Nazish Jehan, Mobin-ur Rehman, Muhammad Hussein Zarkoon.
To Determine the Efficacy of Inhaled Corticosteroids Compared to Montelukast in Reducing Exacerbation in Uncontrolled Asthma in Children 6 Months to 5 Years.
Pak J Med Health Sci Jan ;8(3):662-6.

Aim: To determine the efficacy of Inhaled corticosteroids compared to Montelukast in reducing exacerbations in uncontrolled bronchial asthma in children 6 months to 5 years of age. Methods: This was a randomized controlled trial study Pediatric Unit-1 Bolan Medical Complex Hospital Quetta from March 2011 to August 2011. Children 6 months to 5 years of age were admitted through OPD and emergency. The patients present with history of atopy, wheeze and nocturnal cough, children with history of use of rescue treatment in the last 4 weeks, wheezing apart from colds, sensitization to weather changes and history of exposure to pets were included. Children with acquired or congenital heart defects, those with history of pulmonary tuberculosis, pneumonia, gastroesophageal reflux, tracheoesophageal fistula, foreign body aspiration, cystic fibrosis, immune deficiency syndromes presents with recurrent infections, any comorbid condition such as hemoglobinopathy (thalassemia, sickle cell anemia) were excluded. The patients were classified into uncontrolled asthma according to the GINA guidelines. Patients were given ICS and tab Montelukast by lottery method to remove the bias. The doses for ICS were 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. Results: The majority of the patients enrolled for the study were boys making up about 1383 (57.6%) out of 2400 remaining 1017 (42%) were females. The mean SD age of the patients was 2.42±1.25 with P value is significant (P<0.5).The mean±SD age for the diagnosis was 4.37±5.06 with P value for diagnosis was to be significant (P<0.5). Among the 1200 patients who were prescribed an ICS, 51.58% of patients (n=1238) were stepped down after treatment with an ICS while 153(6.375%) were stepped up.1 patient was admitted in status when the one was treated with in ICS. The other group which was put on montelukast, being, 402(16.75%) of patients were stepped down when they were treated with montelukast whereas stepping up of the treatment was considered in 771(32.125%), 2 patients were admitted in status while 7 patients were showed static response to treatment with montelukast. Conclusion: Inhaled corticosteroids proved to be the most effective controller therapy in children 6 months to 5 years of age then Montelukast.

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