Fractional Exhaled Nitric Oxide Test For Assessment Of Therapeutic Effect Of Children With Asthma Treated With Inhaled Corticosteroids And Oral Leukotriene Receptor Antagonists

BackgroundIn recent years, the prevalence of asthma in children around the world is stillrising, especially in children. The prevalence of asthma in children also showed asignificant upward trend in our country, the third Chinese urban children with asthmaepidemiological survey shows that prevalence of children with asthma in China’smajor cities was3.02%,2-years prevalence rate was2.32%. Recurrent asthma, seriousimpact on children’s health, learning and life, to the family is a big financial burdenand stress, but also consumes a huge health care resource. However, unlike adults,children due to the process of growth and development, the development of all ages inthe path physiology of respiratory and immune systems are different, and asthma is aheterogeneous disease, especially in children with asthma in different individualsresponse to various treatments are not exactly the same. Therefore, effectivemonitoring and assessment of asthma control is essential to asthma in children.China’s Bronchial asthma Diagnosis and Prevention Guide" noted that asthma patientstreated should periodically evaluate to determine the level of asthma control andadjust the treatment in time; to control asthma is the dominant strategy. FeNO is fast,simple, reproducible, and can get results quickly, so as asthma inflammatory marker,it has a unique advantage. ObjectiveAccording to the encountered actual situation of children with asthma clinicallevel of control and adjust the treatment plan, comparing therapeutic effect of inhaledcorticosteroids (ICS) and oral leukotriene receptor antagonists (LTRAs) by testing theFeNO levels, FEV1/pred,and Children asthma control test score to clarify the clinicalefficacy differences between the two common asthma drugs and response to differentseverity of airway inflammation. In order to provide a basis for choosing drugs and toinvestigate the clinical significance of monitoring FeNO levels in children withasthma treatment.MethodsWe selected83asthmatic children aged5-14years old, who were divided intoinhaled corticosteroids group and oral leukotriene receptor antagonist group randomly,and to test the levels of FeNO, FEV1/pred, and Children asthma control test scorebefore treatment and after one month. According to FeNO levels of above two groupsbefore treatment and then were sub-divided into two sub-groups, namely normalFeNO group (FeNO values5-24ppb) and elevated FeNO group (FeNO values>24ppb).To take a comparison of therapeutic effect of children with asthma treatedwith inhaled corticosteroids and oral leukotriene receptor antagonists, meanwhilecomparative analysis of the efficacy of the two drugs at different levels of FeNO inasthmatic children. All the data were analyzed with SPSS17.0statistical software, andthere was statistical significance when P <0.05.Results(1) For all children completed the experiment, each baseline data was nosignificant difference between the inhaled budesonide group and oral montelukastgroup （P>0.05）.(2) FeNO levels were significantly decreased andFEV1/pred,C-ACT/ACT score were increased after treatment with inhaledcorticosteroids group and oral leukotriene receptor antagonist group（P<0.01）, andthere was no significantly statistical difference in the degree of decline in FeNO levelsbetween the two groups.(3) In the patients with elevated FeNO levels, the levels of FeNO were significantly decreased and FEV1/pred,C-ACT/ACT score weresignificantly increased in inhaled budesonide group and oral montelukast group（P<0.01）, inhaled budesonide group was more significant than oral montelukastgroup in terms of the degree of change in FeNO level, FEV1/pred and C-ACT/ACTscore（P<0.05）.(4) In the patients with normal FeNO levels, the level of FeNO wasdecreased significantly in oral montelukast group（P<0.01）, FeNO levels decreaseddegree was no statistical significance in the inhaled budesonide group (P>0.05);FEV1/pred and C-ACT/ACT score increased degree were more significant thanpre-treatment, degree of change between two group was no significance（P<0.01）.Conclusions(1) Inhaled corticosteroids and oral leukotriene receptor antagonists caneffectively treat children with mild to moderate persistent asthma.（2）For childrenwith severe airway inflammation, the preferred inhaled and oral corticosteroids orleukotriene receptor antagonist in combination.（3）For children with mild airwayinflammation, oral leukotriene receptor antagonists corticosteroids good alternativemedicine can be used alone as an inhaled.（4）Dynamic follow FeNO levels, andguidance to help assess asthma control of asthma therapy with inhaled corticosteroidsand oral leukotriene receptor antagonists.