Budesonide vs. montelukast in children with mild persistent asthma: budesonide worked better

Both treatments provided acceptable asthma control; however, overall measures favored budesonide inhalation over montelukast (Singulair).

The percentage of patients requiring oral corticosteroids over 1 year was lower with budesonide vs. montelukast (25.5% vs. 32.0%.) Peak flow and Caregiver and Physician Global Assessments also favored budesonide.

Other studies in older children have also shown better outcomes with inhaled corticosteroids versus montelukast.

A mnemonic:

S
Singulair
Single daily dose
Suicude risk (potential)

Leukotriene Receptor Antagonists (LTRA)

Antagonists of the CysLT1 receptor (LTRA) are efficacious as controller therapy in asthma and montelukast is FDA-approved for treatment of seasonal allergic rhinitis.

Mast cells quickly generate different mediators from the metabolism of arachidonic acid: leukotrienes and prostglandins (LTC4, LTB4, PGD2). These substances are produced within minutes of IgE-receptor crosslinking on the surface of mast cells.


Eicosanoids are signaling molecules made by oxygenation of 20-carbon essential fatty acids. There are 4 families of eicosanoids (PP-LT): prostaglandins (PG), prostacyclins (PGI), leukotrienes (LT) and thromboxanes (TX).


Mast cell mediators including PP-LT): prostaglandins (PG), prostacyclins (PGI), leukotrienes (LT) and thromboxanes (TX). See more Allergy and Immunology mind maps here.

References:
Comparative study of budesonide inhalation suspension and montelukast in young children with mild persistent asthma. J Allergy Clin Immunol. 2007 Nov;120(5):1043-50. Szefler SJ, Baker JW, Uryniak T, Goldman M, Silkoff PE.

Urinary leukotriene E(4)/exhaled nitric oxide ratio predicts montelukast response in childhood asthma http://goo.gl/i5cG
Suicide and a common allergy medication. NewsChannel 13, WNYT.com.
Mast Cells and Basophils. Allergy Cases.
Pathogenesis of Asthma. Allergy Cases.

Image source: Montelukast, from Wikipedia, the free encyclopedia, public domain.

Updated: 02/27/2008