Department of Respiratory Diseases, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.
Department of Respiratory Diseases, Children's Hospital of Nanjing Medical University, Nanjing, 210029, China.
World J Pediatr. 2021 Dec;17(6):619-625. doi: 10.1007/s12519-021-00464-7. Epub 2021 Oct 6.
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.
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).
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).
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.
在治疗依从性和持久性可能不理想的真实环境中，比较布地奈德吸入悬浮液（BIS）和孟鲁司特的研究有限。本真实世界研究旨在调查孟鲁司特或 BIS 作为单一疗法在患有轻度哮喘的中国儿童中的控制效果。
数据来自对接受 500μg BIS（n=153）或 4-5mg 孟鲁司特（n=240）的 2-14 岁轻度持续性哮喘儿童进行回顾性问卷调查分析。评估哮喘控制指标、哮喘控制测试（ACT）/儿童 ACT（C-ACT）评分和哮喘相关医疗费用。使用配对 t 检验（正态分布）、Mann-Whitney U 检验（非正态分布）或卡方检验（分类变量）比较两组之间的差异。
在过去 3 个月期间，孟鲁司特组的药物依从性优于 BIS 组（P=0.042）。在过去 4 周期间，孟鲁司特组的哮喘控制更好，包括每周出现症状超过两次的哮喘儿童比例较低（P=0.021）、夜间醒来或夜间咳嗽（P=0.022）或每周需要缓解药物超过两次（P<0.001）。孟鲁司特组 ACT/C-ACT 评分≤19 的儿童比例较低（P=0.015）。在过去 12 个月期间，接受孟鲁司特的儿童的运动耐量明显优于接受 BIS 的儿童（P<0.001）。在过去 12 个月期间，BIS 组归因于哮喘的医疗支出明显高于孟鲁司特组（P<0.001）。
在患有轻度持续性哮喘的儿童中，两种治疗方法均提供了可接受的总体哮喘控制；然而，在考虑到依从性等因素的真实环境中，BIS 比孟鲁司特需要更多的缓解药物和更多归因于哮喘的医疗支出。
