Evaluation of switching low-dose inhaled corticosteroid to pranlukast for step-down therapy in well-controlled patients with mild persistent asthma.
OBJECTIVE
Treatment guidelines for asthma recommend step-down therapy for well-controlled asthma patients. However, the precise strategy for step-down therapy has not been well defined. We investigated whether well-controlled patients with mild persistent asthma can tolerate a step-down therapy of either a reduced dose of inhaled corticosteroid (ICS) or a switch to a leukotriene receptor antagonist (LTRA), pranlukast hydrate.


METHODS
We recruited 40 adult patients with mild persistent asthma who were well-controlled for at least 3 months with a low-dose ICS therapy. The patients were randomly assigned to either an ICS dose reduction or a switch to pranlukast for 6 months.


RESULTS
FeNO levels in the pranlukast group were significantly increased over that in the ICS group. There were no significant differences between the two groups for lung function, FOT, at the endpoint. The percentage of patients with controlled asthma was 72.2% in the pranlukast group and 90% in the ICS group. No statistically significant difference between the two groups in the percentages of patients with treatment failure was observed.


CONCLUSIONS
Patients with mild persistent asthma that is well-controlled by a low dose of ICS can be switched to pranlukast safely for at least 6 months. However, 27.8% of the pranlukast group failed to maintain well-control, and FeNO levels increased with the switch to pranlukast at 6 months. This study was been limited by the small sample size and should therefore be considered preliminary. Further studies are needed to investigate the therapeutic efficacy of LTRA monotherapy as a step-down therapy.
a Department of Respiratory Medicine , Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan .|b Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan , and.
Sonoko
S
Harada
a Department of Respiratory Medicine , Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan .|b Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan , and.|c Atopy (Allergy) Research Center, Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan.
Norihiro
N
Harada
a Department of Respiratory Medicine , Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan .
Yukinari
Y
Itoigawa
a Department of Respiratory Medicine , Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan .
Yoko
Y
Katsura
a Department of Respiratory Medicine , Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan .
Fumiko
F
Kasuga
a Department of Respiratory Medicine , Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan .
Ayako
A
Ishimori
a Department of Respiratory Medicine , Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan .
Fumihiko
F
Makino
a Department of Respiratory Medicine , Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan .
Jun
J
Ito
a Department of Respiratory Medicine , Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan .|b Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan , and.
Ryo
R
Atsuta
a Department of Respiratory Medicine , Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan .|b Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine , Tokyo , Japan , and.
Kazuhisa
K
Takahashi
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D002867:Chromones / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005540:Forced Expiratory Flow Rates; D005541:Forced Expiratory Volume; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D016896:Treatment Outcome; D014797:Vital Capacity; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D002867:Chromones; D020024:Leukotriene Antagonists; D009569:Nitric Oxide; C047681:pranlukast
Antagonist; asthma; inhaled corticosteroid; leukotriene receptor; pranlukast hydrate; step-down therapy