New insights into treatment of children with exercise-induced asthma symptoms.

BACKGROUND: Exercise is one of the most common triggers of bronchoconstriction and affects up to 80% of children with asthma. OBJECTIVE: The purpose of this randomized, double-blind, placebo-controlled study was to assess the effectiveness of treatment with ciclesonide 160 microgram, either alone, with a higher dose, with a leukotriene receptor antagonist (LTRA), or with a long-acting beta-agonist (LABA) in children with asthma with postexercise-induced symptoms. METHODS: Eighty adolescents, ages 1218 years, with asthma and postexercise symptoms were enrolled. Children were treated in one of four treatment groups: ciclesonide 160 microgram daily dose (cic 160), ciclesonide 320 microgram daily dose (cic 320), ciclesonide 160 microgram daily dose combined with montelukast (cic + LTRA), or ciclesonide 160 microgram daily combined with formoterol (cic + LABA). The impact of treatment on clinical symptoms, maximum percentage decrease in forced expiratory volume in 1 second after intense exercise effort, fractional exhaled nitric oxide in exhaled breath, and the contribution of inflammatory mediators in exhaled breath condensate were assessed. RESULTS: In children with asthma and with postexercise symptoms, 8-week daily administration of ciclesonide 320 microgram, ciclesonide 160 microgram plus LABA, and ciclesonide 160 microgram alone decreased daytime symptoms; decrease in maximal fall in forced expiratory volume in 1 second reached the level of significance in the cic 320, cic + LABA, and cic + LTRA groups. A higher prevalence of positive responses to treatment after addition of an LTRA or LABA to ciclesonide 160 microgram for patients with exercise treadmill challengeinduced clinical symptoms only was revealed. CONCLUSION: Monotherapy with ciclesonide 320 microgram can be as effective as combined therapy in reducing exercise-induced bronchoconstriction. We revealed a higher prevalence of positive responses to treatment after the addition of LTRA or LABA to ciclesonide 160 microgram for patients with exercise treadmill challengeinduced clinical symptoms only. ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov"www.ClinicalTrials.gov/ext-link NCT01798823.

The prevalence of mouse allergen in inner-city homes.

Mouse allergen has not been studied in detail in the general population. It is common for patients from inner-city environments to report significant mouse infestation in their homes and neighborhoods. The aim of this study was to determine the prevalence of mouse allergen in the homes of inner-city children with asthma in relation to the demographic features of these children and their specific housing characteristics. Seventy-eight dust samples from 39 inner-city homes of Lodz, Poland, were analyzed for mouse allergen. Skin-prick tests (SPTs) to mouse allergen were performed in all patients. In addition, data regarding the demographics and housing of the subjects were related to the mouse allergen levels. Mouse allergen was detected in 22 of 78 dust samples (28%), and in 18 of 39 homes (46%), including 13 kitchen (33%) and nine bedroom (23%) samples. Mouse allergen levels did not correlate between different rooms in the same home. The levels detected ranged from 0.09 to 2.34 micro g/g of dust. The highest levels were found in kitchens, with median levels of 0.2 micro g/g, 95% confidence interval (CI): 0.12-0.85 (range: 0.1-2.34 microg/g); in bedrooms the mean levels were 0.23 microg/g, 95% CI: 0.1-0.97 (range: 0.09-1.62 microg/g). Eleven of 18 children with detectable mouse allergen in house dust, and three of 21 without detectable mouse allergen in house dust, had a positive SPT to mouse allergen. On home inspection, 18% of the homes had evidence of mice in one or two rooms and had higher levels of mouse allergen (p < 0.01). None of the other subject or housing variables evaluated were associated with higher mouse allergen levels. In Polish children, mouse allergen is an important factor of sensitivity and should be recognized in the diagnosis of allergic diseases as well as in allergen-reduction programmes.