Prevention of exercise-induced asthma by a fixed combination of disodium cromoglycate plus reproterol compared with montelukast in young patients.
BACKGROUND
The leukotriene inhibitor montelukast has been recommended against exercise-induced asthma (EIA), however, single-dose agents might be favourable in several aspects.


OBJECTIVE
To compare the protective effects against EIA of a single inhalation of the combination disodium cromoglycate (DSCG, CAS 16110-51-3) and reproterol (REP, CAS 54063-54-6) with 3 days oral treatment of montelukast (MON, CAS 158966-92-8).


METHODS
Open-label, cross-over, single-centre trial. Twenty-four 6 to 18-year-old children and adolescents, with reversible and stable airway obstruction, baseline FEV1 > or = 70%, predicted and proven EIA (i.e. a maximum decrease of FEV1 by > or = 20% compared with baseline) were treated with MON, orally for 3 days in the evening, or one single inhalation of DSCG/REP 20 min before the exercise challenge. The treatment sequence was randomised. The exercise test on a treadmill was performed under standardised conditions.


RESULTS
24 patients completed both periods. Both treatments clearly provided protection against EIA; however, protection of DSCG/REP was more pronounced than that of MON. This difference was statistically significant even if the data were adjusted for the increase in FEV1 between inhalation of DSCG/REP and challenge (DSCG/REP(adjusted). The nadir FEV1 level after exercise following prophylaxis with DSCG/REP was even higher than the pre-inhalation FEV1 value. From these data, protection indices of 66%, 81%, and 113% for MON, DSCG/REP(adjusted), and DSCG/REP(unadjusted), respectively, were estimated.


CONCLUSIONS
Inhalation of DSCG/REP before exercise provides significantly better protection against EIA than three days treatment with MON.
Lecheler
Josef
J
Asthma-Zentrum Buchenhöhe, Berchtesgaden, Germany.
Pfannebecker
Bernhard
B
Nguyen
Duc Tung
DT
Petzold
Ursula
U
Munzel
Ullrich
U
Kremer
Hans-Joachim
HJ
Maus
Joachim
J
D000085:Acetates / Q000627:therapeutic use*; D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001250:Asthma, Exercise-Induced / Q000517:prevention & control*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D004205:Cromolyn Sodium / Q000627:therapeutic use*; D018592:Cross-Over Studies; D003521:Cyclopropanes; D004311:Double-Blind Method; D004338:Drug Combinations; D005080:Exercise Test; D005260:Female; D005540:Forced Expiratory Flow Rates / Q000187:drug effects; D006801:Humans; D008297:Male; D009921:Metaproterenol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011804:Quinolines / Q000627:therapeutic use*; D013440:Sulfides; D013806:Theophylline / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000085:Acetates; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D003521:Cyclopropanes; D004338:Drug Combinations; D011804:Quinolines; D013440:Sulfides; C014792:reproterol; D009921:Metaproterenol; D013806:Theophylline; C093875:montelukast; D004205:Cromolyn Sodium