Efficacy of antileukotriene drugs for the treatment of bronchial asthma in overweight and obese children

Abstract

Background. Overweight and obesity reduce the effectiveness of basic asthma treatment with inhaled glucocorticosteroids and their combination with long-acting β2-agonists and theophyllines, so achieving asthma control requires increasing the dose of drugs. Antileukotriene drugs are considered as a se­cond line of therapy as an alternative to corticosteroids in the treatment of mild persistent asthma and as a component of basic anti-inflammatory therapy of persistent moderate asthma. The choice of basic therapy in the combined course of asthma and overweight in children should be reasoned by the doctor, providing a risk-based approach to therapy. The purpose of the research is to compare the effectiveness of two schemes of basic therapy of bronchial asthma in overweight and obese children — schemes of medium doses of inhaled glucocorticosteroids and schemes of combination of low doses of inhaled glucocorticosteroids with antileukoriene drugs. Materials and methods. The histories of 64 children with bronchial asthma aged 6 to 18 years with overweight and obesity were studied. The children were divided into two treatment groups by random sampling. Group I received a combination of antileukoriene drugs with low-dose inhaled glucocorticosteroids for 3 months (therapy regimen I). Group II received medium do­ses of inhaled glucocorticosteroids for 3 months (therapy regimen II). To compare the effectiveness of treatment regimens, all children underwent spirometry, analysis of serum leptin levels, assessment of clinical symptoms of asthma, Asthma Control Test, assessment of qua­lity of life according to the PAQLQ questionnaire. Non-parametric methods of statistical data processing were used to analyze the results. Results. The result of pairwise comparisons of therapeutic groups after treatment revealed a statistically significant (p < 0.05) difference in the results of the positive effect of treatment in favor of treatment regimen I to improve indicators (Me [QI; QIII]) of clinical symptoms (reduction of daytime, night symptoms and use of bronchodilators), decreased serum levels of pro-inflammatory adipokine leptin and quality of life indicators on PAQLQ scales “Activity” and “Symptoms”. In the intergroup comparison of Asthma Control Test results, the relative risk of RR = 2.06 (95% ВІ 1.1 ÷ 3.9) indicates a twofold increase in the risk of achieving fully controlled asthma when ­using the treatment regimen I compared to the treatment regimen II (p = 0.037). Conclusions. The therapeutic effect of the combination of low doses of inhaled glucocorticosteroids with antileukoriene drugs allows recommending it when choosing the option of basic therapy for moderate bronchial asthma in overweight and obese children.

Keywords

• bronchial asthma
• overweight, obesity
• antileuko­riene drugs
• children