Journal of Family Practice - Modest relief with montelukast for kids’ asthma attacks
Robertson CF, Price D, Henry R, et al. Short-course montelukast for intermittent asthma in children: a randomized controlled trial. Am J Respir Crit Care Med 2007; 175: 323-329.
* Clinical question
Does montelukast reduce an asthma attack’s severity when given early in an acute attack to children with intermittent asthma?
* Bottom line
Yes. Montelukast (Singulair), when given at the first sign of an exacerbation or an upper respiratory infection, was slightly better than placebo in relieving symptoms and reducing health care use for children with intermittent asthma and 3 to 6 significant exacerbations per year. The children in this study were not taking controller medications.
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It’s not clear from this study whether montelukast is better than steroids, or if this approach is effective for children who are taking controller medications.
Level of evidence
2b: individual cohort study (including low-quality RCT)
Study design
Randomized controlled trial (double-blinded)
Funding
Industry
Allocation
Uncertain
Setting
Outpatient (any)
Synopsis
To be eligible for this study, children who were 2 to 14 years of age had to have:
(1) intermittent asthma with a history of at least 3, and no more than 6, episodes in the previous year that resulted in a hospital admission;
(2) an emergency department visit, plus 2 visits to a physician during asthma exacerbations; or
(3) 3 to 6 visits to a physician during asthma exacerbations.
Also, the eligible children could not be taking medications between attacks.
A total of 220 children were randomly assigned to receive montelukast or placebo administered by the parent or caregiver at the onset of asthma symptoms or at the first sign of an acute upper respiratory infection. Children between 2 and 5 years of age received 4 mg montelukast; older children received 5 mg daily. The children were treated for a minimum of 7 days, or until symptoms had resolved for 2 days. The maximum duration of treatment was 20 days. In addition to montelukast or placebo, the patients were also treated with a customized asthma management plan that included inhaled beta-agonists and oral prednisone.
During the follow-up period (approximately 10 months), 7 children had no acute episodes. The outcomes were evaluated using intention-to-treat analysis.
There were 345 acute episodes in the montelukast group and 336 in the placebo group. The children using montelukast sought health care 163 times, compared with 228 times for those using placebo. The symptom scores were slightly improved for the children taking montelukast. The episodes lasted, on average, approximately 1 week in each group. There was no difference in hospitalizations, the use of beta-agonists, or the use of prednisone.
FAST TRACK
Montelukast or placebo was given at the first sign of asthma exacerbation or upper respiratory infection
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