Eosinophil-mediated damage to the respiratory epithelium is a major pathogenetic mechanism in
asthma.
Glucocorticoids have confirmed antiinflammatory properties and effect of
formoterol,
montelukast and
nedocromil on markers of
inflammation has been studied. Eosinophil blood counts and eosinophil
cation protein (ECP) serum level are often use as markers of clinical monitoring of the disease activity. To evaluate the effect of treatment on allergic
inflammation, we measured eosinophil blood counts and ECP serum level, and clinical parameters before and after 4 weeks treatment with triamcinolon,
montelukast,
nedocromil,
formoterol. It was 8 week, placebo-controlled and randomized, double blind trial of 154 children with moderate atopic
asthma. Patients were randomly allocated to receive 400 mg triamcinolon (n = 28), 5 or 10 mg (according to age)
montelukast (n = 27), 16 mg
nedocromil (n = 26), 24 micrograms
formoterol (n = 28) or placebo (n = 45). 140 children completed the study.
After treatment with triamcinolon and
montelukast eosinophil blood counts significantly decreased,
after treatment with triamcinolon,
montelukast and
nedocromil ECP serum level significantly decreased; all clinical parameters improved
after treatment with each
drug; treatment with triamcinolon had the strongest effect on most parameters (except of FEV1). Mean eosinophil blood counts before and
after treatment with triamcinolon were 277.4 and 187.2 cells/mm3 respectively (p < 0.001); with
montelukast were 279.6 and 250.7 cells/mm3 respectively (p = 0.002); with
nedocromil were 181.7 and 170.1 cells/mm3 respectively (p < 0.183); with
formoterol were 276.4 and 264.1 cells/mm3 respectively (p = 0.2). Mean ECP serum levels before and
after treatment with triamcinolon were 94.3 and 63.5 micrograms/l respectively (p < 0.001); with
montelukast were 85.1 micrograms/l and 71.2 micrograms/l respectively (p < 0.001); with
nedocromil were 92.6 and 80.1 micrograms/l respectively (p < 0.001); with
formoterol were 95.9 micrograms/l and 87.8 micrograms/l (p = 0.05). We found significant correlation between ECP and hyperresponsiveness
after treatment with triamcinolon,
montelukast. This study shows that triamcinolon,
montelukast contribute to inhibition of allergic
inflammation by decreasing eosinophil blood counts and ECP. The serum level of ECP seems to be a good
clinical marker of monitoring the disease.