Fluticasone or montelukast for preschool children with asthma-like symptoms: Randomized controlled trial

Kooi, Elisabeth M. W.; Schokker, Siebrig; Boezen, H. Marike; Vries, Tjalling W. de; Vaessen-Verberne, Anja; Molen, Thys van der; Duiverman, Eric J.

doi:10.1016/j.pupt.2008.06.004

Cited by 47 publications

(53 citation statements)

References 34 publications

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“…Kooi et al [24] completed a small RCT ( n = 63 Dutch children aged 2–6 years. with asthma-like symptoms) comparing daily fluticasone (100 μg twice daily) vs. montelukast (4 mg/day) vs. placebo for three months.…”

Section: Resultsmentioning

confidence: 99%

Treatment of asthma in young children: evidence-based recommendations

Castro-Rodriguez

Čustović

Ducharme

2016

asthma res and pract

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In the present review, we focus on evidence-based data for the use of inhaled corticosteroids (ICS), leukotriene receptor antagonist (LTRA), long-acting beta2-agonits (LABA) and oral corticosteroids (OCS), with a special emphasis on well-performed randomized clinical trials (RCTs) and meta-analyses of such trials for the chronic management of asthma/wheeze in infants and preschoolers. Results: Seven meta-analyses and 14 RCTs were reviewed. Daily ICS should be the preferred drug for infants/preschoolers with recurrent wheezing, especially in asthmatics. For those with moderate or severe episodes of EVW, the use of high intermittent ICS doses significantly reduce the use of OCS. There is no evidence of effect of intermittent ICS at low-moderate dose in preschoolers with mild EVW episodes. In preschoolers with asthma, there were no significant differences between daily vs. intermittent ICS in terms of asthma exacerbations with insufficient power to conclude to equivalence; however, for other asthma control outcomes, daily ICS works significantly better than intermittent ICS for older children. Daily ICS is superior to daily or intermittent LRTA for reducing symptoms, preventing exacerbations, and improving lung function. No RCTs testing combination therapy with ICS and LABA (or LTRA) were published in infant/preschoolers. Parent-initiation of OCS at the first sign of symptoms is not effective in children with recurrent wheezing episode. In terms of ICS safety, growth suppression is dose and molecule-dependent but it’s effect is not cumulative beyond the first year of therapy and may be associated with some catch-up growth while on or off therapy. Linear growth must be monitored as individual susceptibility to ICS drugs may vary considerably.

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Section: Resultsmentioning

confidence: 99%

Treatment of asthma in young children: evidence-based recommendations

Castro-Rodriguez

Čustović

Ducharme

2016

asthma res and pract

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“…In a blinded, placebo-controlled study of 63 children, fluticasone propionate treatment significantly improved symptoms over placebo, whereas montelukast did not, and fluticasone propionate also improved lung function after three months 90 (Evidence B).…”

Section: Inhaled Glucocorticosteroids and Leukotriene Modifiersmentioning

confidence: 99%

Global strategy for the diagnosis and management of asthma in children 5 years and younger

Pedersen

Hurd

Lemanske

et al. 2010

Pediatric Pulmonology

267

207

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Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease as measured by school absences, emergency department visits, and hospitalions1. During the past two decades, many scientific advances have improved our understanding of asthma and our ability to manage and control it effectively. However, in children 5 years and younger, the clinical symptoms of asthma are variable and non‐specific. Furthermore, neither airflow limitation nor airway inflammation, the main pathologic hallmarks of the condition, can be assessed routinely in this age group. For this reason, to aid in the diagnosis of asthma in young children, a symptoms‐only descriptive approach that includes the definition of various wheezing phenotypes has been recommended2. In 1993, the Global Initiative for Asthma (GINA) was implemented to develop a network of individuals, organizations, and public health officials to disseminate information about the care of patients with asthma while at the same time assuring a mechanism to incorporate the results of scientific investigations into asthma care. Since then, GINA has developed and regularly revised a Global Strategy for Asthma Management and Prevention. Publications based on the Global Strategy for Asthma Management and Prevention have been translated into many different languages to promote international collaboration and dissemination of information.In this report, Global Strategy for Asthma Management and Prevention in Children 5 Years and Younger, an effort has been made to present the special challenges that must be taken into account in managing asthma in children during the first 5 years of life, including difficulties with diagnosis, the efficacy and safety of drugs and drug delivery systems, and the lack of data on new therapies. Approaches to these issues will vary among populations in the world based on socioeconomic conditions, genetic diversity, cultural beliefs, and differences in healthcare access and delivery. Patients in this age group are often managed by pediatricians and general practitioners routinely faced with a wide variety of issues related to childhood diseases. Pediatr Pulmonol. 2011; 46:1–17. © 2010 Wiley‐Liss, Inc.

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“…Although symptoms were improved in all treatment groups, only FP produced a statistically significant improvement compared with placebo, whereas only montelukast significantly reduced blood eosinophils [130].…”

Section: Studies In Children (Aged ~5 Years)mentioning

confidence: 87%