Effect of different antiasthmatic treatments on exercise-induced bronchoconstriction in children with asthma

The role of leukotriene receptor antagonists in exercise induced bronchoconstriction in children

“…Randomised control crossover study Participants -144 participants aged 6-14 years old -Asthmatic children receiving ICS with an FEV1 of ≥ 70% of the predicted value and a decrease in FEV1 ≥ 15% compared with pre-exercise baseline FEV1 on two occasions Intervention -Oral montelukast (5 mg) or inhaled salmeterol (50 μg) added to inhaled fluticasone for a 4 week period -All 144 participants received both medications over two separate treatment periods Outcomes -Maximum percentage decrease in FEV1 after a EC -Response to rescue bronchodilation with albuterol performed at baseline and at the end of each active treatment period -Results -Montelukast significantly reduced the mean maximum percentage decrease in FEV1 compared to salmeterol (10.6% compared to 13.8%) -Response to albuterol rescue after EC was also significantly greater with montelukast Notes Prevention of EIB and response of EIB to albuterol rescue were greatly improved with montelukast when compared to salmeterol after 4 weeks of treatment Montelukast (n = 25) of unspecified dose or placebo (n = 25) randomly assigned combined with aerobic training for 12 weeks Outcomes -Outcomes measured -Bronchial responsiveness to methacholine -EIB by FEV1 measurement -Inflammatory markers in exhaled breath condensate -Measured before and after 12 week training period -Results: -The methacholine dose sufficient to cause a ≥ 20% fall in FEV1 increased in both groups after training period -EIB prevalence halved after training in both groups -Children treated with montelukast showed decreased bronchial reactivity (FEV1 slope) and were protected agaist exacerbations greater with montelukast Notes -Aerobic exercise is beneficial in reducing EIB -There may be beneficial synergistic action when aerobic exercise is combined with montelukast [7].…”

“…Inhaled corticosteroids should be the first line of treatment in children with asthma Author Brand PL Methods Clinical practice review Participants Critically reviews and compares the efficacy of ICS to montelukast as first line therapy in children with asthma complicated by allergic rhinitis, virus-induced exacerbations, EIB and those experiencing difficulties with inhalation therapy from RCTs with clear guidelines regarding children Intervention -Inhaled corticosteroids or montelukast as first-line monotherapy for asthma with EIB -All other findings of the review were not included in this report Outcomes -Mean % fall in FEV1 following EC -Results: -Reduction in FEV1 following ICS OR montelukast therapy are comparable (around 50% for both) Notes Study found that the time length (4 weeks) of only known trial comparing two drugs head to head [7] was not sufficient to conclude that montelukast monotherapy is superior to ICS in treatment of EIB.…”

“…Stelmach et al compared five different treatment regimens and their efficacy in controlling EIB over a 4 week period [7]. The lowest maximum percentage fall in FEV1 following EC was in the budesonide and montelukast combined therapy groups (12.1%), and the montelukast monotherapy groups (11.5%).…”

“…This systematic review confirms that montelukast is an effective preventer of EIB both as monotherapy and a useful add-on medication when combined with ICS. In one study, montelukast provided greater protection against EIB when compared to ICS and LABA combination therapy [7].…”

Montelukast in the treatment of asthma and beyond

“…Moreover, in another study in asthmatic children (6-12 years), 4 weeks of treatment with montelukast (5 mg) significantly protected against EIB without the development of tolerance to the bronchoprotective effect [115]. More recently, a 4-week randomized, placebocontrolled study in children (aged 6-18 years) with atopic asthma, compared the protective effect against EIB of monotherapy with montelukast (5 or 10 mg), with budesonide (200 µg; n = 20), budesonide (200 µg) plus montelukast (5 or 10 mg; n = 20), and budesonide (200 µg) plus salmeterol (9 µg; n = 20), respectively [116]. Although all active treatment regimens appeared effective against EIB, montelukast offered the greatest protection, both as a single and a combination therapy [116].…”