Skip to main content
SpringerLink
Log in

Montelukast in guidelines and beyond

  • Review
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

In all asthma guidelines, preventive anti-inflammatory treatment is essential in all patients with persistent asthma. Inhaled corticosteroids are the mainstay of treatment in the control of asthma, but other treatments may be used as a monotherapy in patients with mild asthma or as an add-on treatment in those with moderate-to-severe asthma. Leukotriene modifiers are the only validated preventive treatment for all age groups. This review discusses the place of montelukast, a leukotriene receptor antagonist, using guidelines and consensus reports on asthma and rhinitis: the US National Asthma Education and Prevention Program (NAEPP); the British Guideline on the Management of Asthma; the Global Initiative on Asthma (GINA); and Allergic Rhinitis and its Impact on Asthma (ARIA). This review includes new studies that have not yet been considered in guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bousquet J. Global Initiative for Asthma (GINA) and its objectives. Clin Exp Allergy. 2000;30(suppl. 1):2–5.

    Article  PubMed  Google Scholar 

  2. Bousquet J, Bieber T, Fokkens W, et al. Consensus statements, evidence-based medicine and guidelines in allergic diseases. Allergy. 2008;63:1–4.

    CAS  PubMed  Google Scholar 

  3. Bousquet J, Clark TJ, Hurd S, et al. GINA guidelines on asthma and beyond. Allergy. 2007;62:102–112.

    CAS  PubMed  Google Scholar 

  4. Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008;31:143–178.

    Article  CAS  PubMed  Google Scholar 

  5. Busse WW, Lemanske RFJr. Expert Panel Report 3: Moving forward to improve asthma care. J Allergy Clin Immunol. 2007;120:1012–1014.

    Article  PubMed  Google Scholar 

  6. British Thoracic Society Scottish Intercollegiate Guidelines Network. British Guideline on the Management of Asthma. Thorax. 2008;63(suppl. 4):iv1–iv121.

    Article  Google Scholar 

  7. Humbert M, Holgate S, Boulet LP, Bousquet J. Asthma control or severity: that is the question. Allergy. 2007;62:95–101.

    CAS  PubMed  Google Scholar 

  8. Accordini S, Corsico A, Cerveri I, et al. The socioeconomic burden of asthma is substantial in Europe. Allergy. 2008;63:116–124.

    CAS  PubMed  Google Scholar 

  9. Campbell JD, Spackman DE, Sullivan SD. Health economics of asthma: assessing the value of asthma interventions. Allergy. 2008;63:1581–1592.

    Article  CAS  PubMed  Google Scholar 

  10. van Weel C. General practitioners’ central role in management of asthma and allergic rhinitis. Allergy. 2008;63:1005–1007.

    Article  PubMed  Google Scholar 

  11. Herland K, Akselsen JP, Skjonsberg OH, Bjermer L. How representative are clinical study patients with asthma or COPD for a larger “real life” population of patients with obstructive lung disease? Respir Med. 2005;99:11–19.

    Article  PubMed  Google Scholar 

  12. Tomlins R. International Primary Care Respiratory Group (IPCRG) Guidelines: Dissemination and Implementation — a proposed course of action. Prim Care Respir J. 2006;15:71–74.

    Article  PubMed  Google Scholar 

  13. Bousquet J, Reid J, van Weel C, et al. Allergic rhinitis management pocket reference 2008. Allergy. 2008;63:990–996.

    Article  CAS  PubMed  Google Scholar 

  14. van Weel C, Bateman ED, Bousquet J, et al. Asthma management pocket reference 2008. Allergy. 2008;63:997–1004.

    Article  PubMed  Google Scholar 

  15. Bousquet J, Van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108:S147–S334.

    Article  CAS  PubMed  Google Scholar 

  16. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(suppl. 86):8–160.

