|
SELECTED ARTICLES FROM THE RECENT LITERATURE 2006
10/1/06
Cysteinyl leukotrienes in childhood asthma
Summary
Background - Treatment with leukotriene receptor antagonists such as montelukast (Mont) improves persistent asthma (PA) in many children and adults. However, it is still not clear whether the degree of such clinical improvement correlates with effects of such treatment on leukotriene levels in childhood asthma.
Findings - Rabinovitch et al carried out sequential analyses in 50 children who had moderate to severe PA despite treatment with inhaled corticosteroids (ICS) plus inhaled long acting beta agonists (LABA). In baseline studies the urinary leukotriene E4 (LTE4) levels correlated generally with lower FEV-1 levels and greater rescue use of inhaled albuterol in such children. This association was most striking in the children with less reversible airway obstruction.
Following treatment with Mont, urinary LTE4 levels decreased in the children showing clinical improvement.
Reference
J Allergy Clin Immunol - 2006;118:635-40
Editor's Comments
The findings in this study were surprising to me in at least 2 respects: 1) clinical and FEV-1 improvement was seen in many asthmatic children treated with Mont despite the presence of fairly severe asthma at baseline even though they were already receiving ICS plus LABA. Most previous studies of which I am aware found Mont to be beneficial in mild - moderate but not in severe asthma; 2) urinary LT4 levels decreased during treatment with Mont, an agent thought to inhibit binding of LTC4/LDT4 to their receptor but not inhibit formation/secretion of leukotrienes. Also previous studies have come to somewhat conflicting conclusions about the correlation of urinary LTE4 levels and clinical severity in asthmatics.
|