pulmicort and Asthma--Exercise-Induced

To discuss the clinical efficacy and safety of formoterol when used to relieve symptoms of asthma and prevent exercise-induced bronchoconstriction (EIB).. A PubMed search was performed for articles published between 1997 and 2005 with the keywords formoterol, asthma, and long-acting beta2-adrenergic agonist, with cross-referencing to identify peer-reviewed journal articles.. Published articles on the clinical use of formoterol for asthma or EIB were included as well as articles detailing the pharmacologic properties of the drug. To present a thorough review of the literature, published studies based on patient number, study design, or other measures of study quality were not excluded.. Formoterol is the only long-acting beta2-adrenergic agonist that combines a rapid onset of action (within 3 minutes) with a long duration of effect (approximately 12 hours). Clinically, as recommended by asthma treatment guidelines, formoterol in conjunction with inhaled corticosteroids (ICSs) is a preferred treatment for moderate to severe persistent asthma. Significant clinical data support the use of formoterol in combination with ICSs for the treatment of asthma, with studies demonstrating improved pulmonary function and symptom scores and decreased need for maintenance ICSs and short-acting beta2-adrenergic agonists (SABAs) as relief medication. Recent studies also demonstrate that use of formoterol as needed as relief medication is associated with a prolonged time to exacerbation, improved pulmonary function, and decreased asthma symptoms. When used as monotherapy, formoterol provides protection against EIB. Clinical data also demonstrate that formoterol is safe and well tolerated even in high doses, with an adverse event profile similar to that of SABAs.. Overall, formoterol is safe and effective as adjunct controller therapy for moderate and severe persistent asthma and as monotherapy for EIB.

Topics: Administration, Inhalation; Adolescent; Adrenergic beta-2 Receptor Agonists; Adrenergic beta-Agonists; Adult; Anti-Asthmatic Agents; Asthma; Asthma, Exercise-Induced; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Clinical Trials as Topic; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Ethanolamines; Formoterol Fumarate; Humans; Hydrophobic and Hydrophilic Interactions; Hypokalemia; Infant; Polymorphism, Genetic; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Receptors, Adrenergic, beta-2; Tachycardia; Terbutaline; Treatment Outcome

Salmeterol/fluticasone propionate, administered twice daily via a multidose dry powder inhaler (Seretide/Advair Diskus), Seretide Accuhaler or metered-dose hydrofluoroalkane (chlorofluorocarbon-free) inhaler (Seretide Evohaler), is a combination of the long-acting beta(2)-adrenoceptor agonist (beta(2)-agonist) [LABA] salmeterol and the corticosteroid fluticasone propionate. Maintenance therapy with combined salmeterol/fluticasone propionate is at least as effective in improving lung function and symptoms and is as well tolerated in patients with asthma as concurrent salmeterol plus fluticasone propionate. In patients previously receiving as-required short-acting beta(2)-agonists (SABAs) or inhaled corticosteroids, salmeterol/fluticasone propionate was significantly more effective in providing asthma control than fluticasone propionate and in improving lung function and asthma symptoms than inhaled corticosteroids (at equivalent or higher dosages), salmeterol or montelukast (as monotherapy or in combination with fluticasone propionate). Salmeterol/fluticasone propionate was more effective in improving asthma symptoms than adjusted-dose budesonide/formoterol in patients with uncontrolled asthma despite treatment with inhaled corticosteroids with or without a LABA in a well designed 1-year study. In pharmacoeconomic analyses, salmeterol/fluticasone propionate compared favourably with inhaled corticosteroids and mono- or combination therapy with oral montelukast. Salmeterol/fluticasone propionate is, therefore, an effective, well tolerated and cost-effective option for the maintenance treatment of patients with asthma.