    Article  PubMed  Google Scholar 

  17. Virchow JCJr., Prasse A, Naya I, Summerton L, Harris A. Zafirlukast improves asthma control in patients receiving high-dose inhaled corticosteroids. Am J Respir Crit Care Med. 2000;162:578–585.

    PubMed  Google Scholar 

  18. Watkins PB, Dube LM, Walton-Bowen K, Cameron CM, Kasten LE. Clinical pattern of zileuton-associated liver injury: results of a 12-month study in patients with chronic asthma. Drug Saf. 2007;30:805–815.

    Article  CAS  PubMed  Google Scholar 

  19. NAEPP (National Asthma Education and Prevention Program) Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Heart Lung and Blood Institute. Available at: http://www.nhlbi.nih.gov/guidelines/asthma/index.htm. Accessed May 2007.

  20. Peters SP, Anthonisen N, Castro M, et al. Randomized comparison of strategies for reducing treatment in mild persistent asthma. N Engl J Med. 2007;356:2027–2039.

    Article  PubMed  Google Scholar 

  21. Vaquerizo MJ, Casan P, Castillo J, et al. Effect of montelukast added to inhaled budesonide on control of mild to moderate asthma. Thorax. 2003;58:204–210.

    Article  CAS  PubMed  Google Scholar 

  22. Lofdahl CG, Reiss TF, Leff JA, et al. Randomised, placebo controlled trial of effect of a leukotriene receptor antagonist, montelukast, on tapering inhaled corticosteroids in asthmatic patients. BMJ. 1999;319:87–90.

    CAS  PubMed  Google Scholar 

  23. Baiardini I, Braido F, Brandi S, et al. The impact of GINA suggested drugs for the treatment of asthma on health-related quality of life: a GA(2)LEN review. Allergy. 2008;63:1015–1030.

    Article  CAS  PubMed  Google Scholar 

  24. Montuschi P, Mondino C, Koch P, Ciabattoni G, Barnes PJ, Baviera G. Effects of montelukast treatment and withdrawal on fractional exhaled nitric oxide and lung function in children with asthma. Chest. 2007;132:1876–1881.

    Article  CAS  PubMed  Google Scholar 

  25. Jayaram L, Duong M, Pizzichini MM, et al. Failure of montelukast to reduce sputum eosinophilia in high-dose corticosteroid-dependent asthma. Eur Respir J. 2005;25:41–46.

    Article  CAS  PubMed  Google Scholar 

  26. Bjermer L, Bisgaard H, Bousquet J, et al. Montelukast and fluticasone compared with salmeterol and fluticasone in protecting against asthma exacerbation in adults: one year, double blind, randomised, comparative trial. BMJ. 2003;327:891.

    Article  CAS  PubMed  Google Scholar 

  27. Ducharme FM, Lasserson TJ, Cates CJ. Long-acting beta2-agonists versus anti-leukotrienes as add-on therapy to inhaled corticosteroids for chronic asthma. Cochrane Database Syst Rev. 2006;(4):CD003137.

  28. Joos S, Miksch A, Szecsenyi J, et al. Montelukast as add-on therapy to inhaled corticosteroids in the treatment of mild to moderate asthma: a systematic review. Thorax. 2008;63:453–462.

    Article  CAS  PubMed  Google Scholar 

  29. Deykin A, Wechsler ME, Boushey HA, et al. Combination therapy with a long-acting beta-agonist and a leukotriene antagonist in moderate asthma. Am J Respir Crit Care Med. 2007;175:228–234.

    Article  CAS  PubMed  Google Scholar 

  30. Robinson DS, Campbell D, Barnes PJ. Addition of leukotriene antagonists to therapy in chronic persistent asthma: a randomised double-blind placebo-controlled trial. Lancet. 2001;357:2007–2011.

    Article  CAS  PubMed  Google Scholar 

  31. Baumgartner RA, Martinez G, Edelman JM, et al. Distribution of therapeutic response in asthma control between oral montelukast and inhaled beclomethasone. Eur Respir J. 2003;21:123–128.

