ANTI-LEUKOTRIENE COMPARED TO INHALED CORTICOSTEROID FOR RECURRENT WHEEZING IN CHILDREN LESS THAN FIVE YEARS OF AGE
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Keywords
Asthma, Wheezing, Fluticasone, Montelukast
Abstract
Background: Many children with asthma continue to have symptoms even after receiving maintenance treatment with medicines.
Objective: The aim of this study was to compare the anti-leukotriene versus inhaled corticosteroid in the treatment of recurrent wheezing in children less than five years
Material and method: The present randomized control study was carried out at the department of Pediatrics Gambat Institute of medical and health sciences from January 2017 to June 2017 after taking permission from the research committee of the institute. A total 74 children less than 5 years of age of both genders with recurrent wheeze (more than three episodes in the previous year) or moderate persistent asthma according to NIH guidelines (two or less nighttime symptoms per month and everyday symptoms that occur many times per week but not daily) were included. The participants of the study were divided equally in to group A and B .The group a was treated with inhaled fluticasone 55 mcg twice daily with a spacer device with a face mask, and group B received the granules of 4 mg montelukast daily in the evening. Both the groups were followed up for 6 months and decline in the wheezing was considered as the response to the medicines. The data was analyzed using the SPSS version 16.
Results: A total of 74 individuals were enrolled in this study out of which 37(50%) were girls and 37(50%) were boys. Gender differences were not statistically significant. 40 patients (54.0%) had wheezing symptoms when crying, 70 patients (94.5%) while resting, and 30 patients (40%) while sleeping. Furthermore, 31 patients (41.8%) had a family history of asthma, 53 patients (71.6%) had a family history of atopy, & 50%) of the participants had a history of passive smoking. Children under five who wheezed did not have a statistically significant correlation with a family history of asthma, atopy, or smoking habit (P > 0.05). Following six months of inhaled fluticasone therapy, thirty individuals (81.0%) showed substantial improvement (P less than 0.001). Additionally, following six months of intervention, 27 of the participants (72.9%) in the montelukast group had a substantial response to therapy (P < 0.001). The response to therapy did not differ statistically significantly between the two patient groups receiving montelukast or inhaled fluticasone.
Conclusion: The current study concluded that there was no statistically significant difference in the decrease of wheeze in children under five years old between the therapeutic effects of fluticasone and montelukast.
References
2. Wenzel S. Severe asthma: from characteristics to phenotypes to endotypes. Clinical and experimental allergy. J Br Soc Allergy Clin Immunol 2012;42(5):650-8.
3. Gozde Kanmaz H, Harmanci K, Razi C, Kose G, Cengizlier MR. Specific immunotherapy improves asthma related quality of life in childhood. Allergologia et Immunopathologia. 2011;39:68-72.
4. Chauhan BF, Ben Salah R, Ducharme FM. Addition of anti-leukotriene agents to inhaled corticosteroids in children with persistent asthma. Cochrane Database 2013;10:CD009585.
5. Chauhan BF, Ducharme FM. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children. Cochrane Database 2012;5:CD002314.
6. Ciolkowski J, Mazurek H, Stasiowska B. Evaluation of step-down therapy from an inhaled steroid to montelukast in childhood asthma. Allergologia et Immunopathologia. 2013.
7. Amirav I. Real-life effectiveness of singulair (montelukast) in 506 children with mild to moderate asthma. IMAJ 2008;10(4):287-91.
8. Amlani S, McIvor RA. Montelukast in childhood asthma: what is the evidence for its use? Expert Rev Resp Med 2011;5(1):17-25.
9. Liu CH, Shao MJ, Wang Q, Sha L, Li S, Luo YQ, et al. Epidemiological survey of children asthma prevalence in Beijing urban area. Zhonghua yi xue za zhi. 2013;93(8):574-8.
10. Brand P, de Jongste J. Treating asthma in children successfully: 10 tips. Nederlands tijdschrift voor geneeskunde. 2013;157(19): A5500.
11. Chisolm SS, Taylor SL, Balkrishnan R, Feldman SR. Written action plans: potential for improving outcomes in children with atopic dermatitis. J Am Acad Dermatol 2008;59(4):677-83.
12. Liu AH, Gilsenan AW, Stanford RH, Lincourt W, Ziemiecki R, Ortega H. Status of asthma control in pediatric primary care: results from the pediatric Asthma Control Characteristics and Prevalence Survey Study (ACCESS). J Pediatr 2010;157(2):276-81.