Topics: Acetates; Administration, Inhalation; Albuterol; Androstadienes; Asthma; Asthma, Exercise-Induced; Bronchodilator Agents; Budesonide; Clinical Trials as Topic; Cyclopropanes; Drug Combinations; Economics, Pharmaceutical; Ethanolamines; Fluticasone; Fluticasone-Salmeterol Drug Combination; Formoterol Fumarate; Humans; Quinolines; Salmeterol Xinafoate; Sulfides; Therapeutic Equivalency

Topics: Acute Disease; Aminophylline; Aspirin; Asthma; Asthma, Exercise-Induced; Bronchodilator Agents; Budesonide; Calcium Channel Blockers; Cromolyn Sodium; Humans; Parasympatholytics; Pregnenediones; Rifampin; Theophylline

In mild asthma exercise-induced bronchoconstriction (EIB) is usually treated with inhaled short-acting β2 agonists (SABAs) on demand.. The hypothesis was that a combination of budesonide and formoterol on demand diminishes EIB equally to regular inhalation of budesonide and is more effective than terbutaline inhaled on demand.. Sixty-six patients with asthma (>12 years of age) with verified EIB were randomised to terbutaline (0.5 mg) on demand, regular budesonide (400 μg) and terbutaline (0.5 mg) on demand, or a combination of budesonide (200 μg)  + formoterol (6 μg) on demand in a 6-week, double-blind, parallel-group study (ClinicalTrials.gov identifier: NCT00989833). The patients were instructed to perform three to four working sessions per week. The main outcome was EIB 24 h after the last dosing of study medication.. After 6 weeks of treatment with regular budesonide or budesonide+formoterol on demand the maximum post-exercise forced expiratory volume in 1 s fall, 24 h after the last medication, was 6.6% (mean; 95% CI -10.3 to -3.0) and 5.4% (-8.9 to -1.8) smaller, respectively. This effect was superior to inhalation of terbutaline on demand (+1.5%; -2.1 to +5.1). The total budesonide dose was approximately 2.5 times lower in the budesonide+formoterol group than in the regular budesonide group. The need for extra medication was similar in the three groups.. The combination of budesonide and formoterol on demand improves asthma control by reducing EIB in the same order of magnitude as regular budesonide treatment despite a substantially lower total steroid dose. Both these treatments were superior to terbutaline on demand, which did not alter the bronchial response to exercise. The results question the recommendation of prescribing SABAs as the only treatment for EIB in mild asthma.

Topics: Administration, Inhalation; Adolescent; Adrenergic beta-2 Receptor Agonists; Adult; Asthma, Exercise-Induced; Bronchodilator Agents; Budesonide; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Ethanolamines; Exercise Test; Female; Forced Expiratory Volume; Formoterol Fumarate; Glucocorticoids; Humans; Male; Terbutaline; Vital Capacity; Young Adult

Inhaled combined therapy improves the pulmonary function in asthmatic patients. The effect on the airway hyperresponsiveness (AHR) and the efficacy of different pharmacological schedules is not well clarified on adolescent asthmatics.. Evaluate the responses to different combined inhaled therapies in adolescent asthmatics and study its impact on exercise induced AHR.. Basal lung function tests (LFT) were performed in 30 adolescents (13 to 16 years old; 19 female) with allergic asthma. They were submitted to exercise challenge test (EC) followed by bronchodilator test (BD). During 4 weeks, 15 adolescents were submitted to inhaled fluticasone/salmeterol (group A) and other 15 to inhaled budesonide/formoterol (group B). After this period, they underwent another functional evaluation as previous.. Before treatment, pulmonary function was similar in both groups. After 4 weeks of treatment, these groups showed an improvement of the basal LFT (p = 0.001 for FEV1 in both), decrease on bronchoconstriction induced by exercise (NS for both) and less recovery on BD response (p = 0.001 and 0.002, for FEV1 respectively groups A and B). Group B showed a better performance, with higher improvement of basal FEF 25/75 (p = 0.001), reduced bronchoconstriction response to EC (p = 0.008 for FEV1) and fewer response to BD test (p < 0.0001 for FEV1 and 0.024 for FEF 25/75) No adverse events were observed.. After 4 weeks of inhaled combined therapy, these patients improved their pulmonary function and bronchomotricity. Those under budesonide/formoterol showed the highest improvement. These medications are a safe measure in controlling the asthma in these patients.

