Use of inhaled steroid and montelukast may be related to behavioral problems, including hyperactivity

An increased prevalence of behavioral problems has been described among children with asthma.

This Turkish study included 400 children with asthma. They were assessed for the following behavioral problems:

- attention deficit-hyperactivity disorder (ADHD)
- attention deficit (AD)
- hyperactivity and impulsivity (HI)
- oppositional defiant disorder (ODD)

Prevalences of AD, hyperactivity, ADHD, and ODD were not significantly different between the study and control groups.

Among those patients receiving leukotriene antagonist (LTRA) drugs adjunctive to inhaled corticosteroids (ICS), duration of treatment was correlated with hyperactivity (P = 0.03), AD (P = 0.04), ADHD (P = 0.042), and ODD (P = 0.03).

Patients with asthma receiving LTRA abd ICS treatment had a higher risk for oppositional behavior (4 times compared with the control group (P = 0.04) and 8 times compared with patients with asthma not using any drug (P = 0.02).

The authors concluded that tather than asthma itself, adjunctive use of ICS+LTRA therapy appears to be related with symptoms of common behavioral problems, including hyperactivity, AD, ADHD, and ODD and to increase the risk of ODD.

However, most of the p values in this study were marginally significant, with large confidence intervals, and I would not put too much emphasis on the results until I see more convincing evidence of causation, rather than association.

Asthma Inhalers (click to enlarge the image).


Common behavioral problems among children wıth asthma: Is there a role of asthma treatment? Hulya Ercan Saricoban et al. Ann of Allergy, Asthma and Immunology, Volume 106, Issue 3, Pages 200-204 (March 2011).
Montelukast failure index that may be helpful in predicting response in patients with asthma
Image source:, public domain.

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