title: New insights into treatment of children with exercise-induced asthma symptoms.
abstract: BACKGROUND
  Exercise is one of the most common triggers of bronchoconstriction and affects up to 80% of children with asthma.
  
  
  OBJECTIVE
  The purpose of this randomized, double-blind, placebo-controlled study was to assess the effectiveness of treatment with ciclesonide 160 microgram, either alone, with a higher dose, with a leukotriene receptor antagonist (LTRA), or with a long-acting beta-agonist (LABA) in children with asthma with postexercise-induced symptoms.
  
  
  METHODS
  Eighty adolescents, ages 1218 years, with asthma and postexercise symptoms were enrolled. Children were treated in one of four treatment groups: ciclesonide 160 microgram daily dose (cic 160), ciclesonide 320 microgram daily dose (cic 320), ciclesonide 160 microgram daily dose combined with montelukast (cic + LTRA), or ciclesonide 160 microgram daily combined with formoterol (cic + LABA). The impact of treatment on clinical symptoms, maximum percentage decrease in forced expiratory volume in 1 second after intense exercise effort, fractional exhaled nitric oxide in exhaled breath, and the contribution of inflammatory mediators in exhaled breath condensate were assessed.
  
  
  RESULTS
  In children with asthma and with postexercise symptoms, 8-week daily administration of ciclesonide 320 microgram, ciclesonide 160 microgram plus LABA, and ciclesonide 160 microgram alone decreased daytime symptoms; decrease in maximal fall in forced expiratory volume in 1 second reached the level of significance in the cic 320, cic + LABA, and cic + LTRA groups. A higher prevalence of positive responses to treatment after addition of an LTRA or LABA to ciclesonide 160 microgram for patients with exercise treadmill challengeinduced clinical symptoms only was revealed.
  
  
  CONCLUSIONS
  Monotherapy with ciclesonide 320 microgram can be as effective as combined therapy in reducing exercise-induced bronchoconstriction. We revealed a higher prevalence of positive responses to treatment after the addition of LTRA or LABA to ciclesonide 160 microgram for patients with exercise treadmill challengeinduced clinical symptoms only. ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov"www.ClinicalTrials.gov/ext-link NCT01798823.
authors.affiliation: Department of Pediatrics and Allergy, Medical University of Lodz, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Stelmach
authors.forename: Anna
authors.initials: A
authors.lastname: Sztafiska
authors.forename: Joanna
authors.initials: J
authors.lastname: Jerzyska
authors.forename: Daniela
authors.initials: D
authors.lastname: Podlecka
authors.forename: Pawe
authors.initials: P
authors.lastname: Majak
authors.forename: Wodzimierz
authors.initials: W
authors.lastname: Stelmach
mesh_terms: D000293:Adolescent; D000485:Allergens; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001250:Asthma, Exercise-Induced / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D015415:Biomarkers; D002648:Child; D016207:Cytokines / Q000378:metabolism; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D012129:Respiratory Function Tests
chemical_list: D000485:Allergens; D018927:Anti-Asthmatic Agents; D015415:Biomarkers; D016207:Cytokines; D005938:Glucocorticoids; D020024:Leukotriene Antagonists