Topics: Adolescent; Albuterol; Androstadienes; Asthma; Asthma, Exercise-Induced; Bronchial Hyperreactivity; Bronchodilator Agents; Budesonide; Drug Combinations; Ethanolamines; Female; Fluticasone-Salmeterol Drug Combination; Formoterol Fumarate; Humans; Male; Respiratory Function Tests

Topics: Acetates; Administration, Inhalation; Adolescent; Adult; Anti-Asthmatic Agents; Asthma, Exercise-Induced; Budesonide; Child; Cyclopropanes; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Leukotriene Antagonists; Male; Placebos; Quinolines; Receptors, Leukotriene; Signal Transduction; Sulfides

The aim of this study was to compare the clinical efficacy of low-dose inhaled budesonide (once or twice daily) and placebo, administered via Turbuhaler, on exercise-induced bronchoconstriction (EIB) in children with mild asthma. Fifty-seven steroid-naive children (7-16 years old; 41 boys, 16 girls) with EIB participated in this sub-population study according to the following inclusion criterion: a maximum fall in forced expiratory volume in 1 s (FEV1) > or = 10% after a standardized treadmill test. Mean baseline FEV1 was 100.3% of predicted, and mean maximum fall in FEV1 after the standardized exercise test was 22%. The study was a double-blind, randomized, parallel-group design. After 2 weeks of run-in, the children received inhaled budesonide 100 microg or 200 microg once daily in the morning, 100 microg twice daily, or placebo, for 12 weeks. After 12 weeks of treatment, the fall in FEV1 after the exercise test was significantly less in all three budesonide groups (7.2-7.8%) vs. placebo (16.7%). Daytime symptom scores were significantly lower in all three budesonide groups compared with placebo (p <0.02). The three budesonide groups did not differ significantly, and no significant change in lung function was found in any group. Therefore children with mild asthma, but with significant EIB, improved their exercise tolerance and symptom control after 3 months of treatment with a low dose of inhaled budesonide given once or twice daily.

Topics: Administration, Inhalation; Adolescent; Asthma; Asthma, Exercise-Induced; Bronchodilator Agents; Budesonide; Child; Double-Blind Method; Humans; Respiratory Function Tests

The effect of single-dose inhaled terbutaline, sodium cromo-glycate and budesonide were compared with control in 11 exercise-induced asthma (EIA) patients, aged 9-14 years. Patients exercise for 6 minutes, 15 minutes after inhaling drugs. The FVC, FEV1, PEFR and MMEF were recorded before exercise and after exercise at 5 minutes interval up to 25 minutes. After exercise, the mean (SEM) maximal percentage fall in FEV1 after placebo, 200 micrograms of terbutaline, 10 mg of sodium cromoglycate, and 100 micrograms of budesonide were 22.81 (3.45), 4.05 (2.11), 11.29 (1.18), and 20.36 (2.33) respectively. It was concluded that single-dose inhaled terbutaline and sodium cromoglycate resulted in a significant protective effect on exerxide-induced asthma whereas budesonide did not.

Topics: Administration, Inhalation; Adolescent; Anti-Asthmatic Agents; Asthma, Exercise-Induced; Bronchodilator Agents; Budesonide; Child; Cromolyn Sodium; Female; Forced Expiratory Volume; Humans; Male; Pregnenediones; Terbutaline; Treatment Outcome

