Abstract
Background:
Guidelines recommend inhaled corticosteroids and leukotriene modifiers as daily therapies to control asthma in children. However, few studies have compared the effects of these drugs on bronchial hyperreactivity in children with asthma.
Methods:
The effects of inhaled fluticasone and pranlukast on bronchial hyperreactivity in 42 patients aged 7–15 years with mild persistent asthma (24 treated with inhaled fluticasone and 18 with pranlukast), who had experienced no asthma exacerbations after these treatments started, were studied. At the start of and after 6 and 18 months of treatment, bronchial hyperreactivity (PC20: provocative concentration of methacholine causing a 20% fall in FEV1) was assessed with methacholine.
Results:
Geometric averages of PC20 in patients treated with inhaled fluticasone were 385.2 μg/mL at the start, 2271.8 μg/mL after 6 months, and 4181.0 μg/mL after 18 months of treatment, whereas those patients treated with pranlukast were 415.8 μg/mL, 792.2 μg/mL, and 2105.1 μg/mL, respectively. Both treatments induced significant improvements in PC20. The ΔPC20 values, expressed as doubling concentrations of PC20 after 6 and 18 months compared with that before treatment, were higher in patients treated with inhaled fluticasone than in those treated with pranlukast (p < 0.05 after both 6 and 18 months), whereas the ΔPC20 between PC20 after 18 months and that after 6 months of treatment did not differ between the two treatments.
Conclusions:
These findings suggest that the therapeutic effects of inhaled fluticasone in increasing PC20 in patients with mild persistent asthma, who had experienced no asthma exacerbations after treatment commenced, were greater after 6 months of treatment, when compared with those of pranlukast, and then decreased.
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