A prospective study on inhaled corticosteroids combined with oral montelukast to prevent exacerbation of airway allergic inflammation in children

Abstract

Objective To investigate the effect on preventing exacerbation of airway allergy inflammation by inhaled corticosteroid with a spacer through nose and mouth combined with oral montelukast,in order to prevent transformation from allergic rhinitis (AR) to cough variant asthma (CVA) and bronchial asthma (BA).Methods 232 cases of AR were randomly divided into control group (114 cases) and observation group (118 cases).Control group was treated by oral loratadine (Wt ＜ 30 kg,5 mg once daily; Wt ≥ 30 kg,10mg once daily).Observation group was administered by inhaled fluticasone propionate with 125 μ g twice daily and oral montelukast (1-5 yrs,4 mg once daily; 6-14 yrs,5 mg once daily) on basis of control group.When patients' symptoms were controlled,dose of fluticasone propionate was reduced to once daily.Fluticasone was inhaled with a spacer,patients were required to close their mouth and to breathe for 1 minute through their nose if they were able to cooperate.Course of treatment was 3 months in both groups.After treatment,patients were followed up at least once a month for 3 years.If patients' symptoms weren' t controlled or didn' t recur,treatment above would be continued for another 3 months.The unhealed and recurrent rates of AR,incidence of CVA and BA were compared between two groups half a year,1 year,2 years and 3years after treatment.If patients were diagnosed with BA,they would be treated by routine therapy of BA.If patients corresponded to diagnostic criteria of CVA.they would be randomly divided into control group and observation group again.Observation group would continue to he treated by above-mentioned therapy for half a year,while control group was treated by antitussives,expectorants and antibiotics.Patients were followed up every 1-2 weeks when their symptoms weren't controlled,then they were followed up once a month when their symptoms were controlled.Follow-up lasted for 3 years.The unhealed and recurrent rates of CVA,incidence of BA were compared between two groups half a year,1 year,2 years and 3 years after treatment.Results Half a year,1 year,2 years and 3 years after treatment,the unhealed and recurrent rates of AR in control group and observation group were 52％,60％,71％,80％ and 14.15％,16.38％,18.87％,25.47％respectively (P ＜ 0.001),the incidences of CVA in control group and observation group were 40％,48％,57％,71％ and 15.09％,16.98％,20.75％,23.73％ respectively (P ＜ 0.001),the incidences of BA in control group and observation group were 30％,39％,47％,53％ and 11.32％,13.21％,16.04％,18.87％ respectively (P ≤ 0.001).In patients with CVA,the unhealed and recurrent rates in control group and observation group were 45％,55％,62.5％,75％ and 17.5％,25％,30％,37.5％ respectively (P ＜ 0.01),incidences of BA in control group and observation group were 35％,45％,60％,70％ and 10％,12.5％,15％,17.5％ respectively (P ＜ 0.01).As the time of follow-up extended,above-mentioned rates in control group had increased more obviously than those in observation group.Conclusions Repetitions of AR and CVA were prevented,and transformation from AR to CVA and BA was also prevented by inhaled corticosteroid combined with oral montelukast,which could stop airway allergy inflammation from worsening. Key words: Inhalant corticosteroid; Montelukast; Airway allergy inflammation; Children