The effect of long-term treatment with inhaled corticosteroid on exercise-induced asthma (EIA) was studied in 55 children, aged 7-18 yrs (mean 12 yrs). We also compared the time course of stabilization of EIA to that of other indicators of airway responsiveness, such as peak expiratory flow (PEF) variation and the provocation dose of histamine causing a 20% fall in forced expiratory volume in one second (FEV1). All children participated in an ongoing multicentre study to compare the effects of long-term treatment either with the beta 2-agonist salbutamol (600 micrograms.day-1) plus the inhaled corticosteroid budesonide (600 micrograms.day-1) (BA+CS), or salbutamol plus placebo (BA+PL), on airway calibre, airway responsiveness and symptoms. After a median follow-up of 22 months, the study design had to be changed, because of the high number of drop-outs on BA+PL. At that time, the treatment regimen of all children who had not withdrawn was changed into BA+CS. At the moment of change, and after 2 and 8 months of treatment, a treadmill exercise test was performed in two centres. Eighteen of the 22 children (82%) who were treated with BA+PL from the beginning had EIA, compared to 18 of the 33 children (55%) who were treated with BA-CS (p < 0.05). After 2 and 8 months of treatment with BA+CS in the patients previously on BA+PL this percentage decreased to 59 and 55%, respectively, and was not significantly different between both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Inhalation; Adolescent; Albuterol; Asthma, Exercise-Induced; Bronchodilator Agents; Budesonide; Child; Double-Blind Method; Drug Therapy, Combination; Humans; Peak Expiratory Flow Rate; Pregnenediones; Treatment Outcome

It has been suggested that inhaled corticosteroids may provide greater protection against constrictor stimuli that act indirectly such as exercise than those that act directly such as histamine.. The effects of six weeks treatment with inhaled budesonide (800 micrograms twice daily) on bronchial reactivity to histamine, exercise, and eucapnic voluntary hyperventilation of dry air were compared in a double blind, placebo controlled, non-crossover study in 40 subjects with asthma. Change in bronchial reactivity to histamine and eucapnic hyperventilation over the six weeks was measured as change in the provocative dose of histamine or dry air causing a 20% fall in FEV1 (PD20 histamine and PV20 eucapnic hyperventilation (EVH) of dry air); this was not possible for exercise because of the development of refractoriness. To enable the change in response to all three stimuli to be compared, the response (percent fall in FEV1) to a fixed dose was measured for all three challenge tests.. After budesonide there was an increase in PD20 histamine from 0.48 to 2.81 mumol and in PV20 EVH from 364 to 639 litres, and a significant correlation between the changes in PD20 histamine and PV20 EVH (r = 0.63). The median percentage fall in FEV1 in response to eucapnic hyperventilation, exercise, and histamine was similar before budesonide (25.5%, 26.6%, and 24.5%); the reduction in the percentage fall in FEV1 with budesonide was also similar for the three challenges (18.9%, 17.5%, and 16.6%), and all differed significantly from the changes following placebo. There was a significant correlation between change in percentage fall in FEV1 after budesonide with the three stimuli (histamine v exercise: r = 0.48; histamine v eucapnic hyperventilation: r = 0.46; exercise v eucapnic hyperventilation: r = 0.63).. The similar magnitude of change in bronchial reactivity to all three stimuli after budesonide and the within subject correlation obtained between these changes suggest that corticosteroids act by a common mechanism to protect against eucapnic hyperventilation, exercise, and histamine.

Topics: Administration, Inhalation; Adolescent; Adult; Asthma; Asthma, Exercise-Induced; Bronchi; Bronchodilator Agents; Budesonide; Double-Blind Method; Female; Forced Expiratory Volume; Histamine Antagonists; Humans; Hyperventilation; Male; Middle Aged; Pregnenediones

The variations in serum levels of eosinophil cationic protein (ECP) have been measured after exercise challenge of 13 patients with asthma with exercise-induced asthma (EIA) and nine patients with asthma without EIA. The patients were treated before exercise in a randomized and blinded fashion with inhalation of one dose of either disodium chromoglycate, terbutaline, or budesonide and in an open study with 4 weeks of inhaled budesonide. In the group with EIA, there was, in some patients, an initial increase in serum levels of ECP after exercise, but 60 minutes after exercise, the levels were significantly reduced (p less than 0.001). Disodium chromoglycate and 4 weeks of budesonide treatment inhibited this reduction. Histamine challenge of the group with EIA produced a similar fall in serum ECP levels (p less than 0.001). The group without EIA had initially lower levels of ECP than the group with EIA (p less than 0.05 to p less than 0.01), and ECP stayed unaltered after exercise. The preexercise serum ECP levels correlated significantly to the maximal fall in peak expiratory flow in the untreated group (r = 0.91; p less than 0.001) and in the group receiving one dose of budesonide (r = 0.62; p less than 0.05). The blood eosinophil counts were unchanged after challenge and not related to lung function. The results suggest that the ECP content in serum reflects the degree of allergic inflammation in the lungs and thereby the degree of bronchial hyperreactivity.