    Article  CAS  PubMed  Google Scholar 

  32. Spahn JD, Covar RA, Jain N, et al. Effect of montelukast on peripheral airflow obstruction in children with asthma. Ann Allergy Asthma Immunol. 2006;96:541–549.

    CAS  PubMed  Google Scholar 

  33. Zeidler MR, Kleerup EC, Goldin JG, et al. Montelukast improves regional air-trapping due to small airways obstruction in asthma. Eur Respir J. 2006;27:307–315.

    Article  CAS  PubMed  Google Scholar 

  34. Lazarus SC, Chinchilli VM, Rollings NJ, et al. Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma. Am J Respir Crit Care Med. 2007;175:783–790.

    Article  CAS  PubMed  Google Scholar 

  35. Rabinovitch N, Strand M, Stuhlman K, Gelfand EW. Exposure to tobacco smoke increases leukotriene E4-related albuterol usage and response to montelukast. J Allergy Clin Immunol. 2008;121:1365–1371.

    Article  CAS  PubMed  Google Scholar 

  36. Peters-Golden M, Swern A, Bird SS, Hustad CM, Grant E, Edelman JM. Influence of body mass index on the response to asthma controller agents. Eur Respir J. 2006;27:495–503.

    Article  CAS  PubMed  Google Scholar 

  37. Dahlen SE, Malmstrom K, Nizankowska E, et al. Improvement of aspirin-intolerant asthma by montelukast, a leukotriene antagonist: a randomized, double-blind, placebo-controlled trial. Am J Respir Crit Care Med. 2002;165:9–14.

    PubMed  Google Scholar 

  38. Leff JA, Busse WW, Pearlman D, et al. Montelukast, a leukotriene-receptor antagonist, for the treatment of mild asthma and exercise-induced bronchoconstriction. N Engl J Med. 1998;339:147–152.

    Article  CAS  PubMed  Google Scholar 

  39. Rand C, Bilderback A, Schiller K, Edelman JM, Hustad CM, Zeiger RS. Adherence with montelukast or fluticasone in a long-term clinical trial: results from the mild asthma montelukast versus inhaled corticosteroid trial. J Allergy Clin Immunol. 2007;119:916–923.

    Article  CAS  PubMed  Google Scholar 

  40. Barnes N, Thomas M, Price D, Tate H. The national montelukast survey. J Allergy Clin Immunol. 2005;115:47–54.

    Article  PubMed  Google Scholar 

  41. Bacharier LB, Boner A, Carlsen KH, et al. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy. 2008;63:5–34.

    Article  CAS  PubMed  Google Scholar 

  42. Wahn U, Dass SB. Review of recent results of montelukast use as a monotherapy in children with mild asthma. Clin Ther. 2008;30:1026–1035.

    Article  CAS  PubMed  Google Scholar 

  43. Sorkness CA, Lemanske RFJr., Mauger DT, et al. Long-term comparison of 3 controller regimens for mild-moderate persistent childhood asthma: the Pediatric Asthma Controller Trial. J Allergy Clin Immunol. 2007;119:64–72.

    Article  PubMed  Google Scholar 

  44. Jartti T. Inhaled corticosteroids or montelukast as the preferred primary long-term treatment for pediatric asthma? Eur J Pediatr. 2008;167:731–736.

    Article  CAS  PubMed  Google Scholar 

  45. Strunk RC, Bacharier LB, Phillips BR, et al. Azithromycin or montelukast as inhaled corticosteroid-sparing agents in moderate-to-severe childhood asthma study. J Allergy Clin Immunol. 2008;122:1138–1144 e4.

    Article  CAS  PubMed  Google Scholar 

  46. Becker AB, Kuznetsova O, Vermeulen J, et al. Linear growth in prepubertal asthmatic children treated with montelukast, beclomethasone, or placebo: a 56-week randomized double-blind study. Ann Allergy Asthma Immunol. 2006;96:800–807.

