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Published on: November 4, 2010
Can montelukast shorten prednisolone therapy in children with mild to moderate acute asthma? A randomized controlled
Suzanne Schuh1, Andrew R Willan, Derek Stephens
1Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. suzanne.schuh@sickkids.ca
Insights
Montelukast is not an effective substitute for prednisolone in treating mild to moderate acute asthma after hospital discharge. Oral corticosteroids are recommended for continued treatment in children to prevent treatment failure.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
- Asthma Management
Background:
- Acute asthma requires effective post-stabilization management to prevent relapse.
- Oral corticosteroids are a common treatment for acute asthma exacerbations.
- The efficacy of montelukast as an alternative to corticosteroids needs investigation.
Purpose of the Study:
- To compare the effectiveness of montelukast versus prednisolone for outpatient post-stabilization therapy in children with acute asthma.
- To determine if montelukast leads to more treatment failures than prednisolone.
Main Methods:
- A randomized, double-blind, double-dummy, non-inferiority trial was conducted.
- 130 children (2-17 years) with stabilized acute asthma received 5 days of either prednisolone or montelukast post-discharge.
- Treatment failure within 8 days was the primary outcome, defined by asthma-related unscheduled visits, hospitalization, or additional systemic corticosteroids.
Main Results:
- Treatment failure occurred in 7.9% of the prednisolone group versus 22.4% in the montelukast group.
- Younger patients were more likely to experience treatment failure (OR, 4.9).
- The montelukast group required more additional pharmacotherapy (23.9% vs. 9.5%, P = .03).
Conclusions:
- Montelukast is not an adequate alternative to oral corticosteroids for outpatient post-stabilization in mild to moderate acute asthma.
- Children with acute asthma should continue receiving oral corticosteroids after discharge for stabilization.
- This finding supports the continued use of corticosteroids in managing pediatric acute asthma.
Objective:
To examine whether outpatient post-stabilization therapy with montelukast produces more treatment failures than prednisolone.
Study Design:
In this randomized, double-blind, double-dummy non-inferiority trial, 130 children 2 to 17 years of age with mild to moderate acute asthma stabilized with prednisolone in the emergency department received 5 daily treatments with either prednisolone or montelukast after discharge. The primary outcome was treatment failure within 8 days (ie, an asthma-related unscheduled visit, hospitalization, or additional systemic corticosteroids).
Results:
The rates of treatment failure were 7.9% in the prednisolone group and 22.4% in the montelukast group (95% CI, 26.5%-2.4%). Treatment was more likely to fail in younger patients (odds ratio, 4.9). In the montelukast group, more patients received additional pharmacotherapy than in patients receiving prednisolone (23.9% versus 9.5%, P = .03). The differences in the daily salbutamol treatments, asymptomatic days, and changes in the Pediatric Respiratory Assessment Measure score were not significant (P = .85, .75, and .26, respectively).
Conclusion:
Montelukast does not represent an adequate alternative to corticosteroids after outpatient stabilization in mild to moderate acute asthma. This population should receive oral corticosteroids after discharge.
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