Topics: Adolescent; Adult; Aerosols; Asthma, Exercise-Induced; Blood Proteins; Budesonide; Double-Blind Method; Eosinophil Granule Proteins; Eosinophils; Female; Humans; Male; Peak Expiratory Flow Rate; Pregnenediones; Random Allocation; Ribonucleases; Terbutaline

Heat-stable neutrophil chemotactic activity (HS NCA) has been demonstrated in serum of subjects with asthma after exercise and after allergen inhalation challenge. Heat-labile neutrophil chemotactic activity (HL NCA) has been investigated only after allergen inhalation challenge. In this study, we have measured HS NCA and HL NCA after exercise of 22 adult patients with asthma, 13 of whom had exercise-induced asthma (EIA). In the 13 patients, the effect of pharmacologic pretreatment on the generation of HS NCA and EIA was evaluated in a double-blind study with inhalation of either disodium cromoglycate, terbutaline, or budesonide 15 minutes before exercise. Additionally, the effect of 4 weeks of treatment with budesonide aerosol was evaluated in an open study. A significant increase (p less than 0.01) in HS NCA was found in the patients with EIA with peak activities 15 minutes after exercise. In patients without EIA, the activity of HS NCA was variable. No HL NCA was detectable after exercise. EIA was inhibited by disodium chromoglycate, terbutaline, and 4 weeks of treatment with budesonide. The generation of HS NCA was more or less inhibited by all three drugs with 4 weeks of treatment with budesonide as the most potent regimen. No late-phase asthmatic reactions to exercise were found. It is concluded that only HS NCA is generated after exercise of subjects with asthma and that this production is controlled by antiasthmatic drugs. However, the generation of HS NCA occurs irrespective of EIA.

Topics: Adult; Aerosols; Asthma; Asthma, Exercise-Induced; Budesonide; Chemotaxis, Leukocyte; Cromolyn Sodium; Double-Blind Method; Exercise Test; Glucocorticoids; Hot Temperature; Humans; Neutrophils; Pregnenediones; Randomized Controlled Trials as Topic; Terbutaline; Time Factors

Twelve young adult asthmatic patients were selected in an asthma-free interval to be tested for exercise-induced bronchoconstriction. The degree of bronchoconstriction was estimated indirectly by spirometry, using FEV1 as parameter. Exercise was performed on a 10% steep treadmill for six minutes, leading to a pulse rate of more than 180 beats/min. Spirometry was done before, immediately after, and 10 and 20 min after the work. Only patients with more than a 10% fall in FEV1 during the 20 min period of recovery were selected. In the randomized crossover double blind trial the asthmatic patients received placebo inhalations for one week and budesonide inhalations for another week (2 X 800 micrograms daily). Spirometry was repeated at the end of each week. Under placebo we found a surprisingly high rate of protection against exercise-induced bronchoconstriction (50%, p less than 0.05). With budesonide 8% additional protection (compared to placebo) was achieved (mean of all 12 patients). The patient-drug-interaction was significant at the level of F = 30, p less than 0.05. There are some nonresponders to budesonide. Of the 12 asthmatics, 8 recognized the drug inhalation period. We conclude that one week of high dosage budesonide regimen recudes the tendency to exercise-induced asthma in adults. Budesonide seems to influence and mitigate bronchial hyperreactivity in the responder group.

