From the Guidelines
Montelukast (Singulair) can be an effective addition to albuterol (Ventolin) for a 12-year-old with exercise-induced asthma, as it helps prevent airway narrowing triggered by exercise. For exercise-induced asthma, the typical regimen would include albuterol (2 puffs 15-30 minutes before exercise) as the primary quick-relief medication, while montelukast serves as a complementary daily controller medication. The standard dose for montelukast in a 12-year-old is 5 mg once daily, taken in the evening 1. This combination works well because the medications target different aspects of asthma. Albuterol is a short-acting beta-agonist that quickly relaxes airway muscles to provide immediate relief, while montelukast is a leukotriene receptor antagonist that reduces inflammation and constriction by blocking chemicals involved in the asthma response.
Key Points to Consider
- Montelukast has the advantages of ease of use and high rates of compliance, and it can provide good control of asthma symptoms in many patients 1.
- The response to montelukast varies between individuals, and it may take 1-2 weeks of daily use before the full benefits are apparent.
- Side effects are generally mild but may include headache, gastrointestinal symptoms, or rarely, mood changes that should be monitored.
- According to the most recent guidelines, for individuals aged 12 years and older with mild persistent asthma, intermittent ICS dosing may be considered, but regular follow-up is necessary to ensure the appropriateness of the regimen 1.
- Shared decision-making between clinicians and patients is crucial in choosing the best treatment option, considering factors such as symptom perception and the potential for undertreatment or overtreatment 1.
Treatment Approach
Given the age of the patient and the specific condition of exercise-induced asthma, the combination of albuterol for quick relief and montelukast as a daily controller is a reasonable approach, considering the patient's need for effective management of symptoms during physical activity like soccer. However, it's essential to monitor the patient's response to the medication and adjust the treatment plan as necessary, based on guidelines and clinical judgment 1.
From the FDA Drug Label
The efficacy of SINGULAIR in pediatric patients 6 to 14 years of age was demonstrated in one 8-week, double-blind, placebo-controlled trial in 336 patients (201 treated with SINGULAIR and 135 treated with placebo) using an inhaled β-agonist on an “as-needed” basis SINGULAIR, one 5-mg chewable tablet daily at bedtime, significantly decreased the percent of days asthma exacerbations occurred (SINGULAIR 20.6% vs placebo 25.7%, p≤0.05). SINGULAIR is used for the prevention of exercise-induced asthma in patients 15 years of age and older.
Montelukast (Singulair) is effective in pediatric patients, including those with exercise-induced asthma. However, the specific age range for exercise-induced asthma prevention is 15 years and older. For a 12-year-old patient, while montelukast has been shown to be effective in pediatric patients aged 6 to 14 years for asthma management, its effectiveness specifically for exercise-induced asthma in this age group is not directly stated. Given the available information, it is reasonable to consider montelukast as an option for a 12-year-old with exercise-induced asthma, especially when added to albuterol, but caution and consultation with a healthcare provider are advised due to the age specification for exercise-induced asthma prevention starting at 15 years old 2.
From the Research
Effectiveness of Montelukast in Exercise-Induced Asthma
- Montelukast (Singulair) has been shown to be effective in preventing exercise-induced bronchoconstriction (EIB) in children and adults 3.
- The medication works by blocking the action of cysteinyl leukotrienes, which are important mediators of airway allergic inflammation and have a role in the pathogenetic mechanism of EIB 3.
- Studies have demonstrated that montelukast provides effective protection against EIB, and chronic treatment with the medication does not induce tolerance to the bronchoprotective effect over time 3.
Combination Therapy with Albuterol
- For a 12-year-old with exercise-induced asthma, the addition of montelukast to albuterol (Ventolin) may be a viable treatment option 4, 5.
- Albuterol is a short-acting beta(2)-adrenoceptor agonist that is commonly used to treat acute asthma symptoms, while montelukast is a leukotriene receptor antagonist that can help prevent asthma symptoms 4, 5.
- The combination of these two medications may provide better control of asthma symptoms and improve the child's ability to participate in physical activities like soccer 4, 5.
Considerations for Treatment
- The treatment of exercise-induced asthma in children should take into account the nature of their physical activities, which are often not planned and may be prolonged 4.
- The delivery of medication needs to be age-appropriate, and the child should be able to use the medication correctly and consistently 4.
- The use of warm-up exercises has been shown to be helpful in reducing the severity of EIB, but this may not be practical for most children with exercise-induced asthma 4.