Urinary leukotriene E4/exhaled nitric oxide ratio and montelukast response in childhood asthma
Nathan Rabinovitch, Nora J Graber, Vernon M Chinchilli, Christine A Sorkness, Robert S Zeiger, Robert C Strunk, Leonard B Bacharier, Fernando D Martinez, Stanley J Szefler, Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute, Stanley J Szefler, Gary Larsen, Joseph Spahn, Ronina Covar, Andrew Liu, D Sundström, Amy Grumann, Melanie Phillips, Katie Patterson, Michael White, Keith Breese, Kate Morgan, Robert F Lemanske Jr, Christine A Sorkness, Mark H Moss, Marzena E Krawiec, James E Gern, David B Allen, Kristen Blotz, Sarah Garibay, Kelly Miller, Holly Eversoll, Alana Clark, Kathleen Kelly Shanovich, Rick Kelley, Luke Weasler, Robert S Zeiger, Gregory Heldt, Michael H Mellon, Noah J Friedman, Alfredo A Jalowayski, Michael Schatz, Sandra C Christiansen, Michael S Kaplan, Hal Hoffman, Kathleen Harden, Catherine Nelle, Eva Rodriguez, Elaine Jenson, Linda Galbreath, Robert C Strunk, Leonard B Bacharier, Gordon R Bloomberg, James M Corry, Tina Oliver-Welker, Valerie Morgan, Kevin Hodgdon, Wanda Caldwell, Valerie Morgan, Kevin Hodgdon, Wanda Caldwell, Cindy Moseid, Fernando D Martinez, Wayne Morgan, Theresa W Guilbert, John D Mark, Mark Brown, James Goodwin, Melisa Celaya, Anna Valencia, Janet Lawless, Rosemary Weese, Shelley Radford, William Hall, Lynn M Taussig, James Kiley, Virginia Taggart, Gail Weinmann, Vernon M Chinchilli, Elizabeth Mauger, David Mauger, Timothy Craig, Ian Paul, Gavin Graff, Susan Boehmer, Brenda Phillips, Jessica Beiler, Loretta Doty, Anne-Marie Dyer, Lindsay Texter, Jim Schmidt, Patsy Rawa, Jill Kuennen, Jill Hofsass, Sherrie Whisler, Linda Ferrari, Pamela Arminavage, Brenda Beers, Linda Miller, Judy Potteiger, Lori Schell, Venus Mintz-Grella, Liza Say, Margaret Sheely, Trina Armstrong, Holly Hess, Vanessa Simmons, Sherrie Whisler, Thuy Tran, Lincoln Milner, Brian Moore, Andrew Sutton, Stephanie Olexovitch, Thomas F Boat, William C Bailey, Mary Kay Garcia, Carolyn M Kercsmar, H William Kelly, Lester LyndonKey Jr, James Tonascia, Benjamin Wilfond, Philip Ballard, Clarence E Davis, Diane E McLean, Gail Shapiro, Paul O'Byrne, Mark Liu, Lynn M Taussig, Virginia S Taggart, Stanley J Szefler, Robert F Lemanske Jr, Robert S Zeiger, Robert C Strunk, Fernando D Martinez, Vernon M Chinchilli, Robert F Lemanske Jr, Stanley J Szefler, Fernando D Martinez, Robert S Zeiger, Vernon M Chinchilli, A Sorkness, Robert C Strunk, Theresa W Guilbert, Stanley Szefler, David Mauger, Timothy J Craig, Susan Boehmer, Jill T Kuennen, James Goodwin, James R Schmidt, Brenda Phillips, D Sundström, James Schmidt, Kristen Blotz, Sarah Garibay, Kelly Miller, Wayne Morgan, Gregory Heldt, Gary Larsen, Christine A Sorkness, Joseph D Spahn, Kevin Hodgdon, Rick Kelley, Shelley Radford, Eva Rodriguez, Melanie Phillips, Brenda Phillips, Loretta Doty, Richard Evans, Jason Lennon, Lori Sanders, Jeff Davis, Fernando D Martinez, Stanley J Szefler, Robert F Lemanske Jr, Vernon M Chinchilli, David Mauger, Brenda Phillips, Nathan Rabinovitch, Nora J Graber, Vernon M Chinchilli, Christine A Sorkness, Robert S Zeiger, Robert C Strunk, Leonard B Bacharier, Fernando D Martinez, Stanley J Szefler, Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute, Stanley J Szefler, Gary Larsen, Joseph Spahn, Ronina Covar, Andrew Liu, D Sundström, Amy Grumann, Melanie Phillips, Katie Patterson, Michael White, Keith Breese, Kate Morgan, Robert F Lemanske Jr, Christine A Sorkness, Mark H Moss, Marzena E Krawiec, James E Gern, David B Allen, Kristen Blotz, Sarah Garibay, Kelly Miller, Holly Eversoll, Alana Clark, Kathleen Kelly Shanovich, Rick Kelley, Luke Weasler, Robert S Zeiger, Gregory Heldt, Michael H Mellon, Noah J Friedman, Alfredo A Jalowayski, Michael Schatz, Sandra C Christiansen, Michael S Kaplan, Hal Hoffman, Kathleen Harden, Catherine Nelle, Eva Rodriguez, Elaine Jenson, Linda Galbreath, Robert C Strunk, Leonard B Bacharier, Gordon R Bloomberg, James M Corry, Tina