Montelukast works better than salmeterol for exercise-induced asthma in children (study sponsored by Merck)

The prevalence of exercise-induced bronchoconstriction (EIB) is 10% in the general population, up to 90% of those with asthma, and 50% of those with allergic rhinitis.

This Merck-sponsored study evaluated the effect of montelukast 5 mg, or inhaled salmeterol, 50 mcg, added to inhaled fluticasone in reducing the maximum percentage decrease in forced expiratory volume in 1 second (FEV1) after an exercise challenge and response to rescue bronchodilation with albuterol in 154 children aged 6 to 14 years with persistent asthma and exercise-induced bronchoconstriction (EIB).

Exercise challenges were performed at baseline (pre-randomization) and at the end of each active treatment period.

Montelukast, compared with salmeterol, significantly reduced the percentage decrease in FEV1 (10.6% vs 13.8%) and time to recovery (6.0 vs 11.1 minutes).

Response to albuterol rescue after exercise challenge was significantly greater with montelukast.

Attenuation and response of EIB to albuterol rescue after exercise challenge were significantly better with montelukast than with salmeterol after 4 weeks of treatment.

Exercise-induced bronchospasm (EIB) (click to enlarge the image):


Effect of montelukast or salmeterol added to inhaled fluticasone on exercise-induced bronchoconstriction in children. Ann Allergy Asthma Immunol. 2010 Jun;104(6):511-7. Fogel RB, Rosario N, Aristizabal G, Loeys T, Noonan G, Gaile S, Smugar SS, Polos PG.
Urinary leukotriene E(4)/exhaled nitric oxide ratio predicts montelukast response in childhood asthma
Montelukast failure index that may be helpful in predicting response in patients with asthma
Image source: Montelukast, from Wikipedia, the free encyclopedia, public domain.

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