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SELECTED ARTICLES FROM THE RECENT LITERATURE 2006
11/29/06
Montelukast therapy for acute intermittent asthma
Summary
Background - In children, intermittent asthma (IA) is the most common asthma presentation and is responsible for the majority of acute asthma exacerbations (AAE). Based on pharmacodynamic patterns one would expect that treatment with montelukast (Mont) may abort developing AAE.
Findings - Robertson et al of the Royal Children's Hospital in Melbourne, Australia carried out a double blind randomized comparison of Mont vs placebo taken at the first signs of upper respiratory infection or asthma symptoms. This was carried out in 220 children (ages 2-14 years) with documented previous IA.
In the children treated with Mont there were fewer unscheduled health care visits for AAE but no significant reduction in the duration of such AAE, hospitalizations required, or the rescue use of inhaled beta agonists or oral steroids when compared with placebo-treated children. Symptoms were reduced by 14% and there was 37% less time lost from school/day care (with associated 33% less time lost from work by parents (p<0.0001).
Reference
Am j Respir Crit Care Med 2006;Nov 16, E pub
Editor's Comments
The authors concluded that the as needed use of Mont with the onset of URI (a common trigger of AAE in children with IA) and asthma symptoms had a modest preventive effect on the occurrence/severity of AAE in those children with documented IM. However, there was a more impressive reduction in time lost from school/day care (and less time lost from work by parents who had to stay home with the children involved). Perhaps, it is because the parents felt more comfortable sending their children to school/day care when there was medication taken (although this study was double blind).
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