13. Ducharme FM, Bhogal SK. The role of written action plans in childhood asthma. Curr Opin Allergy ClinImmunol 2008;8(2):177-88.
14. Cornell A, Shaker M, Woodmansee DP. Update on the pathogenesis and management of childhood asthma. Curr Opin Pediatr 2008;20(5): 597-604.
15. Bacharier LB. Management of asthma in preschool children with inhaled corticosteroids and leukotriene receptor antagonists. Curr Opin Allergy Clin Immunol 2008;8(2):158-62.
16. Cabana MD, Kunselman SJ, Nyenhuis SM, Wechsler ME. Researching asthma across the ages: Insights from the National Heart, Lung, and Blood Institute's Asthma Network. J Allergy Clin Immunol 2014;133(1):27-33
16.Kovesi T, Schuh S, Spier S, Bérubé D, Carr S, Watson W, et al. Achieving control of asthma in preschoolers. CMAJ. 2010;182(4):E172-83. doi: 10.1503/cmaj.071638.
17.van Aalderen WM, Sprikkelman AB. Inhaled corticosteroids in childhood asthma: the story continues. Eur J Pediatr. 2011;170(6):709-18. doi: 10.1007/s00431-010-1319-z.
18.Chavasse RJ, Bastian-Lee Y, Richter H, Hilliard T, Seddon P. Persistent wheezing in infants with an atopic tendency responds to inhaled fluticasone. Arch Dis Child. 2001;85(2):143-8. doi: 10.1136/adc.85.2.143
19.Morgan WJ, Stern DA, Sherrill DL, Guerra S, Holberg CJ, Guilbert TW, et al. Outcome of asthma and wheezing in the first 6 years of life: follow-up through adolescence. Am J Respir Crit Care Med. 2005;172(10):1253-8. doi: 10.1164/rccm.200504-525OC
20.Hossny E, Rosario N, Lee BW, Singh M, El-Ghoneimy D, Soh JY, et al. The use of inhaled corticosteroids in pediatric asthma: update. World Allergy Organ J. 2016;9:26. doi: 10.1186/s40413-016-0117-0
21.Castro-Rodriguez JA, Custovic A, Ducharme FM. Treatment of asthma in young children: evidence-based recommendations. Asthma Res Pract. 2016;2:5. doi: 10.1186/s40733-016-0020-z
22.Shin J, Oh SJ, Petigara T, Tunceli K, Urdaneta E, Navaratnam P, et al. Comparative effectiveness of budesonide inhalation suspension and montelukast in children with mild asthma in Korea. J Asthma. 2020;57(12):1354-64. doi: 10.1080/02770903.2019.1648504.
23.Nagao M, Ikeda M, Fukuda N, Habukawa C, Kitamura T, Katsunuma T, et al. Early control treatment with montelukast in preschool children with asthma: a randomized controlled trial. Allergol Int. 2018;67(1):72-8. doi: 10.1016/j.alit.2017.04.008.
24. Scaparrotta A, Di Pillo S, Attanasi M, Rapino D, Cingolani A, Consilvio NP, et al. Montelukast versus inhaled corticosteroids in the management of pediatric mild persistent asthma. Multidiscip Respir Med. 2012;7(1):13. doi: 10.1186/2049-6958-7-13.
25.Robertson CF, Price D, Henry R, Mellis C, Glasgow N, Fitzgerald D, et al. Short-course montelukast for intermittent asthma in children: a randomized controlled trial. Am J Respir Crit Care Med. 2007;175(4):323-9. doi: 10.1164/rccm.200510-1546OC.
26. Walia M, Lodha R, Kabra SK. Montelukast in pediatric asthma management. Indian J Pediatr. 2006;73(4):275-82. doi: 10.1007/bf02825818.
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Arifa Jabeen
Assistant professor Pediatrics Gambat Institute of medical and health sciences
Amna Begum
FCPS.MBBS Consultant Gynaecologist Assistant professor Pir Sayed Abdul Qadir Shah Jilani Institute of Medical Sciences Gambat
Asghar Ali Memon
Assistant Professor, department of community medicine, GMMMC, (SMBBMU) Larkana
Waheed Ali
Cardiologist PG trainee in NICVD Karachi
Asma waheed
Gynecologist PG trainee in Shaikh Zaid women Hospital Larkana