title: Impact of add-on pranlukast in stable asthma; the additive effect on peripheral airway inflammation.
abstract: BACKGROUND
  The importance of airway inflammation has been highlighted in the pathophysiology of asthma. Even in controlled asthmatics treated with inhaled corticosteroid (ICS), residual airway inflammation is reported. Systemic therapy with oral leukotriene receptor antagonist, pranlukast, may have additive effects to improve asthma control.
  
  
  METHODS
  Twenty-five controlled asthmatics treated with ICS or ICS plus long-acting β2-agonist (LABA) were enrolled for a randomized crossover trial evaluating the effect of additional oral pranlukast. The patients were assigned to two groups receiving ICS (+LABA) or ICS (+LABA) + pranlukast for 8 weeks. After washout period, two groups were switched over for another 8 weeks. Fraction of exhaled nitric oxide (FeNO), lung function tests, peak expiratory flow (PEF) and asthma control test (ACT) were evaluated at the beginning and end of each period. Central airway NO flux (J'(awNO)) and peripheral airway/alveolar NO concentration (C(ANO)) were measured and adjusted for axial NO back-diffusion.
  
  
  RESULTS
  FEV1, % predicted, forced expired flow (FEF) (25-75), % predicted, morning PEF and ACT were significantly increased after the addition of pranlukast. Oral pranlukast administration significantly decreased both C(ANO) and corrected C(ANO).
  
  
  CONCLUSIONS
  The addition of oral pranlukast to ICS or ICS + LABA therapy may improve asthma control with reducing distal airway inflammation.
  
  
  BACKGROUND
  UMIN 000003781.
authors.affiliation: Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. yassy19781119@yahoo.co.jp
authors.forename: Hideki
authors.initials: H
authors.lastname: Yasui
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujisawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Inui
authors.forename: Masato
authors.initials: M
authors.lastname: Kato
authors.forename: Dai
authors.initials: D
authors.lastname: Hashimoto
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Enomoto
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Shirai
authors.forename: Takafumi
authors.initials: T
authors.lastname: Suda
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Nakamura
authors.forename: Kingo
authors.initials: K
authors.lastname: Chida
mesh_terms: D000284:Administration, Oral; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002867:Chromones / Q000008:administration & dosage / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D015656:Respiratory Mechanics / Q000187:drug effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D018927:Anti-Asthmatic Agents; D002867:Chromones; D005938:Glucocorticoids; D020024:Leukotriene Antagonists; D009569:Nitric Oxide; C047681:pranlukast