Abstract
We aimed to determine the variability of response to inhaled corticosteroids (ICS) and leukotriene receptor antagonist (LTRA) in asthmatic children according to the patient phenotype. The present study comprised 56 children (mean age, 9.54 [SD, 2.3] years) with moderate persistent asthma and 18 healthy controls of matched age and sex. Asthmatics were allocated randomly to receive either montelukast (5 mg at bed time) or fluticasone propionate (100 μg twice daily) for 28 days. Serum concentrations of inflammatory mediators as soluble interleukin-2 receptor (sIL-2R), soluble intracellular adhesion molecules-1 (sICAM-1), soluble vascular cell adhesion molecules-1 (sVICAM-1), total serum IgE, peripheral blood eosinophils, and forced expiratory volume in 1 second (FEV1) were done before and after treatment to patients, and done once to controls. Significant increase in all inflammatory mediators, with significant decrease in FEV1, was detected in asthmatics before treatment compared to controls. Asthmatics presented with cough and wheeze showed significant increase of FEV1 and significant decrease in eosinophilic percentage in both treated groups, while the differential response between the two medications was found to be insignificant. Those presented with cough and shortness of breath showed significant increase of FEV1 and significant decrease in eosinophilic percentage in fluticasone-treated group only. Other inflammatory mediators showed insignificant changes between studied groups after intervention. Response to montelukast and fluticasone vary considerably according to the clinical phenotypes of asthma. Response to montelukast may be more effective in asthmatics presented with wheeze compared to those with shortness of breath. Whereas ICS provide clinical benefit in both asthmatic phenotypes.
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