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Effect of montelukast added to inhaled corticosteroids on fractional exhaled nitric oxide in asthmatic children

Dept of Paediatrics, Unit of Allergy and Respiratory Medicine, University of Padua, Padua, Italy

CORRESPONDENCE: E. Baraldi, Dept of Paediatrics, Via Giustiniani 3, 35128, Padova, Italy. Fax: 39 0498213502. E-mail: eugi@pediatria.unipd.it

Keywords: airway inflammation, asthma, exhaled nitric oxide, montelukast

Received: February 21, 2002
Accepted April 12, 2002

These data were in part presented at the annual meeting of the European Respiratory Society, Berlin, Germany, September 2001.

The aim of this prospective, self-controlled, single-blind study was to assess the effect of montelukast added to maintenance therapy with inhaled corticosteroids (ICS) on fractional exhaled nitric oxide (FE_NO) in asthmatic children.

Thirty-five children (age 11.2±0.4 yrs (mean±sem)) with mild-to-moderate persistent asthma treated with low to medium doses of ICS and FE_NO>20 parts per billion (ppb) were included. The patients were randomly assigned to two groups: 17 patients continued ICS (group C) and 18 had montelukast added to ICS for 3 weeks (group M). FE_NO measurements were performed in both groups at baseline (T₁) and after 3 weeks (T₂), and in group M also after 2 weeks of washout. FE_NO was measured by a chemiluminescence analyser using an on-line method (50 mL·s^–1) with nitric oxide-free air.

The overall mean daily dose of ICS was equivalent to 530±58 µg·day^–1 of beclomethasone in group M and to 564±55 µg·day^–1 of beclomethasone in group C. There were no significant differences in baseline FE_NO and forced expiratory volume in one second (FEV₁) between the two groups. After 3 weeks there was a significant reduction of FE_NO values in patients of group M (T₁ 52.2±7.8 ppb, T₂ 36.1±4.6 ppb) but no significant changes in group C (T₁ 43.5±6.0 ppb, T₂ 47.8±9.4 ppb). In group M after 2 weeks of montelukast withdrawal, FE_NO rose to baseline values (55.6±8.7 ppb).

In conclusion, after montelukast treatment there is a fractional exhaled nitric oxide reduction in asthmatic children receiving maintenance therapy with inhaled corticosteroids. This suggests an anti-inflammatory effect of montelukast additive to that of inhaled corticosteroids.

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