Topics: Adolescent; Adult; Aerosols; Asthma; Asthma, Exercise-Induced; Budesonide; Double-Blind Method; Female; Forced Expiratory Volume; Glucocorticoids; Humans; Male; Pregnenediones; Random Allocation; Spirometry

Topics: Adolescent; Aerosols; Asthma; Asthma, Exercise-Induced; Budesonide; Child; Clinical Trials as Topic; Double-Blind Method; Forced Expiratory Volume; Glucocorticoids; Humans; Pregnenediones; Random Allocation

The effect of intranasally administered corticosteroid (budesonide) on nasal symptoms, mode of respiration (nasal versus mouth breathing), and asthma was investigated in 37 asthmatic children who were mouth breathers because of chronic nasal obstruction. After a 2-wk run-in period, the children were allocated randomly to 4 wk of intranasal therapy with either budesonide (400 micrograms/day) or placebo spray. A double-blind, parallel design was used. Diaries for peak expiratory flow, asthma, and rhinitis symptom scores and degree of mouth breathing were recorded at home. Nasal eosinophilia, nasal airway resistance at a flow of 0.2 L/s (NAR0.2), and lung function at rest and after exercise challenge were assessed at the clinic immediately before and at end of the 4-wk treatment. Budesonide, when compared with placebo, significantly decreased nasal obstruction (p less than 0.05), secretion (p less than 0.01), and eosinophilia (p less than 0.02), as well as NAR0.2 (p less than 0.05) and mouth breathing (p less than 0.01). The improvement in nasal obstruction correlated closely to the changes in mouth breathing (r = 0.80, n = 17, p less than 0.001). Furthermore, intranasally administered budesonide resulted in less exercise-induced asthma (EIA) (p less than 0.02) and decreased cough and asthma severity significantly. Pulmonary mechanics were only marginally improved. The present study showed that intranasally administered budesonide is effective in the treatment of perennial allergic rhinitis. An attenuation of EIA and a tendency to less asthma after budesonide therapy suggest a decrease in bronchial reactivity, but the results gave no clear evidence of an association between nasal airway function and asthma.

Topics: Administration, Intranasal; Adolescent; Airway Obstruction; Airway Resistance; Asthma; Asthma, Exercise-Induced; Budesonide; Child; Double-Blind Method; Eosinophilia; Female; Humans; Male; Mouth Breathing; Nose; Nose Diseases; Peak Expiratory Flow Rate; Pregnenediones; Respiratory Function Tests

The effect of aerosolized terbutaline in a dose of 32.5 micrograms and its placebo, administered in a double-blind fashion, was studied in 14 children with exercise-induced asthma (EIA) before and during a 4-wk treatment period with aerosolized steroid (budesonide, 400 micrograms/day). Effects were assessed from the changes in peak expiratory flow (PEF), forced expiratory volume in one second (FEV1), and forced expiratory flow (FEF25-75) before and after treadmill exercise challenge. Compared with placebo there was a significant improvement in pulmonary function after terbutaline. During budesonide therapy, pulmonary function improved further, but there was no enhancement of the response to terbutaline. Terbutaline alone, budesonide plus placebo, and budesonide plus terbutaline reduced the exercise-induced fall in FEV1 by 30, 51, and 84%, respectively. The effect of budesonide on EIA was delayed during the 4 wk of treatment as compared with the improvement in resting pulmonary function. The present results suggest that 1 to 4 wk of therapy with inhaled corticosteroids decreases the severity of EIA. Further, the combined effect of inhaled corticosteroid and beta-2 agonist on pulmonary function appears to be additive.

