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Urinary leukotriene E4/exhaled nitric oxide ratio and montelukast response in childhood asthma

Nathan Rabinovitch1, Nora J Graber, Vernon M Chinchilli

  • 1Department of Pediatrics, National Jewish Health and the University of Colorado Denver School of Medicine, Denver, Colo 80206, USA.

The Journal of Allergy and Clinical Immunology
|September 7, 2010
PubMed

Insights

The ratio of urinary leukotriene E(4) to fractional exhaled nitric oxide can identify children with asthma who respond better to montelukast than fluticasone propionate. This biomarker helps personalize asthma treatment for better outcomes.

Area of Science:

  • Pediatric Pulmonology
  • Biomarkers in Asthma
  • Personalized Medicine

Background:

  • Asthma treatment response varies in children.
  • Some children benefit more from leukotriene receptor antagonists (LTRAs) than inhaled corticosteroids (ICS).
  • Identifying children with preferential LTRA response is crucial for effective asthma management.

Purpose of the Study:

  • To determine if the urinary leukotriene E(4) (LTE(4)) to fractional exhaled nitric oxide (FE(NO)) ratio differentiates children with asthma who respond better to montelukast versus fluticasone propionate (FP).

Main Methods:

  • Analysis of data from 318 children with mild-to-moderate asthma from CLIC and PACT studies.
  • Assessment of the association between baseline LTE(4)/FE(NO) ratios and improvements in lung function (FEV(1)) and asthma control days (ACDs).
  • Evaluation of phenotypic characteristics associated with high LTE(4)/FE(NO) ratios.

Main Results:

  • Higher LTE(4)/FE(NO) ratios were significantly associated with greater improvement in FEV(1) and ACDs with montelukast compared to FP therapy in combined analyses.
  • Children with LTE(4)/FE(NO) ratios in the top quartile were more likely to be younger, female, and have lower atopic markers and methacholine reactivity.
  • The ratio demonstrated predictive value for treatment response in both individual studies (CLIC and PACT).

Conclusions:

  • The LTE(4)/FE(NO) ratio serves as a valuable biomarker for predicting a superior response to montelukast over FP therapy in pediatric patients with mild-to-moderate asthma.
  • This finding supports the use of the LTE(4)/FE(NO) ratio in guiding personalized asthma treatment strategies for children.
Abstract

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