    CAS  PubMed  Google Scholar 

  47. Pedersen S, Agertoft L, Williams-Herman D, et al. Placebo-controlled study of montelukast and budesonide on short-term growth in prepubertal asthmatic children. Pediatr Pulmonol. 2007;42:838–843.

    Article  PubMed  Google Scholar 

  48. Nelson KA, Smith SR, Trinkaus K, Jaffe DM. Pilot study of oral montelukast added to standard therapy for acute asthma exacerbations in children aged 6 to 14 years. Pediatr Emerg Care. 2008;24:21–27.

    PubMed  Google Scholar 

  49. Robertson CF, Price D, Henry R, et al. Short-course montelukast for intermittent asthma in children: a randomized controlled trial. Am J Respir Crit Care Med. 2007;175:323–329.

    Article  CAS  PubMed  Google Scholar 

  50. Johnston NW, Mandhane PJ, Dai J, et al. Attenuation of the September epidemic of asthma exacerbations in children: a randomized, controlled trial of montelukast added to usual therapy. Pediatrics. 2007;120:e702–712.

    Article  PubMed  Google Scholar 

  51. Covar RA, Szefler SJ, Zeiger RS, et al. Factors associated with asthma exacerbations during a long-term clinical trial of controller medications in children. J Allergy Clin Immunol. 2008;122:741–747 e4.

    Article  CAS  PubMed  Google Scholar 

  52. Zeiger RS, Szefler SJ, Phillips BR, et al. Response profiles to fluticasone and montelukast in mild-to-moderate persistent childhood asthma. J Allergy Clin Immunol. 2006;117:45–52.

    Article  CAS  PubMed  Google Scholar 

  53. Szefler SJ, Phillips BR, Martinez FD, et al. Characterization of within-subject responses to fluticasone and montelukast in childhood asthma. J Allergy Clin Immunol. 2005;115:233–242.

    Article  CAS  PubMed  Google Scholar 

  54. de Benedictis FM, del Giudice MM, Forenza N, Decimo F, de Benedictis D, Capristo A. Lack of tolerance to the protective effect of montelukast in exercise-induced bronchoconstriction in children. Eur Respir J. 2006;28:291–295.

    Article  PubMed  CAS  Google Scholar 

  55. Brand PL, Baraldi E, Bisgaard H, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J. 2008;32:1096–1110.

    Article  CAS  PubMed  Google Scholar 

  56. Bisgaard H, Zielen S, Garcia-Garcia ML, et al. Montelukast reduces asthma exacerbations in 2- to 5-year-old children with intermittent asthma. Am J Respir Crit Care Med. 2005;171:315–322.

    Article  PubMed  Google Scholar 

  57. Bacharier LB, Phillips BR, Zeiger RS, et al. Episodic use of an inhaled corticosteroid or leukotriene receptor antagonist in preschool children with moderate-to-severe intermittent wheezing. J Allergy Clin Immunol. 2008;122:1127–1135 e8.

    Article  CAS  PubMed  Google Scholar 

  58. Davies GM, Dasbach EJ, Santanello NC, Knorr BA, Bratton DL. The effect of montelukast versus usual care on health care resource utilization in children aged 2 to 5 years with asthma. Clin Ther. 2004;26:1895–1904.

    Article  CAS  PubMed  Google Scholar 

  59. Bisgaard H, Flores-Nunez A, Goh A, et al. Study of montelukast for the treatment of respiratory symptoms of post-respiratory syncytial virus bronchiolitis in children. Am J Respir Crit Care Med. 2008;178:854–860.

    Article  CAS  PubMed  Google Scholar 

  60. Kearns GL, Lu S, Maganti L, et al. Pharmacokinetics and safety of montelukast oral granules in children 1 to 3 months of age with bronchiolitis. J Clin Pharmacol. 2008;48:502–511.

