Chest
Volume 127, Issue 2, February 2005, Pages 509-514
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Clinical Investigations: Asthma
The Effect of Montelukast on Exhaled Nitric Oxide and Lung Function in Asthmatic Children 2 to 5 Years Old

https://doi.org/10.1378/chest.127.2.509Get rights and content

Objective

The study was undertaken to investigate the influence of once-daily treatment with montelukast (Singulair; MSD; Glattbrugg, Switzerland) on levels of exhaled nitric oxide (eNO) and lung function in preschool children with asthma.

Methods

A total of 30 children (19 girls), 2 to 5 years of age, in whom asthma had been newly diagnosed, who had a positive first-degree family history of asthma and a positive allergy test result, were allocated to undergo a 1-week run-in period of montelukast treatment. eNO and airway resistance were measured in all patients before (visit 1) and after the run-in period (visit 2), and after treatment with montelukast (4 mg once daily) for 4 weeks (visit 3).

Results

There were no significant differences in all parameters before and after the run-in period. However, the mean (SD) levels of eNO and the mean (SD) levels of airway resistance after treatment at visit 3 were 11.6 parts per billion (ppb) [9.5 ppb] and 1.15 kPa/L/s (0.26 kPa/L/s), respectively, and were significantly lower compared to values of 33.1 ppb (12.0 ppb) and 1.28 kPa/L/s (0.23 kPa/L/s), respectively, before treatment (p < 0.001) and at visit 2 (p = 0.01). There was no significant change in mean bronchodilator responsiveness between visit 3 (13.2%; SD, 6.8%) and visit 1/visit 2 (13.3%; SD, 7.0%; p = 0.47).

Conclusion

We have shown that montelukast has a positive effect on lung function and airway inflammation as measured by nitric oxide level in preschool children with allergic asthma.

Section snippets

Study Design

Children who were referred to our outpatient clinic due to recurrent wheeze over a period of 6 months, and who were symptomatic at the time of referral and had a positive parental history of asthma, were allocated to a run-in period if their eNO level was ≥ 15 parts per billion (ppb) and underwent a blood test (ie, the radioallergosorbent test [RAST]) to detect either food or inhaled allergens as well as a lung function measure (ie, Rint) before the run-in period began (visit 1). Therapy with

Results

From 55 preschool children with recurrent wheeze and a parental history of atopy, 9 had to be excluded due to their inability to perform valid Rint measurements. Forty-six children were allocated to the run-in period, but only 30 fulfilled the inclusion criteria, including positive RAST test result, and were included in the study.

The mean eNO levels at visits 1, 2, and 3 were 31.4 ppb (SD, 13.9 ppb), 33.1 ppb (SD, 12.0 ppb), and 11.6 ppb (SD, 9.5 ppb), respectively. The mean Rint values at

Discussion

In the present study, we investigated the effect of montelukast on levels of eNO and pulmonary function in preschool children with allergic asthma. We included children with chronic wheeze, raised eNO levels, and parental atopy to ensure a degree of homogeneity with regard to phenotype and to maximize the likelihood of persistent airway inflammation being present. Levels of eNO and airway resistance were significantly lower after 4 weeks of treatment with montelukast.

Current guidelines

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

    This study was funded by a Medical School Grant (MSD).

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