; D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D016535:Bronchial Hyperreactivity / Q000188:drug therapy; D002648:Child; D003521:Cyclopropanes; D004804:Eosinophils / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D017835:Nedocromil / Q000008:administration & dosage*; D011804:Quinolines / Q000008:administration & dosage*; D012129:Respiratory Function Tests; D013440:Sulfides; D014221:Triamcinolone / Q000008:administration & dosage*
D000085:Acetates; D000318:Adrenergic beta-Agonists; D000893:Anti-Inflammatory Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D017835:Nedocromil; D014221:Triamcinolone; C093875:montelukast