Allergy Asthma Immunol Res.  2013 Jan;5(1):26-33. 10.4168/aair.2013.5.1.26.

Ratio of Leukotriene E4 to Exhaled Nitric Oxide and the Therapeutic Response in Children With Exercise-Induced Bronchoconstriction

Affiliations
  • 1Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea.
  • 2Department of Biochemistry and Molecular Biology, Hanyang University School of Medicine, Seoul, Korea.
  • 3Department of Pediatrics, Hanyang University School of Medicine, Seoul, Korea. hablee@hanyang.ac.kr

Abstract

PURPOSE
This study assessed the association between the ratio of leukotriene E4 (LTE4) to fractional exhaled nitric oxide (FENO) in the response of children with exercise-induced bronchoconstriction (EIB) enrolled in a therapeutic trial with montelukast or inhaled corticosteroid (fluticasone propionate [FP]).
METHODS
Children aged 6 to 18 years with EIB were randomized in a 4-week, placebo-controlled, double-blinded trial with montelukast or FP. Before and after treatment, treadmill exercise challenges were performed. The LTE4 levels in the induced sputum and urine and the FENO levels were measured in subjects before and 30 minutes after the exercise challenges. The same tests were conducted after treatment.
RESULTS
A total of 24 patients completed the study: 12 in the montelukast group and 12 in FP group. Both study groups displayed a similar postexercise maximum decrease in forced expiratory volume in one second (FEV1) before treatment as well as after treatment. However, there were significant differences in the magnitude of change between the two (Delta; -18.38+/-14.53% vs. -4.67+/-8.12% for the montelukast and FP groups, respectively; P=0.021). The Delta logarithmic sputum baseline and postexercise LTE4/FENO ratio were significantly lower in the montelukast group than in the FP group (baseline; -0.09+/-0.21 vs. -0.024+/-0.03, P=0.045; postexercise, -0.61+/-0.33 vs. -0.11+/-0.28, P=0.023).
CONCLUSIONS
These data indicate that the efficacy of montelukast for preventing a maximum decrease in FEV1 after exercise is significantly higher than that of FP, and the high LTE4/FENO ratio is associated with a greater response to montelukast than to FP for EIB therapy. These results suggest that LTE4 may play an important role in EIB.

Keyword

Exercise-induced bronchoconstriction; fractional exhaled nitric oxide; inhaled corticosteroid; leukotriene E4; montelukast

MeSH Terms

Acetates
Aged
Bronchoconstriction
Child
Diethylpropion
Forced Expiratory Volume
Humans
Leukotriene E4
Nitric Oxide
Quinolines
Sputum
Acetates
Diethylpropion
Leukotriene E4
Nitric Oxide
Quinolines
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