Premium
Exercise‐induced wheeze: Fraction of exhaled nitric oxide‐directed management
Author(s) -
COWAN Douglas C.,
HEWITT Richard S.,
COWAN Jan O.,
PALMAY Rochelle,
WILLIAMSON Avis,
LUCAS Samuel J.E.,
MURRELL Carissa J.,
THOMAS Kate N.,
TAYLOR D. Robin
Publication year - 2010
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/j.1440-1843.2010.01740.x
Subject(s) - formoterol , medicine , montelukast , exhaled nitric oxide , fluticasone , formoterol fumarate , bronchoconstriction , wheeze , salbutamol , mannitol , corticosteroid , asthma , gastroenterology , anesthesia , budesonide , chemistry , organic chemistry
Background and objective: Exercise‐induced wheeze (EIW) is common. Several treatment options exist. Patients with low fraction of exhaled nitric oxide (F E NO) are unlikely to be steroid‐responsive and might benefit from non‐steroidal therapies. We assessed: the efficacy of cromoglycate, formoterol and montelukast in patients with EIW and low F E NO (<35 ppb) in a randomized cross‐over trial, and the efficacy of inhaled corticosteroid in a high F E NO (>35 ppb) group. Methods: Patients had EIW and airway hyperresponsiveness (AHR) to mannitol and/or exercise. Those with low F E NO ( n = 19) received cromoglycate (20 mg inh. bd + before challenge tests), formoterol (12 µg inh. bd + before challenge tests) and montelukast (10 mg p.o. od), each for 2 weeks. Those with high F E NO ( n = 20) took inhaled fluticasone (500 µg) daily for 4 weeks. Primary end‐points were: 50% reduction in maximum FEV 1 %fall (clinical protection) and decrease in AHR to mannitol. Results: In patients with low F E NO, cromoglycate, formoterol and montelukast significantly decreased AHR to mannitol in 63%, 61% and 47% of patients, respectively. In this group, the magnitude of exercise‐induced bronchoconstriction (EIB) was significantly reduced with montelukast and formoterol; between‐treatment differences were not significant. Of 6/19 with low F E NO and EIB, protection occurred in 67% (cromoglycate), 83% (formoterol) and 50% (montelukast), respectively. In the high F E NO group, AHR to mannitol and EIB decreased significantly with fluticasone ( P < 0.001, P = 0.005, respectively), and protection occurred in 7/8 (88%) with EIB. Conclusions: In patients with EIW and low F E NO, the number of ‘responders’ to cromoglycate, formoterol and montelukast was similar. In a high F E NO population the response to inhaled corticosteroid was highly significant and comparable to previous studies.