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Comparative effect of triamcinolone, nedocromil and montelukast on asthma control in children: A randomized pragmatic

Iwona Stelmach1, Pawel Majak, Joanna Jerzynska

  • 1The M Curie Hospital, Department of Pediatrics and Allergy, Zgierz, Poland. interna@wss.zgierz.pl

Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology
|August 13, 2004
PubMed

Insights

Low-dose inhaled corticosteroids demonstrated the strongest effect on asthma control, lung function, and bronchial hyper-reactivity in children with dust mite allergy. Triamcinolone, montelukast, and nedocromil all improved symptoms, but inhaled steroids were most effective.

Area of Science:

  • Pediatric Pulmonology
  • Allergy and Immunology
  • Pharmacology

Background:

  • Asthma severity is assessed by symptoms, lung function, and medication needs.
  • Children with mild to moderate asthma often have allergic triggers like dust mites.
  • Comparing different asthma medications is crucial for effective treatment strategies.

Purpose of the Study:

  • To compare the efficacy of triamcinolone acetonide, montelukast, and nedocromil in children with dust mite-allergic asthma.
  • To evaluate the impact of these monotherapies on asthma control, lung function, blood eosinophils, and bronchial hyper-reactivity.

Main Methods:

  • A 3-arm, randomized pragmatic trial involving 256 children (aged 6-18) with mild to moderate asthma.
  • Participants received 4 weeks of monotherapy: low-dose inhaled triamcinolone acetonide (400 mcg/day), inhaled nedocromil, or montelukast sodium.
  • Outcomes measured included asthma symptom scores, forced expiratory volume in 1 second (FEV1), PC20H (bronchial hyper-reactivity), and serum eosinophil counts.

Main Results:

  • Triamcinolone and montelukast significantly improved FEV1 and PC20H, while reducing symptom scores and eosinophil counts after 4 weeks.
  • Triamcinolone showed a stronger effect on PC20H compared to montelukast.
  • All three drugs reduced daytime and nighttime asthma symptoms and beta-agonist use, with inhaled steroids (triamcinolone) exhibiting the most significant impact.

Conclusions:

  • Low-dose inhaled corticosteroids (triamcinolone) demonstrated superior efficacy over montelukast and nedocromil in improving clinical symptoms, lung function, bronchial hyper-reactivity, and eosinophil counts in children with dust mite-allergic asthma.
  • Montelukast also showed significant benefits, while nedocromil provided moderate improvements.
  • Inhaled steroids are the most effective option for managing mild to moderate allergic asthma in this pediatric population.

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