Source: Blood  |  Posted 4 years ago

By Bryan DeBusk

SAN DIEGO, CA -- February 26, 2007 -- By supplementing existing control measures with a readily available leukotriene receptor antagonist, physicians may be able to reduce the frequency of worsening symptoms and unscheduled office visits that result from an epidemic of asthma in children each September, according to findings presented here at the 2007 American Academy of Allergy, Asthma, and Immunology (AAAAI) annual meeting.

"During the September back-to-school season there is an increased incidence of hospitalisations and emergency visits and worsening of asthma," said Piush Mandhane, MD, clinical scholar, Firestone Institute for Respiratory Health, Hamilton, Ontario, Canada. "We looked for an easy way for physicians to reduce the epidemic of asthma during that period."

In a randomised, double-blind, placebo-controlled, 45-day study of individuals with physician-diagnosed asthma, Dr. Piush and his colleagues assigned children aged 2 to 14 years to receive an age-specific dose of montelukast (n = 98) or placebo (n = 94) from September 1[^]st[] through October 15[^]th[]. Participants used colour-coded stickers to record the daily severity of asthma symptoms on a magnet-backed refridgerator calendar, and 99.7% of 8,720 possible days were reported.

Compared with the group receiving placebo, participants taking montelukast reported 53% fewer days of worsened asthma symptoms over the course of the study (3.9% of days vs 8.3%, []P[] < .02). Participants taking montelukast also reported 78% fewer unscheduled physician visits for treatment of asthma symptoms (4 visits in 4 subjects vs 18 visits in 14 subjects, []P[] = .011).

In the session on February 24[^]th[], Dr. Mandhane noted that 1 of the most striking findings of the study was a significant difference between boys and girls and a difference by age.

Boys aged 2 to 5 years experienced 0.4% of days with worse symptoms compared with 8.8% on placebo ([]P[] < .001), while girls in the same age group did not experience a significant difference between treatment and placebo in the number of days with worse symptoms (5.7% vs 6.9%, []P[] = .44).

The difference in response was reversed among children aged 10 to 14 years with no significant difference in days of worse symptoms for boys but 4.6% days of worse symptoms for girls on montelukast compared with 17% with placebo ([]P[] = .03).

Participants aged 6 to 9 years reported intermediate results (2.0% vs 7.0%, []P[] = .12 among boys; 4.5% vs 4.6% among girls).

Dr. Mandhane and colleagues intend to further examine the effects of age and sex on treatment response in future studies.

This study was funded by a Medical School Grant from Merck-Frosst Canada Limited.

[Poster title: Montelukast Added to Usual Therapy During the September Epidemic of Asthma Exacerbations in Children. Abstract 14]