Modest relief near montelukast for kids' asthma attacks

* Clinical question

Does montelukast reduce an asthma attack's severity when given rash in an acute attack to children near 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 surrounded by relieving symptoms and reducing health safekeeping use for children with intermittent asthma and 3 to 6 significant exacerbations per year. The children here study were not taking controller medication.

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 medication.

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 have to have:

(1) intermittent asthma near a history of at least 3, and no more than 6, episodes within the previous year that resulted in a hospital declaration of guilt;

(2) an emergency department visit, plus 2 visit 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 medication between attacks.

A total of 220 children were fitfully 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; elder children received 5 mg daily. The children be treated for a minimum of 7 days, or until symptoms had resolved for 2 days. The maximum duration of treatment be 20 days. In addition to montelukast or placebo, the patients be also treated with a customized asthma running plan that included inhaled beta-agonists and oral prednisone.

During the follow-up period (approximately 10 months), 7 children have no acute episodes. The outcomes were evaluated using intention-to-treat analysis.

There be 345 acute episodes in the montelukast group and 336 surrounded by the placebo group. The children using montelukast sought health fastidiousness 163 times, compared with 228 times for those using placebo. The symptom score were slightly enhanced for the children taking montelukast. The episodes lasted, on average, approximately 1 week surrounded by each group. There be no difference in hospitalizations, the use of beta-agonists, or the use of prednisone.

FAST TRACK

Montelukast or placebo be given at the first sign of asthma exacerbation or upper respiratory infection