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Treatment of pediatric mild persistent asthma with low-dose budesonide inhalation suspension vs. montelukast in China

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Abstract

Background

There are limited studies comparing budesonide inhalation suspension (BIS) with montelukast in real-world settings where treatment adherence and persistency may be suboptimal. This real-world study aims to investigate the control effectiveness of montelukast or BIS as a monotherapy in Chinese children with mild asthma.

Methods

Data were derived from a retrospective questionnaire-based analysis of 2‒14-year-old children with mild persistent asthma, who received either 500 µg of BIS (n = 153) or 4‒5 mg of montelukast (n = 240) once daily. The indicators of asthma control, the Asthma Control Test (ACT)/Childhood ACT (C-ACT) score, and the asthma-related medical costs were assessed. The differences between the two groups were compared using an unpaired t-test (normally distributed), Mann–Whitney U test (non-normally distributed) or chi-squared test (categorical variables).

Results

Medication compliance in the past 3-month period was better in the montelukast group than in the BIS group (P = 0.042). The montelukast group exhibited better asthma control in the past 4-week period, including lower percentages of asthmatic children with symptoms more than twice a week (P = 0.021), had night waking or night coughing (P = 0.022), or required reliever medication more than twice a week (P < 0.001). The montelukast group had a lower percentage of children with an ACT/C-ACT score ≤ 19 (P = 0.015). Caregivers reported a significantly better exercise tolerance in the children who received montelukast vs. BIS in the past 12 months (P < 0.001). Significantly higher medical expenditures attributable to asthma in the past 12 months were observed in the BIS group vs. montelukast group (P < 0.001).

Conclusion

Both treatments provided acceptable overall asthma control in children with mild persistent asthma; however, more reliever medication and more medical expenditures attributable to asthma were needed for BIS vs. montelukast in real-world settings, where factors such as compliance were also taken into account.

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Data availability

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank all of the patients and investigators for their participation to achieve this study goal. Qi Zhong helped design the research. Lin Chen helped explain the data. Both are employees of MSD China, Shanghai, China. Editorial assistance with the preparation of this article was provided by Medjaden Bioscience Limited. This assistance was supported by MSD China, Shanghai, China.

Funding

This work was supported by MSD China, Shanghai, China (grant number: 50146).

Author information

Authors and Affiliations

  1. Department of Respiratory Diseases, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China

    Zhi-Min Chen

  2. Department of Respiratory Diseases, Children’s Hospital of Nanjing Medical University, Nanjing, 210029, China

    De-Yu Zhao

  3. Department of Allergy, Beijing Children’s Hospital, Capital Medical University, National Children’s Hospital Center, Beijing, 100045, China

    Li Xiang

  4. Department of Pediatrics, Shanghai General Hospital, Shanghai Jiaotong University, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China

    Jian-Guo Hong

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  1. Zhi-Min Chen
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Contributions

ZC and DZ contributed equally to this paper. JH conceived and designed research; JH collected data and conducted research; DZ and LX analyzed and interpreted data; ZC wrote the initial paper; ZC, DZ, LX and JH revised the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jian-Guo Hong.

Ethics declarations

Ethical approval

This study was approved by the Ethics Committee of the Beijing Children’s Hospital, Capital Medical University (approval number: 2012-70). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participant’s guardians included in the study.

Conflict of interest

None of the authors declare any conflict of interest in this study. Authors Zhimin Chen and Jianguo Hong are members of the Editorial Board for the World Journal of Pediatrics. The paper was handled by the other Editor and has undergone a rigorous peer-review process. Authors Zhimin Chen and Jianguo Hong were not involved in the journal’s review of, or decisions related to, this manuscript.

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Chen, ZM., Zhao, DY., Xiang, L. et al. Treatment of pediatric mild persistent asthma with low-dose budesonide inhalation suspension vs. montelukast in China. World J Pediatr 17, 619–625 (2021). https://doi.org/10.1007/s12519-021-00464-7

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