0933 ‘Research opportunities’ in asthma management

In similar vein to all the neonatal research around treatment and prevention of bronchopulmonary dysplasia in preterm infants, there appears to be almost no end to the treatment modifications that can be researched in children with asthma. In a 2004 summary in this series, montelukast was being advocated as a treatment option for 2-5 year olds, with advice to revert to steroids if the anti-leukotriene failed to control symptoms. The same summary commented on a Cochrane review that indicated there would be one additional exacerbation requiring systemic steroids for every 26 montelukast-treated patients and one extra withdrawal for poor asthma control for every 29 patients. Studies continue to appear in the literature comparing montelukast to placebo or to inhaled steroids, and the message appears to be fairly consistent: montelukast works better than placebo and not as well as fluticasone or beclomethasone. One may still try montelukast as a first option for mild intermittent or persistent asthma, but as per the Cochrane review, expect failures and be prepared to change treatment. The combination has also been shown to be effective i.e. montelukast added to inhaled steroids is better than either drug alone. More recently another combination has been tried, loratidine added to montelukast. The combination works better than loratidine alone, but still not as well as steroids on their own.

Read more:
J Asthma 2009; 46: 465-9
Eur J Pediatr 2008;167: 731-6
Am J Respir Crit Care Med 1999; 160: 1862-8