Topics: Adolescent; Aerosols; Asthma; Asthma, Exercise-Induced; Budesonide; Child; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Forced Expiratory Flow Rates; Forced Expiratory Volume; Humans; Peak Expiratory Flow Rate; Pregnenediones; Terbutaline

Mannitol- and exercise bronchial provocation tests are both used to diagnose exercise-induced bronchoconstriction. The study aim was to compare the short-term treatment response to budesonide and montelukast on airway hyperresponsiveness to mannitol challenge test and to exercise challenge test in children and adolescents with exercise-induced bronchoconstriction.. Patients were recruited from a paediatric asthma rehabilitation clinic located in the Swiss Alps. Individuals with exercise-induced bronchoconstriction and a positive result in the exercise challenge test underwent mannitol challenge test on day 0. All subjects then received a treatment with 400 μg budesonide and bronchodilators as needed for 7 days, after which exercise- and mannitol-challenge tests were repeated (day 7). Montelukast was then added to the previous treatment and both tests were repeated again after 7 days (day 14).. Of 26 children and adolescents with exercise-induced bronchoconstriction, 14 had a positive exercise challenge test at baseline and were included in the intervention study. Seven of 14 (50%) also had a positive mannitol challenge test. There was a strong correlation between airway responsiveness to exercise and to mannitol at baseline (r = 0.560, p = 0.037). Treatment with budesonide and montelukast decreased airway hyperresponsiveness to exercise challenge test and to a lesser degree to mannitol challenge test. The fall in forced expiratory volume in one second during exercise challenge test was 21.7% on day 0 compared to 6.7% on day 14 (p = 0.001) and the mannitol challenge test dose response ratio was 0.036%/mg on day 0 compared to 0.013%/mg on day 14 (p = 0.067).. Short-term treatment with an inhaled corticosteroid and an additional leukotriene receptor antagonist in children and adolescents with exercise-induced bronchoconstriction decreases airway hyperresponsiveness to exercise and to mannitol.

Topics: Acetates; Administration, Inhalation; Adolescent; Anti-Asthmatic Agents; Asthma, Exercise-Induced; Bronchial Provocation Tests; Bronchoconstrictor Agents; Bronchodilator Agents; Budesonide; Child; Cyclopropanes; Drug Administration Schedule; Exercise Test; Female; Forced Expiratory Volume; Humans; Male; Mannitol; Quinolines; Sulfides; Treatment Outcome; Young Adult

Topics: Administration, Inhalation; Adolescent; Adrenergic beta-Agonists; Albuterol; Androstadienes; Asthma; Asthma, Exercise-Induced; Bronchodilator Agents; Budesonide; Drug Therapy, Combination; Ethanolamines; Fluticasone; Humans; Male; Salmeterol Xinafoate

Topics: Administration, Inhalation; Albuterol; Asthma, Exercise-Induced; Bronchodilator Agents; Budesonide; Child; Diagnosis, Differential; Dyspnea; Follow-Up Studies; Humans; Male; Respiratory Function Tests; Respiratory Sounds; Risk Assessment; Severity of Illness Index

Previous studies in which leukotriene-receptor antagonist and corticosteroids were used have suggested a possible role for these anti-inflammatory drugs in the prevention of exercise-induced bronchoconstriction, but no direct comparisons have been made.. A crossover study was undertaken to compare the ability of both montelukast and budesonide to protect patients from exercise-induced bronchoconstriction.. A total of 20 patients (median age, 17 years; range, 8 to 36 years), who had clinical exercise-induced bronchoconstriction for 1 year and decreased FEV1 of at least 20% after exercise on two occasions, were enrolled in this study. To compare the therapies in each patient, we administered, consecutively, 10 mg of montelukast once daily at bedtime for 3 days and, later, 400 microg of budesonide twice daily for 15 days, or vice versa, with a 15-day intervening washout period during which no patient received treatment. Exercise challenges were performed at baseline (no therapy) and after each treatment. The percentage of FEV1 declines at 2, 7, and 12 minutes after exercise and the area under the curve (summarizing the extent and modification of FEV1 decreases relative to time) were measured and compared.. Both budesonide and montelukast significantly reduced the decrease in FEV1 (area under the curve) after exercise with respect to the baseline condition of no therapy (P = 0.0001). Overall, budesonide offered better protection (area under the curve) than did montelukast (P = 0.01), particularly in the short-term evaluation (2 minutes after exercise; P = 0.003); however, considerable individual variations in the responses to both budesonide and montelukast were observed. The degree of protection against decreases in FEV1 ranged from 0% to almost 100% for both treatments. In 16 of 20 patients, budesonide therapy offered better protection than did montelukast, and in the other 4 patients, montelukast showed better protection than did budesonide. No side effects of either montelukast or budesonide were detected during the study.. Treatment with budesonide or montelukast prevents exercise-induced bronchoconstriction. Because substantial variation in the response may be present among patients, both drugs should be tested in each patient before long-term therapy is chosen.

