Montelukast versus inhaled corticosteroids as monotherapy for prevention of asthma: which one is best?

The GINA guidelines (GL)1, the BTS-SIGN GL2, and the paediatric PRACTALL GL3, indicate inhaled corticosteroids (ICS) as the frst choice for controller therapy of paediatric asthma. The authors of BTS-SIGN GL recommended a leukotriene receptor antagonist, if ICS cannot be administered. Montelukast (MLK) is the most commonly used in children. If ICS remain the frst choice, they can be considered the Gold Standard for pharmacological asthma prevention and the value of any alternative treatment must be measured against them, not only against a placebo. Here we will try to shed some light as to which of those two drugs is better according to the present evidence. We chose a generic research strategy trying to analyse all relevant articles. We searched MEDLINE to gather relevant, English-language articles using search terms �montelukast AND asthma�, selecting �randomized controlled trial� and �all child�. No time limits were imposed. The bibliography of the relevant articles was checked. We considered eligible for the inclusion randomised, double-blind, double-dummy studies with paediatric data, where 80 % or more of randomised patients are included in the fnal analysis of the data, and with a Jadad score4 of = 3. The search ended on December 16, 2008.