Short-term antiinflammatory treatment may reduce airway hyperresponsiveness

By Laura Cowen, medwireNews Reporter

Short-term treatment with budesonide and montelukast may decrease airway hyperresponsiveness to exercise and mannitol challenge in children and adolescents with exercise-induced bronchoconstriction, Swiss study data show.

The study included 26 individuals with an average age of 13.5 years who were undergoing a structured multimodal treatment programme, including physical training and medical treatment, for their asthma at a clinic in the Swiss Alps.

Fourteen of the 26 participants, who all had exercise-induced bronchoconstriction, had a positive response to the exercise challenge test (ECT) and therefore began treatment with budesonide 400 µg daily. Of these 14, seven also had a positive mannitol challenge test (MCT) on day 0.

On day 7, the ECT and MCT were repeated and montelukast was added to budesonide treatment for all 14 participants. A final ECT and MCT took place on day 14.

Jörg Leuppi (University of Basel) and co-authors of the study report that after 7 days of budesonide treatment, 10 of the 14 individuals had become unresponsive to the ECT, while one of the seven participants with a positive MCT at baseline was unresponsive to this test. Another participant initially unresponsive to the MCT was positive on day 7.

By day 14, three of the four participants with a positive ECT on day 7 had become unresponsive and another, who was unresponsive on day 7, had become responsive again. In addition, five of the seven individuals responsive to MCT on day 7 were unresponsive by day 14.

The researchers calculated that the maximum fall in forced expiratory volume in 1 second (FEV₁) after the ECT decreased significantly during the study, from a median of 21.7% on day 0 to 11.9% on day 7 and 6.7% on day 14.

There was also a trend towards decreased reactivity in the MCT with the median response–dose ratio falling from 0.0036% per mg on day 0 to 0.0021% per mg and 0.0013% per mg on days 7 and 14 respectively.

However, Leuppi et al point out that the intervention period was relatively short, and it is “quite likely that ongoing treatment with budesonide and montelukast could have further decreased the [patients’] sensitivity in the MCT.”

The team also notes in BMC Pediatrics that their study design meant that they were unable to determine whether the decreased airway hyperresponsiveness was due to the pharmacological treatment alone or a combination of that and the structured exercise program that all participants took part in.

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