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Pretreatment with albuterol versus montelukast for exercise-induced bronchospasm in children.
Pharmacotherapy. 2008 Mar; 28(3):287-94.P

Abstract

STUDY OBJECTIVES

To compare pretreatment with albuterol versus montelukast added to the current asthma regimen for protection against exercise-induced bronchospasm in children with mild-to-moderate asthma, and to determine whether cysteinyl leukotriene (Cys-LT) concentrations measured in the exhaled breath condensate correlated with response to montelukast.

DESIGN

Prospective, randomized, double-blind, double-dummy, crossover study.

SETTING

Asthma clinic at a university-affiliated medical center.

PATIENTS

Eleven children aged 7-17 years with physician-diagnosed mild-to-moderate asthma for at least 6 months and with self-reported exercise-induced bronchospasm (defined as > or = 15% decrease in forced expiratory volume in 1 sec [FEV(1)] at screening and baseline visit).

INTERVENTION

Patients were randomly assigned to receive 3-7 days of oral montelukast 5-10 mg/day or 2 puffs of an albuterol metered-dose inhaler just before an exercise challenge and then were crossed over to the alternate therapy for the last visit.

MEASUREMENTS AND MAIN RESULTS

Serial spirometry was performed before and at 0, 5, 10, 15, 30, 45, and 60 minutes after the exercise challenge at each visit. Measurement of exhaled breath condensate was performed at the screening visit and study visits 1 and 2. The primary outcome was the maximum change in FEV(1) after exercise. Secondary outcomes were the area under the curve for FEV(1) (expressed as percentage decrease from baseline) during the first 60 minutes (AUC(0-60)) after exercise and the proportion of patients in whom exercise-induced bronchospasm was prevented (defined as < 15% decrease in FEV(1) after exercise challenge). The mean +/- SD maximum decrease in FEV(1) was 27.5 +/- 7.9% at baseline. Patients receiving montelukast had an 18.3 +/- 13.7% decrease in FEV(1) compared with 0.7 +/- 1.6% in patients receiving albuterol (p=0.002, paired t test). Exercise-induced bronchospasm was prevented in 100% of the patients receiving albuterol compared with 55% receiving montelukast (p<0.05, McNemar's test). The AUC(0-60) was significantly smaller with albuterol compared with montelukast (p<0.001, Wilcoxon signed rank test). No correlations were found between Cys-LT concentration and the severity of exercise-induced bronchospasm or the response to montelukast.

CONCLUSION

Pretreatment with albuterol is more effective than montelukast for prevention of exercise-induced bronchospasm in children with asthma.

Authors+Show Affiliations

Departments of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, New Mexico 87131-0001, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18294107

Citation

Raissy, Hengameh H., et al. "Pretreatment With Albuterol Versus Montelukast for Exercise-induced Bronchospasm in Children." Pharmacotherapy, vol. 28, no. 3, 2008, pp. 287-94.
Raissy HH, Harkins M, Kelly F, et al. Pretreatment with albuterol versus montelukast for exercise-induced bronchospasm in children. Pharmacotherapy. 2008;28(3):287-94.
Raissy, H. H., Harkins, M., Kelly, F., & Kelly, H. W. (2008). Pretreatment with albuterol versus montelukast for exercise-induced bronchospasm in children. Pharmacotherapy, 28(3), 287-94. https://doi.org/10.1592/phco.28.3.287
Raissy HH, et al. Pretreatment With Albuterol Versus Montelukast for Exercise-induced Bronchospasm in Children. Pharmacotherapy. 2008;28(3):287-94. PubMed PMID: 18294107.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pretreatment with albuterol versus montelukast for exercise-induced bronchospasm in children. AU - Raissy,Hengameh H, AU - Harkins,Michelle, AU - Kelly,Franceska, AU - Kelly,H William, PY - 2008/2/26/pubmed PY - 2008/6/5/medline PY - 2008/2/26/entrez SP - 287 EP - 94 JF - Pharmacotherapy JO - Pharmacotherapy VL - 28 IS - 3 N2 - STUDY OBJECTIVES: To compare pretreatment with albuterol versus montelukast added to the current asthma regimen for protection against exercise-induced bronchospasm in children with mild-to-moderate asthma, and to determine whether cysteinyl leukotriene (Cys-LT) concentrations measured in the exhaled breath condensate correlated with response to montelukast. DESIGN: Prospective, randomized, double-blind, double-dummy, crossover study. SETTING: Asthma clinic at a university-affiliated medical center. PATIENTS: Eleven children aged 7-17 years with physician-diagnosed mild-to-moderate asthma for at least 6 months and with self-reported exercise-induced bronchospasm (defined as > or = 15% decrease in forced expiratory volume in 1 sec [FEV(1)] at screening and baseline visit). INTERVENTION: Patients were randomly assigned to receive 3-7 days of oral montelukast 5-10 mg/day or 2 puffs of an albuterol metered-dose inhaler just before an exercise challenge and then were crossed over to the alternate therapy for the last visit. MEASUREMENTS AND MAIN RESULTS: Serial spirometry was performed before and at 0, 5, 10, 15, 30, 45, and 60 minutes after the exercise challenge at each visit. Measurement of exhaled breath condensate was performed at the screening visit and study visits 1 and 2. The primary outcome was the maximum change in FEV(1) after exercise. Secondary outcomes were the area under the curve for FEV(1) (expressed as percentage decrease from baseline) during the first 60 minutes (AUC(0-60)) after exercise and the proportion of patients in whom exercise-induced bronchospasm was prevented (defined as < 15% decrease in FEV(1) after exercise challenge). The mean +/- SD maximum decrease in FEV(1) was 27.5 +/- 7.9% at baseline. Patients receiving montelukast had an 18.3 +/- 13.7% decrease in FEV(1) compared with 0.7 +/- 1.6% in patients receiving albuterol (p=0.002, paired t test). Exercise-induced bronchospasm was prevented in 100% of the patients receiving albuterol compared with 55% receiving montelukast (p<0.05, McNemar's test). The AUC(0-60) was significantly smaller with albuterol compared with montelukast (p<0.001, Wilcoxon signed rank test). No correlations were found between Cys-LT concentration and the severity of exercise-induced bronchospasm or the response to montelukast. CONCLUSION: Pretreatment with albuterol is more effective than montelukast for prevention of exercise-induced bronchospasm in children with asthma. SN - 0277-0008 UR - https://www.unboundmedicine.com/medline/citation/18294107/Pretreatment_with_albuterol_versus_montelukast_for_exercise_induced_bronchospasm_in_children_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=18294107.ui DB - PRIME DP - Unbound Medicine ER -