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INHALED CORTICOSTEROIDS VERSUS MONTELUKAST IN REDUCING ASTHMA EXACERBATIONS IN CHILDREN 6 MONTHS TO 5 YEARS OF AGE

ABSTRACT:

Asthma is a leading cause of chronic disease in children globally. According to the 2011 report of GINA guidelines, asthma is a problem worldwide with an estimated 300 million individuals affected 1() The diagnosis and management of asthma in young children is difficult, since there are many different wheezy phenotypes with varying underlying etiologies and outcomes,.2() provided the clinical symptoms of asthma are variable and non-specific 3(). Therefore, many infants and young children do not receive adequate therapy. On the other hand, not all wheeze and cough are caused by asthma, and caution is needed to avoid giving infants and young children inappropriate prolonged asthma therapy.4() In this study comparing the effectiveness of ICS versus Montelukast, in reducing asthmatic exacerbation in uncontrolled asthma,ICS was found to be superior than montelukast in nearly all measured outcomes (97) Montelukast is a valid alternative to ICS especially in poorly compliant preschool children, or in subjects who show adverse effects related to long-term steroid therapy (98) . The enormous prevalence of asthma and the reluctance to prescribing the adequate controller therapy was the basic aim behind this study. We lack a consensus protocol for the choice of adequate controller therapy. Currently there are different guidelines which address the management of asthma in young children. This review discusses the approach to manage young children with asthma based on the recommendations of the GINA guidelines.(KEY WORDS: asthma, GINA, ICS, montelukast)OBJECTIVES:Inhaled corticosteroids are more effective than Montelukast in reducing exacerbations in uncontrolled bronchial asthma in children 6 months to 5 years of age.

STUDY DESIGN: Randomized controlled trial study.

SETTING: Pediatric Unit 1 Bolan Medical Complex Hospital Quetta from March 2011 to august 2011.

METHODS:Children 6 months to 5 years of age were admitted to the ward via OPD and emergency. The patients parents were informed about the study duration and informed consent was taken. Baseline tests including CBC, Chest X-ray and blood sugar were done. The patients who fulfilled the inclusion criteria were included in the study. The patients were classified into uncontrolled asthma according to the GINA guidelines. Patient comfort and temperature maintenance were kept in consideration. Patients were given ICS and tab Montelukast by lottery method to remove the bias. Those receiving ICS were named as group A and those receiving Montelukast were labeled as B .The doses for ICS was 200 microgram per day for uncontrolled asthma. Leukotriene modifiers were given in a dose of 4 mg once a day below 1 year and 5 mg once a day above 1 year. They were followed up monthly for up to 6 months. Patients who were admitted to emergency department in exacerbation or status were considered as treatment failure. The results of the study were analyzed after six months.RESULTS: Various synonymous terms are given in the data, so those terms are assembled and so their percentages. Those synonymous terms are as follows:

ICS improved/ICS stepped down/ICS recovered/ICS controlled/ ICS exacerbation

These terms were collectively labeled as ICS stepped down ICS stepped up/ICS treatment stepped up as ICS stepped up Mont improved/mont stepped down/montelukast improved/mont controlled as montelukast stepped down

Mont stepped up/mont exacerbation/montelukast exacerbation as montelukast stepped up. Mont admitted in status/mont give status asthmaticus as montelukast in exacerbation.

Mont not improved/mont static

In 6 months duration of study, out of 2400 participants,1200 were prescribed an inhaled glucocorticosteroids and 1200 were put on montelukast. The results of the treatment response seen after 6 months of study trial were as follows:GENDER

As shown in the table 8 majority of the patients enrolled for the study were boys making up about 1383 out of 2400 i.e.,57.625% remaining 1017(42%) were females with the mean value of 1.4238 and standard deviation 0.49425.the P value for the sex is significant i.e., ,