Exhaled nitric oxide before and after montelukast sodium therapy in school-age children with chronic asthma: a preliminary study

Pediatr Pulmonol. 1999 Dec;28(6):402-7. doi: 10.1002/(sici)1099-0496(199912)28:6<402::aid-ppul3>3.0.co;2-v.


Exhaled nitric oxide (ENO) is a surrogate marker of airway inflammation in asthma. In 12 children aged 6-11 years with mild to moderate persistent asthma, ENO concentrations were measured before and after 4 weeks of treatment with montelukast sodium, a leukotriene receptor antagonist, and 2 weeks after withdrawal of therapy. Baseline ENO levels (mean and 95% confidence interval) were significantly elevated in patients with asthma compared to age-matched nonasthmatic control subjects, with levels of 83 (42-123) vs. 13 (11-15) ppb (P < 0.001). After treatment with montelukast sodium, there was a significant (P < 0.01) reduction in ENO to 58 (27-89) ppb which again rose to 69 (38-99) ppb 2 weeks after treatment was withdrawn. During treatment, the fall in ENO was accompanied by nonsignificant improvements in prebronchodilator forced expiratory volume in 1 s (FEV(1)) from 81-85% predicted or reductions in use of albuterol from a mean of 2.5 to 1.6 puffs/day. Individual ENO measurements and change in ENO concentrations with treatment did not correlate with either pulmonary function changes or use of bronchodilator. These data show that ENO is elevated in children with relatively mild asthma treated with bronchodilator alone, and that treatment with montelukast sodium for 4 weeks results in a significant reduction in ENO concentrations, even in the absence of significant changes in pulmonary function. These findings suggest an anti-inflammatory role for leukotriene D(4) receptor antagonism in the treatment of children with mild to moderate asthma.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetates / administration & dosage*
  • Administration, Inhalation
  • Administration, Oral
  • Analysis of Variance
  • Asthma / diagnosis*
  • Asthma / drug therapy*
  • Biomarkers / analysis
  • Breath Tests*
  • Child
  • Cross-Over Studies
  • Cyclopropanes
  • Female
  • Follow-Up Studies
  • Humans
  • Leukotriene Antagonists / administration & dosage*
  • Male
  • Nitric Oxide / analysis*
  • Quinolines / administration & dosage*
  • Reference Values
  • Respiratory Function Tests
  • Sulfides
  • Treatment Outcome


  • Acetates
  • Biomarkers
  • Cyclopropanes
  • Leukotriene Antagonists
  • Quinolines
  • Sulfides
  • Nitric Oxide
  • montelukast