title: Montelukast for the high impact of asthma exacerbations in Venezuela: a practical and valid approach for Latin America?
abstract: BACKGROUND
  Asthma affects mainly Venezuela's urban and poor majority. Exacerbations bring about a high demand in health services, thus becoming a significant public health problem. In general, asthma control programs (GINA) with use of inhaled steroid medications have proven effective, although their implementation in real life remains cumbersome. Montelukast could be a useful and practical tool for these deprived socioeconomic sectors.
  
  
  METHODS
  This real-life pilot study was conducted in a prospective, double blinded, placebo-controlled manner with randomized and parallel groups. Asthmatics that had never used leukotriene modifiers were recruited and followed-up every three months. The main outcome was the number of exacerbations meriting use of nebulized bronchodilators administered by the health care system.
  
  
  RESULTS
  Eighty-eight asthmatic patients were enrolled, between children and adults. Groups were comparable in: demographic data, previous use of other medications, ACT scores, pulmonary functions (Wright Peak Flow meter), allergy status (Skin Prick Test) as well as adherence to the prescribed Montelukast treatment. By an intention to treat (ITT), a total of 64 patients were included for analysis. For the three and six months time points the difference between placebo and Montelukast was found to be significant (p < 0.03 and p < 0.04, respectively). Such trends continued for the rest of the year, but without statistical significance, due to patient attrition.
  
  
  CONCLUSIONS
  This real-life pilot study shows that a simplified strategy with oral Montelukast was practical and effective in controlling exacerbations in an asthmatic population of a vulnerable community from Caracas. Such an approach reinforces the role of primary care in asthma treatment.
authors.affiliation: Centro Médico de Caracas; Centro Médico Docente La Trinidad y Programa de Medicina Comunitaria; Allergology Unit, Hospital San, Juan de Dios, Caracas, Venezuela.
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Capriles Hulett
authors.affiliation: LETI Laboratories, Caracas, Venezuela.
authors.forename: Maria Gonzalez
authors.initials: MG
authors.lastname: Yibirin
authors.affiliation: General Practitioner, ambulatory health care facility "Los Erasos"; Health District 1, Ministry of Health, Caracas, Venezuela.
authors.forename: Amaris
authors.initials: A
authors.lastname: Garcia
authors.affiliation: Programa de Medicina Comunitaria, Centro Médico Docente, La Trinidad, Venezuela.
authors.forename: Dollys
authors.initials: D
authors.lastname: Hurtado
keywords: Asthma; Asthma control; Asthma exacerbations; Deprived urban majorities; Latin America; Montelukast; Practical approach; Venezuela