DÄ internationalArchive48/2008Bronchial Asthma: Diagnosis and Long-Term Treatment in Adults: In Reply


Bronchial Asthma: Diagnosis and Long-Term Treatment in Adults: In Reply

Dtsch Arztebl Int 2008; 105(48): 842. DOI: 10.3238/arztebl.2008.0842b

Ukena, D

LNSLNS Visser emphasizes some important aspects of the indication for montelukast, for which some particular aspects have to be remembered.

The therapeutic recommendation of the Federal Joint Committee (G-BA) 15. 11. 2007 (Deutsches Ärzteblatt 2008; 105 (18): A 966 - 8) is informative and precise. Montelukast is licensed as adjunct treatment in patients with mild or moderate persistent asthma, that cannot be controlled sufficiently with inhaled corticosteroids and short acting ß2 sympathomimetic drugs taken as needed.

In this setting, combining inhaled corticosteroids and long acting ß2 sympathomimetic drugs is the treatment of choice.

Because of the high costs of treatment, montelukast is used only where none of the other therapeutic options can be applied. Montelukast as monotherapy for asthma is not licensed in persons older than 15. Even for severe persistent asthma in all age groups, it is not licensed. In patients older than 15 in whom montelukast is indicated in asthma, the 10 mg film tablets can relieve the symptoms of seasonal allergic rhinitis.

Combining the therapy of asthma and allergic rhinitis with an inhaled corticosteroid and montelukast is a feasible suggestion in principle.

In children aged 2 to 14 years who have mild persistent asthma, monotherapy with montelukast is indicated only if no severe asthma attacks had occurred that required treatment with systemic corticosteroids and if the children are not able to inhale corticosteroids or these have severe side effects.

We wish to emphasize that in view of the inhalation options available today, this scenario is bound to be a rare exception.

Montelukast can also be used to prevent exercise induced asthma.
DOI: 10.3238/arztebl.2008.0842b

Prof. Dr. med. Dieter Ukena
Klinik für Pneumologie und Beatmungsmedizin
Interdisziplinäres Lungenzentrum
Klinikum Bremen-Ost
Züricher Str. 40
28325 Bremen, Germany

Conflict of interest statement
Professor Dieter Ukena has received honoraria for speaking from Altana, AstraZeneca, GlaxoSmithKline, and Boehringer Ingelheim.