RESUMEN
Upper respiratory tract infections (URIs) represent the most frequent cause of acute asthma exacerbations. It has yet to be determined whether leukotriene receptor antagonist (LTRA) treatment prevents URI-induced acute asthma exacerbations in adults. The objective of the present study was to evaluate the preventive effects of LTRA treatment on URI-induced acute asthma exacerbations. The incidences of URI alone, acute asthma exacerbation without URI, and URI-induced acute asthma exacerbation were determined retrospectively by analyzing diary and medical records of 321 adult asthmatic patients (mean age, 56.3 ± 17.2 years; male/female ratio, 117:204) over 1 year. Results were compared between patients who had been taking an LTRA (n = 137) and those who had never taken any LTRA (n = 184) during the study periods. Significantly fewer URIs alone and acute asthma exacerbations without URI occurred in patients with than in those without prophylactic daily use of LTRA. LTRA treatment significantly reduced the durations of URIs alone and of total acute asthma exacerbations, as well as the incidence of mild exacerbations of asthma. In contrast, in patients with URI-induced acute asthma exacerbations, LTRA treatment failed to significantly reduce the interval between URI onset and acute asthma exacerbation, as well as the duration and severity of both URIs and acute asthma exacerbations. Use of an LTRA for adult asthmatic patients appears to reduce the incidences of URIs alone and acute asthma exacerbations without URI, but it failed to prevent URI-induced acute asthma exacerbations once a URI occurred.
RESUMEN
BACKGROUNDS: Inhaled corticosteroids (ICS)/inhaled long-acting beta(2)-agonists (LABA) combination drugs are widely used for the long-term management of chronic obstructive pulmonary disease (COPD). However, COPD is a heterogeneous condition and treatment with ICS is associated with a higher risk of pneumonia. The identification of a specific marker for predicting the efficacy of ICS/LABA on pulmonary function would be useful in the treatment of COPD. METHODS: Fourteen COPD patients receiving tiotropium therapy participated consecutively. The relationship between the baseline exhaled nitric oxide (FE(NO)) levels as well as serum markers and changes in pulmonary function by fluticasone propionate (FP)/salmeterol (SAL) were analyzed. RESULTS: FP/SAL therapy significantly improved forced vital capacity, forced expiratory volume in 1 s (FEV(1)), and the third phase slope of the single nitrogen washout curve (ΔN(2)) as well as the FE(NO) level. The baseline FE(NO) levels and positive specific IgE (atopy+) were significantly associated with airway obstructive changes assessed by FEV(1) and ΔN(2). A baseline FE(NO) level >35 ppb yielded 80.0% sensitivity and 66.7% specificity for identifying the subjects with significant improvement in FEV(1) (greater than 200 mL). An atopy+ yielded 60.0% sensitivity and 88.9% specificity for an improvement in FEV(1). When combined with FE(NO) > 35 ppb and atopy+, it showed 40% sensitivity and 100.0% specificity for FEV(1) improvement. Alternatively, COPD subjects with FE(NO) ≤ 35 ppb and atopy- did not show significant improvement in FEV(1). CONCLUSION: Combining FE(NO) and specific IgE may be a useful marker for predicting the response to ICS/LABA on airflow limitation in COPD.