Urinary leukotriene E4/exhaled nitric oxide ratio and montelukast response in childhood asthma.
Rabinovitch N,
Graber NJ,
Chinchilli VM,
Sorkness CA,
Zeiger RS,
Strunk RC,
Bacharier LB,
Martinez FD,
Szefler SJ;
Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute.
Szefler SJ, Larsen G, Spahn J, Covar R, Liu A, Sundström D, Grumann A, Phillips M, Patterson K, White M, Breese K, Morgan K, Lemanske RF Jr, Sorkness CA, Moss MH, Krawiec ME, Gern JE, Allen DB, Blotz K, Garibay S, Miller K, Eversoll H, Clark A, Shanovich KK, Kelley R, Weasler L, Zeiger RS, Heldt G, Mellon MH, Friedman NJ, Jalowayski AA, Schatz M, Christiansen SC, Kaplan MS, Hoffman H, Harden K, Nelle C, Rodriguez E, Jenson E, Galbreath L, Strunk RC, Bacharier LB, Bloomberg GR, Corry JM, Oliver-Welker T, Morgan V, Hodgdon K, Caldwell W, Morgan V, Hodgdon K, Caldwell W, Moseid C, Martinez FD, Morgan W, Guilbert TW, Mark JD, Brown M, Goodwin J, Celaya M, Valencia A, Lawless J, Weese R, Radford S, Hall W, Taussig LM, Kiley J, Taggart V, Weinmann G, Chinchilli VM, Mauger E, Mauger D, Craig T, Paul I, Graff G, Boehmer S, Phillips B, Beiler J, Doty L, Dyer AM, Texter L, Schmidt J, Rawa P, Kuennen J, Hofsass J, Whisler S, Ferrari L, Arminavage P, Beers B, Miller L, Potteiger J, Schell L, Mintz-Grella V, Say L, Sheely M, Armstrong T, Hess H, Simmons V, Whisler S, Tran T, Milner L, Moore B, Sutton A, Olexovitch S, Boat TF, Bailey WC, Garcia MK, Kercsmar CM, Kelly HW, LyndonKey L Jr, Tonascia J, Wilfond B, Ballard P, Davis CE, McLean DE, Shapiro G, O'Byrne P, Liu M, Taussig LM, Taggart VS, Szefler SJ, Lemanske RF Jr, Zeiger RS, Strunk RC, Martinez FD, Chinchilli VM, Lemanske RF Jr, Szefler SJ, Martinez FD, Zeiger RS, Chinchilli VM, Sorkness A, Strunk RC, Guilbert TW, Szefler S, Mauger D, Craig TJ, Boehmer S, Kuennen JT, Goodwin J, Schmidt JR, Phillips B, Sundström D, Schmidt J, Blotz K, Garibay S, Miller K, Morgan W, Heldt G, Larsen G, Sorkness CA, Spahn JD, Hodgdon K, Kelley R, Radford S, Rodriguez E, Phillips M, Phillips B, Doty L, Evans R, Lennon J, Sanders L, Davis J, Martinez FD, Szefler SJ, Lemanske RF Jr, Chinchilli VM, Mauger D, Phillips B.
Source
Department of Pediatrics, National Jewish Health and the University of Colorado Denver School of Medicine, Denver, Colo 80206, USA.
Erratum in
- J Allergy Clin Immunol. 2010 Nov;126(5):959-61. Dosage error in article text.
Abstract
BACKGROUND:
A subset of children with asthma respond better to leukotriene receptor antagonists than to inhaled corticosteroids. Information is needed to identify children with these preferential responses.
OBJECTIVE:
We sought to determine whether the ratio of urinary leukotriene E(4) (LTE(4)) to fractional exhaled nitric oxide (FE(NO)) delineates children with preferential responsiveness to montelukast compared with fluticasone propionate (FP) therapy.
METHODS:
Data from 318 children with mild-to-moderate asthma enrolled in 2 National Heart, Lung, and Blood Institute Childhood Asthma Research and Education Network studies (Characterizing the Response to a Leukotriene Receptor Antagonist and an Inhaled Corticosteroid [CLIC] and the Pediatric Asthma Controller Trial [PACT]) were analyzed. The association between LTE(4)/FE(NO) ratios at baseline and improved lung function or asthma control days (ACDs) with montelukast and FP therapy was determined, and phenotypic characteristics related to high ratios were assessed.
RESULTS:
LTE(4)/FE(NO) ratios were associated with a greater response to montelukast than FP therapy for FEV(1) measurements (2.1% increase per doubling of ratio, P = .001) and for ACDs per week (0.3-ACD increase, P = .009) in the CLIC study. In PACT the ratio was associated with greater ACD responsiveness to MT than FP therapy (0.6 ACD increase, P=.03) [corrected]. In a combined study analysis, LTE(4): FE(NO) ratios were associated with greater response to MT than FP therapy for FEV(1) (1.8% increase, P =.0005) and ACDs (0.4 increase, P =.001)[corrected].Children with LTE(4)/FE(NO) ratios at or above the 75th percentile were likely (P < .05) to be younger and female and exhibit lower levels of atopic markers and methacholine reactivity.
CONCLUSION:
LTE(4)/FE(NO) ratios predict a better response to montelukast than FP therapy in children with mild-to-moderate asthma.
Copyright (C) 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
- PMID:
- 20816189
- [PubMed - indexed for MEDLINE]
- PMCID:
- PMC2935914
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