    Article  CAS  PubMed  Google Scholar 

  61. Knorr B, Maganti L, Ramakrishnan R, Tozzi CA, Migoya E, Kearns G. Pharmacokinetics and safety of montelukast in children aged 3 to 6 months. J Clin Pharmacol. 2006;46:620–627.

    Article  CAS  PubMed  Google Scholar 

  62. Patel P, Philip G, Yang W, et al. Randomized, double-blind, placebo-controlled study of montelukast for treating perennial allergic rhinitis. Ann Allergy Asthma Immunol. 2005;95:551–557.

    PubMed  Google Scholar 

  63. Philip G, Williams-Herman D, Patel P, et al. Efficacy of montelukast for treating perennial allergic rhinitis. Allergy Asthma Proc. 2007;28:296–304.

    Article  CAS  PubMed  Google Scholar 

  64. Wallace DV, Dykewicz MS, Bernstein DI, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122(suppl. 2):1–84.

    Article  Google Scholar 

  65. Scadding GK, Durham SR, Mirakian R, et al. Clin Exp Allergy. 2008;38:19–42.

    Article  CAS  PubMed  Google Scholar 

  66. Schünemann H, Brozek J, Bousquet J, et al. ARIA 2009 Revision. Allergy. In press.

  67. Brozek JL, Baena-Cagnani CE, Bonini S, et al. Methodology for development of the Allergic Rhinitis and its Impact on Asthma guideline 2008 update. Allergy. 2008;63:38–46.

    CAS  PubMed  Google Scholar 

  68. Bousquet J, Gaugris S, Kocevar VS, et al. Increased risk of asthma attacks and emergency visits among asthma patients with allergic rhinitis: a subgroup analysis of the investigation of montelukast as a partner agent for complementary therapy. Clin Exp Allergy. 2005;35:723–727.

    Article  CAS  PubMed  Google Scholar 

  69. Bousquet J, Boushey HA, Busse WW, et al. Characteristics of patients with seasonal allergic rhinitis and concomitant asthma. Clin Exp Allergy. 2004;34:897–903.

    Article  CAS  PubMed  Google Scholar 

  70. Dahl R, Nielsen LP, Kips J, et al. Intranasal and inhaled fluticasone propionate for pollen-induced rhinitis and asthma. Allergy. 2005;60:875–881.

    Article  CAS  PubMed  Google Scholar 

  71. Baena-Cagnani CE, Berger WE, DuBuske LM, et al. Comparative effects of desloratadine versus montelukast on asthma symptoms and use of beta 2-agonists in patients with seasonal allergic rhinitis and asthma. Int Arch Allergy Immunol. 2003;130:307–313.

    Article  CAS  PubMed  Google Scholar 

  72. Philip G, Nayak AS, Berger WE, et al. The effect of montelukast on rhinitis symptoms in patients with asthma and seasonal allergic rhinitis. Curr Med Res Opin. 2004;20:1549–1558.

    Article  CAS  PubMed  Google Scholar 

  73. Busse WW, Casale TB, Dykewicz MS, et al. Efficacy of montelukast during the allergy season in patients with chronic asthma and seasonal aero-allergen sensitivity. Ann Allergy Asthma Immunol. 2006;96:60–68.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, 371 avenue Doyen Gaston Giraud, 34275 Montpellier, Cedex 5, France

    Jean Bousquet

  2. INSERM UMR780, Cedex 5, France

    Jean Bousquet

  3. Service des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, Montpellier, France

    Pascal Demoly

  4. INSERM U657, Montpellier, France

    Pascal Demoly

  5. Université Paris, Sud 11 Hôpital Antoine Béclère, Clamart, France

    Marc Humbert

Authors
  1. Jean Bousquet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pascal Demoly
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marc Humbert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean Bousquet.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bousquet, J., Demoly, P. & Humbert, M. Montelukast in guidelines and beyond. Adv Therapy 26, 575–587 (2009). https://doi.org/10.1007/s12325-009-0038-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-009-0038-1

Keywords

Search

Navigation