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Research Article

Vol. 7 No. 1 (2003)

Efficacy of Leukotriene Modifiers for the Treatment of Persistent Asthma in Children

  • Duarte G. Machado
November 6, 2020


The purpose of this study was to evaluate the use of the leukotriene modifiers (LTMs), zafirlukast and montelukast, in children with asthma managed by an inner city pediatric pulmonary practice. A retrospective chart review was done of children 6 years of age with persistent asthma seen at Connecticut Children's Medical Center and prescribed LTM drugs. Eighty-three children whose asthma control was adequately assessed both before and after addition of a LTM to his/her treatment regimen was included in the study. There were statistically significant improvements in several parameters of asthma control following initiation of LTM use, including provider assessment score (p = 0.0005), number of hospitalizations and unscheduled visits (clinic or emergency department; p < 0.0001), use of oral corticosteroids (p = 0.0015), spirometry severity score (p = 0.0015), and spirometry test results (FEV1, FEV1/FVC, FEF, FEF25-75%; p < 0.005 for all). These results suggest that montelukast and zafirlukast help to improve asthma control in young patients with persistent asthma.


  1. Adams PF, Marano MA. Current estimates from the National Health Interview Survey, 1994. Vital Health Stat 10:94; 1995.
  2. National Asthma Education and Prevention Program. Highlights of the Expert Panel Report II: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Institutes of Health. Publication No. 97-4051A; 1997.
  3. Allen DB. Do inhaled steroids impair growth? It all depends. J Respir Dis 19:1023-1036; 1998.
  4. Lemanske RF, Allen DB. Choosing a long-term controller medication in childhood asthma. Am J Respir Crit Care Med 156:685-687; 1997.
  5. Knorr B, Matz J, Bernstein JA, et al. Montelukast for chronic asthma in 6- to 14- year-old children: a randomized, double-blind trial. Pediatric Montelukast Study Group. JAMA 279:1181-1186; 1998.
  6. Fraser CM, Nelson HS, Middleton E Jr. Adrenergic agents. In: Middleton E Jr, Reed CE, Ellis EF, et al, editors. Allergy: Principles and Practice. St Louis, MO: Mosby-Year Book, 1993.
  7. Powell EC, Reynolds SL, Rubenstein JS. Theophylline toxicity in children: a retrospective review. Pediatr Emerg Care 9(3):129-33; 1993.
  8. Drazen JM, Israel E, O'Byrne PM. Treatment of asthma with drugs modifying the leukotriene pathway. N Engl J Med 340:197-206; 1999.
  9. Korenblat PE. The role of antileukotrienes in the treatment of asthma. Ann Allergy Asthma Immunol 86(Suppl):31-39; 2001.
  10. Weisberg SC. Pharmacology of asthma in children, with special reference to leukotriene receptor antagonists. Pediatr Pulmonol 29:46-61; 2000.
  11. Accolate. Manufacturer's prescription information. Zeneca Pharmaceuticals: Carolina, Puerto Rico; 2001.
  12. Zyflo Filmtab. Manufacturer's prescription information. Abbott Laboratories: Chicago, IL, USA; 2000.
  13. Singulair. Manufacturer's prescription information. Merck & Co, Inc: Whitehouse Station, NJ, USA; 2001.
  14. Rachelefsky G, Bruton S, Barnes PJ, et al. Airway remodeling: The inflammatory response in asthma therapy. Dialogues in Asthma Management 1:1-9; 1998.
  15. Evans JF. Cysteinyl leukotriene receptors. Prostaglandins Other Lipid Mediat 68-69:587- 597; 2002.
  16. Adkins JC, Brogden RN. Zafirlukast. A review of its pharmacology and therapeutic potential in the management of asthma. Drugs 55:121-144; 1998.
  17. McGill KA, Busse WW. Zileuton. Lancet 348:519-524; 1996.
  18. Lazarus SC, Lee T, Kemp JP, et al. Safety and clinical efficacy of zileuton in patients with chronic asthma. Am J Manag Care 4:841-848; 1998.