Oliver-Welker, Valerie Morgan, Kevin Hodgdon, Wanda Caldwell, Valerie Morgan, Kevin Hodgdon, Wanda Caldwell, Cindy Moseid, Fernando D Martinez, Wayne Morgan, Theresa W Guilbert, John D Mark, Mark Brown, James Goodwin, Melisa Celaya, Anna Valencia, Janet Lawless, Rosemary Weese, Shelley Radford, William Hall, Lynn M Taussig, James Kiley, Virginia Taggart, Gail Weinmann, Vernon M Chinchilli, Elizabeth Mauger, David Mauger, Timothy Craig, Ian Paul, Gavin Graff, Susan Boehmer, Brenda Phillips, Jessica Beiler, Loretta Doty, Anne-Marie Dyer, Lindsay Texter, Jim Schmidt, Patsy Rawa, Jill Kuennen, Jill Hofsass, Sherrie Whisler, Linda Ferrari, Pamela Arminavage, Brenda Beers, Linda Miller, Judy Potteiger, Lori Schell, Venus Mintz-Grella, Liza Say, Margaret Sheely, Trina Armstrong, Holly Hess, Vanessa Simmons, Sherrie Whisler, Thuy Tran, Lincoln Milner, Brian Moore, Andrew Sutton, Stephanie Olexovitch, Thomas F Boat, William C Bailey, Mary Kay Garcia, Carolyn M Kercsmar, H William Kelly, Lester LyndonKey Jr, James Tonascia, Benjamin Wilfond, Philip Ballard, Clarence E Davis, Diane E McLean, Gail Shapiro, Paul O'Byrne, Mark Liu, Lynn M Taussig, Virginia S Taggart, Stanley J Szefler, Robert F Lemanske Jr, Robert S Zeiger, Robert C Strunk, Fernando D Martinez, Vernon M Chinchilli, Robert F Lemanske Jr, Stanley J Szefler, Fernando D Martinez, Robert S Zeiger, Vernon M Chinchilli, A Sorkness, Robert C Strunk, Theresa W Guilbert, Stanley Szefler, David Mauger, Timothy J Craig, Susan Boehmer, Jill T Kuennen, James Goodwin, James R Schmidt, Brenda Phillips, D Sundström, James Schmidt, Kristen Blotz, Sarah Garibay, Kelly Miller, Wayne Morgan, Gregory Heldt, Gary Larsen, Christine A Sorkness, Joseph D Spahn, Kevin Hodgdon, Rick Kelley, Shelley Radford, Eva Rodriguez, Melanie Phillips, Brenda Phillips, Loretta Doty, Richard Evans, Jason Lennon, Lori Sanders, Jeff Davis, Fernando D Martinez, Stanley J Szefler, Robert F Lemanske Jr, Vernon M Chinchilli, David Mauger, Brenda Phillips
Abstract
Background: A subset of children with asthma respond better to leukotriene receptor antagonists than to inhaled corticosteroids. Information is needed to identify children with these preferential responses.
Objective: We sought to determine whether the ratio of urinary leukotriene E(4) (LTE(4)) to fractional exhaled nitric oxide (FE(NO)) delineates children with preferential responsiveness to montelukast compared with fluticasone propionate (FP) therapy.
Methods: Data from 318 children with mild-to-moderate asthma enrolled in 2 National Heart, Lung, and Blood Institute Childhood Asthma Research and Education Network studies (Characterizing the Response to a Leukotriene Receptor Antagonist and an Inhaled Corticosteroid [CLIC] and the Pediatric Asthma Controller Trial [PACT]) were analyzed. The association between LTE(4)/FE(NO) ratios at baseline and improved lung function or asthma control days (ACDs) with montelukast and FP therapy was determined, and phenotypic characteristics related to high ratios were assessed.
Results: LTE(4)/FE(NO) ratios were associated with a greater response to montelukast than FP therapy for FEV(1) measurements (2.1% increase per doubling of ratio, P = .001) and for ACDs per week (0.3-ACD increase, P = .009) in the CLIC study. In PACT the ratio was associated with greater ACD responsiveness to MT than FP therapy (0.6 ACD increase, P=.03) [corrected]. In a combined study analysis, LTE(4): FE(NO) ratios were associated with greater response to MT than FP therapy for FEV(1) (1.8% increase, P =.0005) and ACDs (0.4 increase, P =.001)[corrected].Children with LTE(4)/FE(NO) ratios at or above the 75th percentile were likely (P < .05) to be younger and female and exhibit lower levels of atopic markers and methacholine reactivity.
Conclusion: LTE(4)/FE(NO) ratios predict a better response to montelukast than FP therapy in children with mild-to-moderate asthma.
Copyright (C) 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
Source: PubMed