Inhaled corticosteroids (ICS) are the main treatment for persistent asthma in younger children in the UK. Montelukast is infrequently used as monotherapy.
To evaluate asthma outcomes in children commenced on ICS or Montelukast as first maintenance treatment in routine practice utilizing the General Practice Research Database.
Children aged 2–5 yrs. prescribed Montelukast or ICS as first maintenance asthma treatment having 12 months data before and after initiation were identified. Successful treatment was defined as: no hospital attendance, no oral corticosteroids, average daily dose of short acting B agonist (SABA) of under 1 dose/day over next 12 months.
Baseline data: no significant differences between Montelukast (n = 24) or ICC (n = 27041) cohorts in age, sex, rhinitis, respiratory hospitalisations, receipt of antibiotics for respiratory infections, courses of oral corticosteroids; montelukast cohort had fewer asthma consultations (Median, IQR) 0 (0–1) vs. 0 (0–1) p = 0.03, SABA devices prescribed, 0.5 (0–1) vs. 1.0 (0–2) p = 0.01. In the subsequent 12 months, the montelukast cohort were prescribed fewer SABA inhalers: 1, (0–2) vs. 2 (1–3) p > 0.001, fewer oral corticosteroid courses: (0 (0–0) vs. 0 (0–0), average 0.04 vs. 0.34, p = 0.03. No significant differences in asthma consultations, respiratory hospitalisations or antibiotics for respiratory infections. Successful treatment was observed for 58% of LTRA and 33% of ICS cohort (p = 0.01). Adjusted for baseline differences, odds ratio (95% CI) for success with LTRA was 2.4 (1.0–5.4) p = 0.04.
In this ‘real-work’ database, limited experience with montelukast showed superior success to ICS therapy. Further research is required.
Conflict of interest and funding
None. Funding: An unrestricted grant from MSD.
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Price, D., von Ziegenweidt, J. & Thomas, M. ABS41: Montelukast as first-line preventative treatment for asthma in children age 2-5 yrs: A retrospective study. Prim Care Respir J 15, 196 (2006) doi:10.1016/j.pcrj.2006.04.139