Can montelukast shorten prednisolone therapy in children with mild to moderate acute asthma? A randomized controlled trial.
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.
Schuh
Suzanne
S
Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. suzanne.schuh@sickkids.ca
Willan
Andrew R
AR
Stephens
Derek
D
Dick
Paul T
PT
Coates
Allan
A
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
D000085:Acetates; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D011239:Prednisolone; C093875:montelukast