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:

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.

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

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