Effects of exercise training and montelukast in children with mild asthma.
OBJECTIVE
Data from the general population suggest that habitual exercise decreases bronchial responsiveness, but the possible role of exercise in asthmatics is undefined. The leukotriene receptor antagonist montelukast decreases bronchial responsiveness and exercise-induced symptoms in asthmatic children. This randomized study in children with mild asthma evaluated the combined effects of aerobic training for 12 wk and montelukast or placebo on bronchial responsiveness (BHR) to methacholine, exercise-induced bronchoconstriction (EIB), inflammatory markers in exhaled breath condensate (EBC), and asthma exacerbations.


METHODS
Fifty children (mean age +/- SD: 10.2 +/- 2.4 yr) with mild stable asthma were randomly assigned to placebo (N = 25) or montelukast (N = 25). Before and after training, we assessed BHR and EIB and markers of airway inflammation-that is, exhaled nitric oxide (eNO), pH, and cysteinyl-leukotriene concentration-in EBC.


RESULTS
Training increased maximal workload and peak minute ventilation. After training, the methacholine dose causing a 20% fall in FEV1 (PD20) increased in both groups. A decreased slope of FEV1 decline at increasing methacholine dose was found only in montelukast-treated children. EIB prevalence halved after training in both groups (EIB + children, placebo group: 10 pretraining, 4 posttraining; EIB + children, montelukast group: 8 pretraining, 5 posttraining; P < 0.05 by chi on all children). Resting eNO was unaffected, whereas the pH of EBC decreased after training in both groups. Cysteinyl-leukotriene concentrations were low in most children at both times. During training, montelukast-treated children showed fewer asthma exacerbations compared with the same period of the previous year.


CONCLUSIONS
In children with mild stable asthma, exercise training decreased bronchial responsiveness to methacholine. Montelukast also decreased bronchial reactivity (FEV1 slope) and protected against exacerbations, suggesting a beneficial synergistic action of these two interventions in mild asthma.
Bonsignore
Maria R
MR
Department of Medicine, Pneumology, Physiology and Nutrition, University of Palermo, Italy. marisa@ibim.cnr.it
La Grutta
Stefania
S
Cibella
Fabio
F
Scichilone
Nicola
N
Cuttitta
Giuseppina
G
Interrante
Amelia
A
Marchese
Margherita
M
Veca
Mario
M
Virzi'
Marco
M
Bonanno
Anna
A
Profita
Mirella
M
Morici
Giuseppe
G
D000085:Acetates / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology*; D001250:Asthma, Exercise-Induced / Q000188:drug therapy* / Q000503:physiopathology; D001944:Breath Tests; D016084:Bronchoconstriction / Q000187:drug effects; D002000:Bronchospirometry; D002648:Child; D003521:Cyclopropanes; D005080:Exercise Test; D005081:Exercise Therapy; D045853:Exhalation / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D016210:Methacholine Chloride / Q000008:administration & dosage; D010809:Physical Fitness / Q000502:physiology; D011804:Quinolines / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D013440:Sulfides
D000085:Acetates; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D016210:Methacholine Chloride; C093875:montelukast