title: Can montelukast shorten prednisolone therapy in children with mild to moderate acute asthma? A randomized controlled trial.
abstract: OBJECTIVE
  To examine whether outpatient post-stabilization therapy with montelukast produces more treatment failures than prednisolone.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors: Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. suzanne.schuh@sickkids.ca
authors: Suzanne
authors: S
authors: Schuh
authors: Andrew R
authors: AR
authors: Willan
authors: Derek
authors: D
authors: Stephens
authors: Paul T
authors: PT
authors: Dick
authors: Allan
authors: A
authors: Coates
mesh_terms: D000085:Acetates / Q000008:administration & dosage*; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003521:Cyclopropanes; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage*; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage*; D011804:Quinolines / Q000008:administration & dosage*; D013440:Sulfides; D016896:Treatment Outcome
chemical_list: D000085:Acetates; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D011239:Prednisolone; C093875:montelukast