title: Characterization of within-subject responses to fluticasone and montelukast in childhood asthma.
abstract: BACKGROUND
  Responses to inhaled corticosteroids (ICSs) and leukotriene receptor antagonists (LTRAs) vary among asthmatic patients.
  
  
  OBJECTIVE
  We sought to determine whether responses to ICSs and LTRAs are concordant for individuals or whether asthmatic patients who do not respond to one medication respond to the other.
  
  
  METHODS
  Children 6 to 17 years of age with mild-to-moderate persistent asthma were randomized to one of 2 crossover sequences, including 8 weeks of an ICS, fluticasone propionate (100 microg twice daily), and 8 weeks of an LTRA, montelukast (5-10 mg nightly depending on age), in a multicenter, double-masked, 18-week trial. Response was assessed on the basis of improvement in FEV 1 and assessed for relationships to baseline asthma phenotype-associated biomarkers.
  
  
  RESULTS
  Defining response as improvement in FEV 1 of 7.5% or greater, 17% of 126 participants responded to both medications, 23% responded to fluticasone alone, 5% responded to montelukast alone, and 55% responded to neither medication. Compared with those who responded to neither medication, favorable response to fluticasone alone was associated with higher levels of exhaled nitric oxide, total eosinophil counts, levels of serum IgE, and levels of serum eosinophil cationic protein and lower levels of methacholine PC(20) and pulmonary function; favorable response to montelukast alone was associated with younger age and shorter disease duration. Greater differential response to fluticasone over montelukast was associated with higher bronchodilator use, bronchodilator response, exhaled nitric oxide levels, and eosinophil cationic protein levels and lower methacholine PC(20) and pulmonary function values.
  
  
  CONCLUSIONS
  Response to fluticasone and montelukast vary considerably. Children with low pulmonary function or high levels of markers associated with allergic inflammation should receive ICS therapy. Other children could receive either ICSs or LTRAs.
authors.affiliation: Department of Pediatrics, National Jewish Medical and Research Medical Center and University of Colorado Health Sciences Center, Denver, CO 80206, USA. szeflers@njc.org
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Szefler
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Phillips
authors.forename: Fernando D
authors.initials: FD
authors.lastname: Martinez
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Chinchilli
authors.forename: Robert F
authors.initials: RF
authors.lastname: Lemanske
authors.forename: Robert C
authors.initials: RC
authors.lastname: Strunk
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zeiger
authors.forename: Gary
authors.initials: G
authors.lastname: Larsen
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Spahn
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Bacharier
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Bloomberg
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Guilbert
authors.forename: Gregory
authors.initials: G
authors.lastname: Heldt
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Morgan
authors.forename: Mark H
authors.initials: MH
authors.lastname: Moss
authors.forename: Christine A
authors.initials: CA
authors.lastname: Sorkness
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Taussig
mesh_terms: D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use*; D000280:Administration, Inhalation; D000293:Adolescent; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D018592:Cross-Over Studies; D003521:Cyclopropanes; D004311:Double-Blind Method; D047150:Eosinophil Cationic Protein / Q000097:blood; D004804:Eosinophils / Q000473:pathology; D045853:Exhalation; D005260:Female; D000068298:Fluticasone; D005541:Forced Expiratory Volume; D006801:Humans; D007073:Immunoglobulin E / Q000378:metabolism; D007958:Leukocyte Count; D008297:Male; D009569:Nitric Oxide; D011237:Predictive Value of Tests; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D013440:Sulfides; D014797:Vital Capacity
chemical_list: D000085:Acetates; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D009569:Nitric Oxide; D007073:Immunoglobulin E; D000068298:Fluticasone; D047150:Eosinophil Cationic Protein; C093875:montelukast