Formoterol, montelukast, and budesonide in asthmatic children: effect on lung function and exhaled nitric oxide.
BACKGROUND
It has been proposed that asthma control may be achieved in part by minimizing airway inflammation. The simultaneous effects of inhaled steroids associated with long-acting beta-agonists and leukotriene antagonists on pulmonary function and airway inflammation are still largely unexplored in children with moderate persistent asthma.


OBJECTIVE
The aim of this study was to investigate the effects of add-on therapy with long-acting beta-agonists and leukotriene antagonists on FEV1 and exhaled nitric oxide levels (FENO) in children.


METHODS
Forty-eight steroid-naïve atopic asthmatic children, 7-11 years of age, were randomly treated in four groups for two consecutive one-month periods, as follows: (1) first month: budesonide 200 microg twice daily; second month: budesonide 400 microg twice daily; (2) first month: budesonide 200 microg twice daily+formoterol 9 microg twice daily; second month: budesonide 200 microg twice daily+montelukast 5mg once daily; (3) first month: budesonide 200 microg twice daily+montelukast 5mg once daily; second month budesonide 200 microg+formoterol 9 microg twice daily; (4) first and second month: budesonide 400 microg twice daily.


RESULTS
All treatments resulted in a significant increase in lung function and a decrease in FENO compared with values at baseline. Budesonide+montelukast in combination was the most effective treatment for reducing FENO levels.


CONCLUSIONS
This study demonstrates that add-on therapy with montelukast plus low-dose budesonide is more effective than the addition of long-acting beta-agonists or doubling the dose of budesonide for controlling FENO in asthmatic children.
Miraglia del Giudice
Michele
M
Dipartimento di Pediatria, Seconda Università di Napoli, Napoli, Italy. michele.miraglia@unina2.it
Piacentini
Giorgio L
GL
Capasso
Michele
M
Capristo
Carlo
C
Maiello
Nunzia
N
Boner
Attilio L
AL
Capristo
Angelo F
AF
D000085:Acetates / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001944:Breath Tests; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use; D002648:Child; D003521:Cyclopropanes; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000627:therapeutic use; D005260:Female; D000068759:Formoterol Fumarate; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000032:analysis*; D011804:Quinolines / Q000627:therapeutic use; D013440:Sulfides
D000085:Acetates; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D003521:Cyclopropanes; D004983:Ethanolamines; D011804:Quinolines; D013440:Sulfides; D009569:Nitric Oxide; D019819:Budesonide; C093875:montelukast; D000068759:Formoterol Fumarate