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Members Unexpected Asthma Findings
Comparative study of budesonide inhalation suspension and montelukast in young children with mild persistent asthma
Stanley J. Szefler, MD, James W. Baker, MD, Tom Uryniak, MS, Mitchell Goldman, MD, PhD, and Philip E. Silkoff, MD
Healthcare providers aim to meet the expectations of parents regarding asthma care while minimizing or eliminating the adverse effects of therapy. It can be a dilemma for these caregivers when choosing between therapies for their young mild persistent asthmatics. This often leads to the need for a choice between an inhaled corticosteroid (ICS) and a leukotriene receptor antagonist (LTRA). The 2002 and 2007 National Asthma Education and Prevention Program (NAEPP) Guidelines have recommended the use of long-term ICSs as the preferred treatment for persistent asthma in children of all ages. The use of LTRAs is an alternative to ICS therapy for the treatment of mild and moderate persistent asthma in children.
The quandry providers face is that on the one hand, asthma in early childhood is frequently underdiagnosed and thus, many infants and young children do not receive adequate therapy. On the other hand, not all wheeze and cough are caused by asthma, and caution is needed to avoid giving infants and young children unnecessary prolonged asthma therapy.
The present study is the first to compare the ICS budesonide inhalation solution (BIS) and montelukast, an LTRA, as long-term asthma controller therapies in young children ages 2-8 years with mild persistent asthma or recurrent wheezing episodes over a 1-year period. The results of this study demonstrated that both BIS and montelukast were effective in this group of children with mild asthma or recurrent wheezing. No significant differences were observed between the BIS and montelukast groups on the primary efficacy variable, time to first additional medication for asthma worsening at 52 weeks, with either step-up BIS given for mild asthma exacerbations or oral corticosteroid for severe exacerbations.
The lack of significant differences between BIS and montelukast on the primary efficacy measure was unexpected. Although several secondary outcomes (exacerbation rates, peak expiratory flow, diary variables) suggested that BIS was more efficacious and yielded better outcomes than montelukast, perhaps some support exists for those who would choose the alternative LTRA for the mild persistent asthmatic.
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