Why use Montelukast (Singulair) for pediatric asthma management?

From the Guidelines

Montelukast is recommended for children with asthma, particularly those who have frequent wheezing episodes, a positive asthma predictive index, or who have not responded adequately to inhaled corticosteroids alone, as it helps prevent symptoms and reduces the frequency of asthma attacks, with a typical dosing of 4 mg for ages 2-5 mg for ages 6-14, and 10 mg for ages 15 and older 1. The medication works by blocking leukotrienes, chemicals that cause inflammation in the airways, making it easier for children to breathe. For asthma, montelukast helps prevent symptoms and reduces the frequency of asthma attacks, while for allergic rhinitis, it relieves symptoms like sneezing, runny nose, and nasal congestion. Some key points to consider when using montelukast for children include:

• Montelukast is particularly valuable for children because it's convenient (once-daily dosing), doesn't require special inhalation techniques like some asthma medications, and has minimal side effects for most children 1.
• It's often used as an add-on therapy when inhaled corticosteroids alone don't provide adequate control of asthma symptoms, or as an alternative for children who struggle with inhaler devices.
• The decision to start long-term daily therapy with montelukast should be based on the child's individual needs and response to treatment, with careful monitoring of their symptoms and adjustment of therapy as needed 1.
• Montelukast has been shown to be effective in reducing impairment and risk of exacerbations in infants and young children with asthma, and is a useful option for children who have difficulty using inhalers or who have contraindications to other asthma medications 1.

From the FDA Drug Label

SINGULAIR is indicated for the prophylaxis and chronic treatment of asthma in adults and pediatric patients 12 months of age and older. SINGULAIR is indicated for the relief of symptoms of allergic rhinitis (seasonal allergic rhinitis in adults and pediatric patients 2 years of age and older, and perennial allergic rhinitis in adults and pediatric patients 6 months of age and older). The efficacy of SINGULAIR for the treatment of seasonal allergic rhinitis in pediatric patients 2 to 14 years of age and for the treatment of perennial allergic rhinitis in pediatric patients 6 months to 14 years of age is supported by extrapolation from the demonstrated efficacy in patients 15 years of age and older with allergic rhinitis as well as the assumption that the disease course, pathophysiology and the drug’s effect are substantially similar among these populations.

Monteleukast is used in children for:

• Prophylaxis and chronic treatment of asthma in pediatric patients 12 months of age and older 2
• Relief of symptoms of allergic rhinitis (seasonal allergic rhinitis in pediatric patients 2 years of age and older, and perennial allergic rhinitis in pediatric patients 6 months of age and older) 2 Key points:
• The safety and efficacy of montelukast in pediatric patients have been established in adequate and well-controlled studies 2
• The disease course, pathophysiology, and the drug's effect are assumed to be substantially similar among different age groups 2

From the Research

Reasons for Using Montelukast in Children

• Montelukast is used to treat allergic diseases such as allergic rhinitis, atopic dermatitis, and asthma in children 3.
• It blocks the interaction of cysteinyl leukotrienes with their receptors, resulting in downstream events that help control symptoms of allergic diseases 3.
• Montelukast can be used as a monotherapy in mild persistent asthma and as an add-on drug to inhaled corticosteroid (ICS) in moderate to severe persistent asthma 3.
• It has a role in controlling rhinitis symptoms in children with allergic rhinitis 3, 4.
• Montelukast has a safety profile similar to placebo and is considered safer than ICS 3.
• It can improve quality of life in patients with asthma and comorbid allergic rhinitis 3.

Efficacy of Montelukast in Children

• Montelukast has been shown to be effective in improving multiple parameters of asthma control in children aged 2 to 5 years 5.
• It reduces daytime and overnight asthma symptoms, daily use of beta-agonist, and frequency of asthma attacks 5.
• Montelukast also improves physician and caregiver global evaluations of asthma control and quality of life 5.
• In children with allergic rhinitis, montelukast may be considered a well-tolerated therapeutic option with minor side effects 4.

Benefits of Montelukast in Children

• Montelukast is easy to administer as a once-daily chewable tablet, which can improve compliance in young children 5.
• It has a consistent effect regardless of concomitant use of inhaled/nebulized corticosteroid or cromolyn therapy 5.
• Montelukast can be used as an add-on therapy with ICS or ICS/long-acting beta-2-agonist (LABA) in the management of patients diagnosed with asthma and concurrent allergic rhinitis 6.