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Learning Objective 1: The learner will be able to discuss advantages and disadvantages of using montelukast compared to inhaled corticosteroids in pediatric patients.
Learning Objective 2: The learner will be able to discuss the implications for use of inhaled corticosteroids compared to montelukast in pediatric patients.
Introduction: Asthma is the most common chronic illness in the pediatric population. Inhaled corticosteroids (ICS) are a first-line treatment for mild-moderate persistent asthma, but leukotriene receptor antagonists such as montelukast have been shown to be beneficial. The aim of this systematic review is to evaluate the current evidence comparing monotherapy with montelukast or inhaled corticosteroids in pediatric patients.
Method: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to evaluate treatment of children with mild-moderate persistent asthma using monotherapy with either montelukast or inhaled corticosteroids in patients ages 2-18 years. PubMed, CINAHL and the Institute of Scientific Information’s Web of Knowledge were searched independently by three reviewers using keywords asthma, montelukast, and inhaled corticosteroids. In order to capture current data, the search was conducted between January 2002-November 2011. Inclusion criteria included randomized controlled trials published in the English language. The quality of each study was evaluated by two reviewers.
Results: A total of 214 studies were identified and 8 randomized controlled trials met our inclusion criteria and were included in the review. Seven out of eight studies showed high quality. The primary outcome measures assessed include forced expiratory volume in 1 second, peak expiratory flow rate, time to asthma exacerbations, number of exacerbations, number of asthma free days, and daily symptom scores. Four studies showed statistically significant results favoring inhaled corticosteroid therapy over montelukast. Four studies showed no difference between inhaled corticosteroids and montelukast.
Conclusion/Implications: Inhaled corticosteroids remain superior to montelukast as a preferred first-line treatment for asthma. However, montelukast may be an effective alternative for specific cases in improving pulmonary function in patients with specific asthma phenotypes in the pediatric setting.