title: An open-label study examining the effect of pharmacological treatment on mannitol- and exercise-induced airway hyperresponsiveness in asthmatic children and adolescents with exercise-induced bronchoconstriction.
abstract: BACKGROUND
  Mannitol- and exercise bronchial provocation tests are both used to diagnose exercise-induced bronchoconstriction. The study aim was to compare the short-term treatment response to budesonide and montelukast on airway hyperresponsiveness to mannitol challenge test and to exercise challenge test in children and adolescents with exercise-induced bronchoconstriction.
  
  
  METHODS
  Patients were recruited from a paediatric asthma rehabilitation clinic located in the Swiss Alps. Individuals with exercise-induced bronchoconstriction and a positive result in the exercise challenge test underwent mannitol challenge test on day 0. All subjects then received a treatment with 400 μg budesonide and bronchodilators as needed for 7 days, after which exercise- and mannitol-challenge tests were repeated (day 7). Montelukast was then added to the previous treatment and both tests were repeated again after 7 days (day 14).
  
  
  RESULTS
  Of 26 children and adolescents with exercise-induced bronchoconstriction, 14 had a positive exercise challenge test at baseline and were included in the intervention study. Seven of 14 (50%) also had a positive mannitol challenge test. There was a strong correlation between airway responsiveness to exercise and to mannitol at baseline (r = 0.560, p = 0.037). Treatment with budesonide and montelukast decreased airway hyperresponsiveness to exercise challenge test and to a lesser degree to mannitol challenge test. The fall in forced expiratory volume in one second during exercise challenge test was 21.7% on day 0 compared to 6.7% on day 14 (p = 0.001) and the mannitol challenge test dose response ratio was 0.036%/mg on day 0 compared to 0.013%/mg on day 14 (p = 0.067).
  
  
  CONCLUSIONS
  Short-term treatment with an inhaled corticosteroid and an additional leukotriene receptor antagonist in children and adolescents with exercise-induced bronchoconstriction decreases airway hyperresponsiveness to exercise and to mannitol.
authors.forename: Salome
authors.initials: S
authors.lastname: Schafroth Török
authors.forename: Thomas
authors.initials: T
authors.lastname: Mueller
authors.forename: David
authors.initials: D
authors.lastname: Miedinger
authors.forename: Anja
authors.initials: A
authors.lastname: Jochmann
authors.forename: Ladina Joos
authors.initials: LJ
authors.lastname: Zellweger
authors.forename: Sabine
authors.initials: S
authors.lastname: Sauter
authors.forename: Alexandra
authors.initials: A
authors.lastname: Goll
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Chhajed
authors.forename: Anne B
authors.initials: AB
authors.lastname: Taegtmeyer
authors.forename: Bruno
authors.initials: B
authors.lastname: Knöpfli
authors.affiliation: Internal Medicine, Kantonal Hospital Baselland and University of Basel, Basel, Switzerland. joerg.leuppi@ksli.ch.
authors.forename: Jörg D
authors.initials: JD
authors.lastname: Leuppi
mesh_terms: D000085:Acetates / Q000494:pharmacology / Q000627:therapeutic use*; D000280:Administration, Inhalation; D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001250:Asthma, Exercise-Induced / Q000139:chemically induced / Q000188:drug therapy* / Q000209:etiology; D001985:Bronchial Provocation Tests / Q000379:methods; D016085:Bronchoconstrictor Agents / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000494:pharmacology / Q000627:therapeutic use; D019819:Budesonide / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D003521:Cyclopropanes; D004334:Drug Administration Schedule; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D011804:Quinolines / Q000494:pharmacology / Q000627:therapeutic use*; D013440:Sulfides; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000085:Acetates; D018927:Anti-Asthmatic Agents; D016085:Bronchoconstrictor Agents; D001993:Bronchodilator Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D008353:Mannitol; D019819:Budesonide; C093875:montelukast
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