title: Addition of Montelukast to Low-Dose Inhaled Corticosteroid Leads to Fewer Exacerbations in Older Patients Than Medium-Dose Inhaled Corticosteroid Monotherapy.
abstract: OBJECTIVE
  There have been few reports regarding the efficacy of antiasthmatics in older patients. To compare the efficacy of the addition of montelukast to low-dose inhaled budesonide (MON-400BUD) versus increasing the dose of inhaled steroid (800BUD) on asthma control in older asthmatics.
  
  
  METHODS
  A randomized, open-label, parallel-designed trial was conducted for 12 weeks. The primary endpoint was the rate of patients who reached "well-controlled asthma status" after the 12-week treatment period. Additionally, asthma exacerbations, sputum inflammatory cells, asthma control test (ACT) and physical functioning scale (PFS), and adverse reactions were monitored.
  
  
  RESULTS
  Twenty-four (36.9%) and 22 (34.9%) subjects in the MON-400BUD (n=65) and 800BUD (n=63) groups had well-controlled asthma at the end of the study, respectively. The numbers of asthma exacerbations requiring oral corticosteroid treatment (20 vs 9, respectively, P=0.036) and the development of sore throat (22 vs 11, respectively, P=0.045) were significantly higher in the 800BUD group than in the MON-400BUD group. Body mass index and changes in ACT, FEV1%, 6-min walk distance and PFS from baseline were all significant determinants for distinguishing subjects with well-controlled and partly controlled asthma from those with uncontrolled asthma (P<0.05) at the end of the study.
  
  
  CONCLUSIONS
  The efficacy of 12-week treatment with MON-400BUD in older asthmatics was comparable to that of 800BUD on asthma control but associated with reduced frequency of asthma exacerbations requiring oral steroids and sore throat events. Changes in ACT and PFS can be useful predictors of asthma control status in older patients.
authors.affiliation: Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Young Min
authors.initials: YM
authors.lastname: Ye
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Sang Ha
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Gyu Young
authors.initials: GY
authors.lastname: Hur
authors.affiliation: Department of Internal Medicine, Hallym University School of Medicine, Anyang, Korea.
authors.forename: Joo Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung Won
authors.initials: JW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Jae Jeong
authors.initials: JJ
authors.lastname: Shim
authors.affiliation: Department of Internal Medicine, Hallym University School of Medicine, Anyang, Korea.
authors.forename: Ki Suck
authors.initials: KS
authors.lastname: Jung
authors.affiliation: Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea. hspark@ajou.ac.kr.
authors.forename: Hae Sim
authors.identifier: http://orcid.org/0000-0003-2614-0303
authors.initials: HS
authors.lastname: Park
keywords: Asthma control; asthma exacerbation; inhaled corticosteroid; leukotriene receptor antagonist; older; physical activity