Short-Course Montelukast Improves Outcomes for Intermittent Asthma in Children

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February 16, 2007 — In children with intermittent asthma, a short course of montelukast resulted in reduction in acute healthcare resources, asthma symptoms, and days lost from school and from work for parents, according to the results of a multicenter, randomized, double-blind, controlled trial reported in the February 15 issue of the American Journal of Respiratory & Critical Care Medicine.

"In children, intermittent asthma is the most common pattern and is responsible for the majority of exacerbations," write Colin F. Robertson, MD, of the Royal Children's Hospital in Melbourne, Australia, and colleagues. "Montelukast has a rapid onset of action and may be effective if used intermittently."

During a 12-month period, 220 children, aged 2 to 14 years with intermittent asthma, were randomized to receive montelukast (n = 107) or placebo (n = 113). Treatment with study medication was initiated by parents at the onset of each upper respiratory tract infection or asthma symptoms and continued for at least 7 days or until symptoms had resolved for 48 hours.

Of 681 treated episodes in 202 children, 345 were treated with montelukast and 336 with placebo. There were 163 unscheduled healthcare resource utilizations for asthma in the montelukast group and 228 in the placebo group (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.47 - 0.89), and there was a nonsignificant trend toward reduction in specialist attendances and hospitalizations, duration of episode, and beta-agonist and prednisolone use.

With montelukast, symptoms were reduced by 14%, nights of disturbed sleep by 8.6% (P = .043), days off from school or childcare by 37%, and parent time off from work by 33% (P < .0001 for both).

"A short course of montelukast, introduced at the first signs of an asthma episode, results in a modest reduction in acute health care resource utilization, symptoms, time off from school, and parental time off from work in children with intermittent asthma," the authors write. "Although there was no significant effect on beta-agonist or oral prednisolone use, there was a significant reduction in asthma symptoms.... Although the difference in the number of days lost from work between treatment groups was relatively small, the days absent per year is a conservative estimate based on the presumption of a 365-day working year."

Merck, Sharp, & Dohme Australia, the maker of montelukast, funded this study. Some of the authors have disclosed relevant financial relationships with Merck, Sharp, & Dohme; AstraZeneca; Altana; GlaxoSmithKline; Novartis; Boehringer-Ingelheim; IVAX Corp; Thorpe Respiratory Research; Pharmaxis, Ltd; Australian Singulair Advisory Board; MSD Australia; and/or Schering Plough.

Am J Respir Crit Care Med. 2007;175:323-329.

Source: http://www.medscape.com/viewarticle/552323?src=0_nl_cme_9