  19. Spector SL, Smith LJ, Glass M. Effects of 6 weeks of therapy with oral doses of ICI 204,219, a leukotriene D4 receptor antagonist, in subjects with bronchial asthma. ACCOLATE Trialists Group. Am J Respir Crit Care Med 150:618-623; 1994.
  20. Lampl KL, Dixon SJ, Bonuccelli CM. Long-term safety and efficacy of zafirlukast (Accolate) in pediatric patients with mild-to-moderate asthma. Am J Respir Crit Care Med 159(3):S138; 1999.
  21. Bisgaard H, Nielsen KG. Bronchoprotection with a leukotriene receptor antagonist in asthmatic preschool children. Am J Respir Crit Care Med 162:187-190; 2000.
  22. Kemp JP, Dockhorn RJ, Shapiro GG, et al. Montelukast once daily inhibits exercise- induced bronchoconstriction in 6-14- year old children with asthma. J Pediatr 133(3):424-8; 1998.
  23. Pearlman DS, Lampl KL, Dowling PJ Jr., Miller CJ, Bonuccelli CM. Effectiveness and tolerability of zafirlukast for the treatment of asthma in children. Clin Ther 22(6):732-47; 2000.
  24. Kemp JP. Guidelines update: where do the new therapies fit in the management of asthma? Drugs 59 Suppl 1:23-28; discussion 43-5; 2000.
  25. Strek ME. Consensus guidelines for asthma therapy. Ann Allergy Asthma Immunol 86(Suppl):40-44; 2001.
  26. Katial RK, Stelzle RC, Bonner MW, Marino M, Cantilena LR, Smith LJ. A drug interaction between zafirlukast and theophylline. Arch Intern Med 158(15):1713-5; 1998.
  27. National Asthma Education and Prevention Program. Highlights of the Expert Panel Report II: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Institutes of Health. Publication No. 97-4051A; 1997. Figure 1-3.
  28. Taussig LM, Chernick V, Wood R, Farrell P, Mellins RB. Standardization of lung function in testing in children. Proceedings and recommendations of the GAP conference committee, Cystic Fibrosis Foundation. J Pediatrics 97:668- 676; 1980.
  29. National Asthma Education and Prevention Program. Highlights of the Expert Panel Report II: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Institutes of Health. Publication No. 97-4051A; 1997. Tables 3-5b and 3-5c.
  30. Connecticut Department of Public Health: Asthma in Connecticut. Hartford, CT; 2001.
  31. Lipworth BJ: Systemic adverse effects of inhaled corticosteroid therapy. A systemic review and meta-analysis. Arch Intern Med 159:941-955; 1999.
  32. Tamioki J, Kondo M, Sakai N, et al. Leukotriene antagonist prevents exacerbation of asthma during reduction of high-dose inhaled corticosteroids. Am J Respir Crit Care Med 155:1235-1240; 1997.
  33. Tashkin DP, Nathan RA, Howland WC, et al. An evaluation of zafirlukast in the treatment of asthma with exploratory subset analyses. J Allergy Clin Immunol 103 (2 Pt 1):246-254; 1998. 34. Price D. Tolerability of montelukast. Drugs 59 Suppl 1:35-42; 2000.
  34. Storms W, Michele TM, Knorr B, et al. Clinical safety and tolerability of montelukast, a leukotriene receptor antagonist, in controlled clinical trials in patients aged > or = 6 years. Clin Exp Allergy 31(1):77-87; 2001.
  35. Ruurd JR, Gerritsen J, Van Aalderen WMC, et al. Risk factors for the persistence of respiratory symptoms in childhood asthma. Am Rev Respir Dis 148:1490-1495; 1993. 37. Canny GJ, Levison H. Asthma. In: Loughlin G, Levison H, editors. Respiratory Diseases in Children: Diagnosis and Management. Baltimore, MD: Williams and Wilkins, 1994.
  36. Wenzel SE. Antileukotriene drugs in the management of asthma. JAMA 280:2068-69; 1998.
  37. Verity CM, Ven Heule B, Carlswell F, Hughes AO. Bronchial lability and skin reactivity in siblings of asthmatic children. Arch Dis Child 42:542-548; 1984.
  38. Gold DR, Wypij D, Wang X, et al. Gender- and race-specific effects of asthma and wheeze on level and growth of lung function in children in six U.S. cities. Am J Respir Crit Care Med 149:1198-1208; 1994.


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