DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20210663

Effectiveness of montelukast in childhood asthma: a prospective observational study

Krutika Gangdev, Hemant Jain, Atul Luhadia

Abstract


Background: Asthma is characterized by hyperresponsiveness of airways to various stimuli, manifested by widespread narrowing of airways causing paroxysmal dyspnoea, wheezing or cough. Most asthma medications are inhalational and compliance is difficult. So, development of an orally active and once daily drug with additional bronchodilator properties would lead to a major advance for managing young patients with asthma.

Methods: Children between 6-18 years with not well controlled asthma on daily controller therapy were enrolled. Their personal data and history regarding the duration of asthma symptoms, frequency and severity of exacerbations was noted. Diagnosis and grading of severity of asthma was confirmed by spirometry. Then subjects were started on montelukast as add on to their daily controller therapy and were reassessed at 4, 8 and 12 weeks by clinical symptoms and PEFR. The change in frequency of symptoms and PEFR at the end of 12 weeks gave the outcome of efficacy of montelukast. Side effects of montelukast were also assessed.

Results: Among total 64 subjects, at 4 weeks, 52 improved to well-controlled asthma. The remaining 12 did not improve, so required an increase in dose of their daily controller medication. Out of those 12 subjects, 10 subjects improved to well-controlled asthma at 8 weeks and 2 subjects still did not improve, so, their inhaled corticosteroids (ICS) dose was further increased. All 64 subjects showed improvement at 12 weeks. No serious side effects were observed.

Conclusions: 81.25% subjects showed improvement at the 1st follow up itself and no serious complications were observed. So, it can be suggested that montelukast is a safe drug.


Keywords


Asthma, Montelukast, Inhaled corticosteroids

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References


Diamant Z, Mantzouranis E, Bjermer L. Montelukast in the treatment of asthma and beyond. Expert Rev Clin Immunol. 2009;5(6):639-58.

Sreejyothi G, Menon M, Raveendranath K. Efficacy and compliance of montelukast as prophylaxis in mild persistent asthma. Int J Contemp Pediatr. 2018;5(6):2133-7.

Bjermer L. History and future perspectives of treating asthma as a systemic and small airways disease. Respir Med. 2001;95(9):703-19.

Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(86):8-16.

Bjermer L. Time for a paradigm shift in asthma treatment: from relieving bronchospasm to controlling systemic inflammation. J Allergy Clin Immunol. 2007;120(6):1269-75.

Kyllonen H, Malmberg P, Remitz A, Rytilä P, Metso T, Helenius I, et al. Respiratory symptoms, bronchial hyper-responsiveness, and eosinophilic airway inflammation in patients with moderate-to-severe atopic dermatitis. Clin Exp Allergy. 2006;36(2):192-7.

Subbarao P, Mandhane PJ, Sears MR. Asthma: epidemiology, etiology and risk factors. CMAJ. 2009;181(9):181-90.

Wenzel SE. Antileukotriene drugs in the management of asthma. JAMA. 1998;280(24):2068-9.

Warner JO. The role of leukotriene receptor antagonists in the treatment of chronic asthma in childhood. Allergy. 2001;56(66):22-9.

Walia M, Lodha R, Kabra SK. Montelukast in pediatric asthma management. Indian J Pediatr. 2006;73(4):275-82.

Doherty GM. Is montelukast effective and well tolerated in the management of asthma in young children: Part A: Evidence-based answer and summary. Paediatr Child Health. 2007;12(4):307-8.

Harmanci K. Montelukast: its role in the treatment of childhood asthma. Ther Clin Risk Manag. 2007;3(5):885-92.

Lazarus SC, Chinchilli VM, Rollings NJ, Boushey HA, Cherniack R, Craig TJ, et al; National Heart Lung and Blood Institute's Asthma Clinical Research Network. Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma. Am J Respir Crit Care Med. 2007;175(8):783-90.

Knorr B, Matz J, Bernstein JA, Nguyen H, Seidenberg BC, Reiss TF, Becker A. Montelukast for chronic asthma in 6- to 14-year-old children: a randomized, double-blind trial. Pediatric Montelukast Study Group. JAMA. 1998;279(15):1181-6.

Laviolette M, Malmstrom K, Lu S, Chervinsky P, Pujet JC, Peszek I, Zhang J, Reiss TF. Montelukast added to inhaled beclomethasone in treatment of asthma. Montelukast/Beclomethasone Additivity Group. Am J Respir Crit Care Med. 1999;160(6):1862-8.

Virchow JC, Mehta A, Ljungblad L, Mitfessel H. A subgroup analysis of the MONICA study: a 12-month, open-label study of add-on montelukast treatment in asthma patients. J Asthma. 2010;47(9):986-93.

Reiss TF, Chevinsky P, Edwards T, et al. Montelukast (MK-0476), a cysLT1 receptor antagonist, improves the signs and symptoms of asthma over a 3 month treatment period. Eur Respoir J. 1996;9:273.

Joos S, Miksch A, Szecsenyi J, Wieseler B, Grouven U, Kaiser T, Schneider A. Montelukast as add-on therapy to inhaled corticosteroids in the treatment of mild to moderate asthma: a systematic review. Thorax. 2008;63(5):453-62.

Nayak A, Langdon RB. Montelukast in the treatment of allergic rhinitis: an evidence-based review. Drugs. 2007;67(6):887-901.

Ducharme FM, Hicks GC. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children. Cochrane Database Syst Rev. 2002;(3):CD002314.

Bisgaard H, Skoner D, Boza ML, Tozzi CA, Newcomb K, Reiss TF, Knorr B, Noonan G. Safety and tolerability of montelukast in placebo-controlled pediatric studies and their open-label extensions. Pediatr Pulmonol. 2009;44(6):568-79.