The Value Of Fractional Exhaled Nitric Oxide In The Curative Effect Evaluation Of Montelukast Among Childhood Asthma

BackgroundBronchialasthma, which is characterized by respiratory allergy and chronic airway inflammation, is one of the main medical burdens all over the world. The therapeutic goal of asthma is to achieve asthma control for a long time with the lowest dose of the drug. Commonly used medicines include long-term controller medications and quick relief medications. Long-term controller medications include glucocorticoid, Leukotriene receptor antagonist (LTRA), long-acting beta 2 agonists. LTRA montelukast, has been widely used in clinics because of its greater medicine compliance and higher security compared with glucocorticoids. GINA2006 has taken it as one of the single drugs to mild persistent asthma to achieve a long-term control. But long-term follow-up studies show that, the heterogeneity of response is great among individuals. The related factors include individual characteristics, body mass index, smoking exposure and genetic factors. Simple and specific detection index, which can early detect the heterogeneity of response, will guide clinical medication effectively. Fractional exhaled nitric oxide (FENO) detection, as one of the most studied and mature airway inflammation detection technologies, is simple, noninvasive, and reproducible. At present, there is no research on the value of fractional exhaled nitric oxide in the curative effect evaluation of Montelukast among childhood asthma both at home and abroad.ObjectiveTo disguss the value of FENO in the curative effect evaluation of Montelukast, provide reference for clinical medication. Methods40 5-14 years old asthmatic children, who went to see doctors of the Fifth People’s Hospital of Shanghai Affiliated to Fudan University from April 2013 to April 2014, were enrolled. The level of asthma control were partial controlled and uncontrolled. The patients did not use Corticosteroid in the last 30 days, did not use leukotriene receptor antagonist in the last 14 days, did not use antihistamines in the last 3 months. Give all patients regular treatment of Montelucast for 3 months. Detected FENO, PEF and the percentages of predicting value (PEF%), assessed C-ACT score before treatment, at 1 week after treatment, at 2 weeks after treatment, at 4 weeks after treatment, at 8 weeks after treatment, at1 2 weeks after treatment respectively. Divided the patients into different groups according to the level of asthma control at the 1 2 weeks after treatment. Patients, whose level of asthma control reached controlled level at 1 2 weeks after treatment, were classified into the effective group. Patients, whose level of asthma control reached partial controlled or uncontrolled level at 1 2 weeks after treatment were classified into the ineffective group. Analyze the clinical data of different groups.Results40 patients were enrolled and 31 patients accomplished the study. According to the therapeutic efficacy standard,21 patients were classified into effective group,10 patients were classified into the ineffective group.1. The two groups had significantly differences in the duration of asthma, level of asthma control, C-ACT scores before treatment and the level of FENO before treatment (P<0.05). The two groups had no difference in age, gender, height, weight and PEE before treatment (P>0.05).2. The effective group’FENO before treatment was 9.929±7.686 ppb, the six measurements during the follow-up period were all in 5-19ppb normal range and had no difference (P=0.350>0.05). The ineffective group’FENO before treatment was 32.520±22.699 ppb, the six measurements during the follow-up period were almost in more than 20ppb high range and had no difference (P=0.344>0.05).The effective group’PEF% and the ineffective group’PEF% were both remarkably improved after treatment. The six measurements during the follow-up period had significant difference (P<0.05), the results indicated a significant improvement in lung function.The effective group’C-ACT score was promoted continuously after treatment (P<0.05). The C-ACT score at the 12 weeks after treatment indicated that the disease was almost controlled according to the C-ACT score standard. The ineffective group’ C-ACT score was also significantly improved after treatment (P<0.05). The C-ACT score at the 12 weeks after treatment indicated that the disease was still partial controlled according to the C-ACT score standard.There was no stable correlation between FENO and PEF%, between FENO and C-ACT score, between PEF% and C-ACT score in the two groups.Conclusions1. The duration of asthma, the level of asthma control, the C-ACT score before treatment and the level of FENO before treatment may have an influence on the therapeutic response of Montelucast. The shorter course, the lighter condition, the lower FENO before treatment, the better therapeutic response.2. The FENO detection may have limited value in the curative effect evaluation of Montelukast. Larger clinical studies remain to be further developed.