Topics: Acetates; Adolescent; Adult; Anti-Asthmatic Agents; Asthma, Exercise-Induced; Bronchoconstriction; Bronchodilator Agents; Budesonide; Child; Cyclopropanes; Female; Forced Expiratory Volume; Humans; Male; Quinolines; Spirometry; Sulfides

Inhaled corticosteroids are widely used for the treatment of bronchial asthma, and a long-term treatment with inhaled corticosteroids is effective in preventing exercise-induced bronchoconstriction (EIB). We have previously shown that hyperosmolarity, and cooling and rewarming induced interleukin-8 (IL-8) expression in human bronchial epithelial cells (BEC). However, the effect of inhalant corticosteroids on hyperosmolarity-induced, and cooling and rewarming-induced IL-8 and RANTES production has not been determined. To clarify these issues, we examined the effect of inhalant corticosteroids, beclomethasone dipropionate (BDP), and budesonide (BUD) on hyperosmolarity-induced, and cooling and rewarming-induced IL-8 and RANTES production. The results showed that BDP and BUD inhibited hyperosmolarity-induced, and cooling and rewarming-induced IL-8 and RANTES production. Because our previous studies have shown that p38 mitogen-activated protein (MAP) kinase and c-Jun-NH(2)-terminal kinase (JNK) regulate hyperosmolarity-induced, and cooling and rewarming-induced IL-8 and RANTES production, we examined the effect of BDP and BUD on p38 MAP kinase and JNK activation. The results showed that BDP and BUD did not inhibit hyperosmolarity-induced and cooling-induced p38 MAP kinase and JNK activation. These results indicated that inhalant corticosteroids inhibited hyperosmolarity-, and cooling and rewarming-induced IL-8 and RANTES production; however, the mechanism of inhaled corticosteroid-mediated inhibition of hyperosmolarity-induced, and cooling and rewarming- induced cytokine production remains to be clarified.

Topics: Administration, Inhalation; Administration, Topical; Anti-Inflammatory Agents; Asthma, Exercise-Induced; Beclomethasone; Body Temperature Regulation; Bronchi; Budesonide; Cells, Cultured; Chemokine CCL5; Epithelial Cells; Glucocorticoids; Humans; Interleukin-8; Water-Electrolyte Balance

Topics: Albuterol; Asthma; Asthma, Exercise-Induced; Bronchodilator Agents; Budesonide; Child; Glucocorticoids; Humans; Leukotrienes; Salmeterol Xinafoate; Theophylline

Topics: Adolescent; Asthma, Exercise-Induced; Bronchodilator Agents; Budesonide; Child; Humans; Pregnenediones

Although most asthmatic athletes can be adequately controlled by beta-adrenergic agents, sodium cromolyn, and/or theophylline, a few do not tolerate these medications or have suboptimal results. Cromolyn-like antiallergic drugs, newer antihistamine, antiserotonin, and antileukotriene agents as well as calcium channel blockers, antimuscarinics , alpha-adrenergic blockers, and new steroid preparations may be suitable for these individuals. Although efficacy has been demonstrated for a number of these new agents, much work remains to be done to evaluate thoroughly their potential pharmacologic effectiveness in exercise-induced asthma.

Topics: Adrenergic alpha-Antagonists; Asthma; Asthma, Exercise-Induced; Benzothiazoles; Budesonide; Calcium Channel Blockers; Carbazoles; Chromones; Cyproheptadine; Humans; Ketotifen; Parasympatholytics; Piperazines; Pregnenediones; Promethazine; Thioxanthenes; Xanthines; Xanthones