Predicting short term response to anti-inflammatory therapy in young children with asthma

• Published in: Current medical research and opinion Vol. 26; no. 2; pp. 483 - 492
• Main Authors: Zielen, Stefan, Christmann, Martin, Kloska, Magdalena, Dogan-Yildiz, Gülben, Lieb, Adrian, Rosewich, Martin, Schubert, Ralf, Rose, Markus A., Schulze, Johannes
• Format: Journal Article
• Language: English
• Published: England Informa UK Ltd 01-02-2010; Taylor & Francis
• Subjects: Acetates - therapeutic use; Airway reversibility; Algorithms; Androstadienes - therapeutic use; Anti-Asthmatic Agents - therapeutic use; Anti-Inflammatory Agents - therapeutic use; Asthma - diagnosis; Asthma - drug therapy; Biomarkers; Biomarkers, Pharmacological - analysis; Breath Tests; Child; Child, Preschool; Childhood asthma; Female; Fluticasone; Humans; Inhaled corticosteroids; Leukotriene receptor antagonist; Male; Montelukast; Prognosis; Quinolines - therapeutic use; Time Factors; Treatment Outcome
• ISSN: 0300-7995; 1473-4877
• DOI: 10.1185/03007990903485148

Abstract
Background:
Currently available anti-inflammatory treatment for young children with asthma includes inhaled corticosteroids (ICS) and the leukotriene receptor antagonist (LTRA) montelukast.
Objective:
To evaluate potential biomarkers of predicting short-term (6-week) response to ICS and LTRAs in children with asthma.
Methods:
A total of 102 children aged 4 to 7 years with episodic asthma were enrolled in an open labelled single-centre study. Biomarkers and asthma characteristics were evaluated as predictors of treatment. Of 102 patients 45 became symptomatic during observation and were randomised to treatment either to montelukast or fluticasone for 6 weeks.
Clinical trial registration:
NCT00543686.
Results:
Forced Expiratory Volume in one second (FEV1) increased with both treatments: FEV1 at randomisation was 90.2% and after therapy 106.8% with fluticasone vs. 90.8% and 103.7% for montelukast, respectively, showing that montelukast and fluticasone were equally effective in this age group (p = 0.44). Strong correlations to a favourable treatment response were pre-bronchodilatory FEV1 (p < 0.001) and airway reversibility (p = 0.04) at time of randomisation. None of the other biomarkers (methacholine testing, exhaled nitric oxide [eNO], presence of allergy, total Immunoglobulin E [IgE], cumulative specific IgE, eosinophils and parental smoking) were predictive.
Conclusion:
Despite the small sample size and the open-label design, the study suggests that the use of pre-bronchodilatory FEV1 and airway reversibility appears to be a good indicator of short-term anti-inflammatory therapy in young children with asthma.