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Montelukast for the high impact of asthma exacerbations in Venezuela: a practical and valid approach for Latin America?

Capriles Hulett A, Yibirin MG, Garcia A, Hurtado D - World Allergy Organ J (2014)

Bottom Line: For the three and six months time points the difference between placebo and Montelukast was found to be significant (p < 0.03 and p < 0.04, respectively).Such trends continued for the rest of the year, but without statistical significance, due to patient attrition.This real-life pilot study shows that a simplified strategy with oral Montelukast was practical and effective in controlling exacerbations in an asthmatic population of a vulnerable community from Caracas.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centro Médico de Caracas; Centro Médico Docente La Trinidad y Programa de Medicina Comunitaria; Allergology Unit, Hospital San, Juan de Dios, Caracas, Venezuela.

ABSTRACT

Background: Asthma affects mainly Venezuela's urban and poor majority. Exacerbations bring about a high demand in health services, thus becoming a significant public health problem. In general, asthma control programs (GINA) with use of inhaled steroid medications have proven effective, although their implementation in real life remains cumbersome. Montelukast could be a useful and practical tool for these deprived socioeconomic sectors.

Methods: This real-life pilot study was conducted in a prospective, double blinded, placebo-controlled manner with randomized and parallel groups. Asthmatics that had never used leukotriene modifiers were recruited and followed-up every three months. The main outcome was the number of exacerbations meriting use of nebulized bronchodilators administered by the health care system.

Results: Eighty-eight asthmatic patients were enrolled, between children and adults. Groups were comparable in: demographic data, previous use of other medications, ACT scores, pulmonary functions (Wright Peak Flow meter), allergy status (Skin Prick Test) as well as adherence to the prescribed Montelukast treatment. By an intention to treat (ITT), a total of 64 patients were included for analysis. For the three and six months time points the difference between placebo and Montelukast was found to be significant (p < 0.03 and p < 0.04, respectively). Such trends continued for the rest of the year, but without statistical significance, due to patient attrition.

Conclusions: This real-life pilot study shows that a simplified strategy with oral Montelukast was practical and effective in controlling exacerbations in an asthmatic population of a vulnerable community from Caracas. Such an approach reinforces the role of primary care in asthma treatment.

No MeSH data available.


Related in: MedlinePlus

Percentage of all patients with acute exacerbations in need of rescue nebulizations at the local health system attended by the group studied.
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Figure 2: Percentage of all patients with acute exacerbations in need of rescue nebulizations at the local health system attended by the group studied.

Mentions: In regards to the co-morbidities (average rhinitis diagnosis of 70% and flexural atopic dermatitis 8%) in patients and the functional aspects for the diagnosis of asthma (reversibility), no difference was observed among the groups. In the case of children however, a better response to bronchodilatadors (>20% reversibility) was shown (80%). There was a trend for improvement in the MLK group for the WPFM and ACT scores, though no significant differences between the groups were detected during the year-long study.Following analysis allowed detecting, during the first 6 months, a significant difference between the groups in the number of exacerbations needing assistance from the health care system (Figure 2). Although there was not a statistically significant difference in the second half of the study, a continued tendency for fewer exacerbations with the use of MLK, was observed. We believe this was due to the small number of patients.


Montelukast for the high impact of asthma exacerbations in Venezuela: a practical and valid approach for Latin America?

Capriles Hulett A, Yibirin MG, Garcia A, Hurtado D - World Allergy Organ J (2014)

Percentage of all patients with acute exacerbations in need of rescue nebulizations at the local health system attended by the group studied.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4155393&req=5

Figure 2: Percentage of all patients with acute exacerbations in need of rescue nebulizations at the local health system attended by the group studied.
Mentions: In regards to the co-morbidities (average rhinitis diagnosis of 70% and flexural atopic dermatitis 8%) in patients and the functional aspects for the diagnosis of asthma (reversibility), no difference was observed among the groups. In the case of children however, a better response to bronchodilatadors (>20% reversibility) was shown (80%). There was a trend for improvement in the MLK group for the WPFM and ACT scores, though no significant differences between the groups were detected during the year-long study.Following analysis allowed detecting, during the first 6 months, a significant difference between the groups in the number of exacerbations needing assistance from the health care system (Figure 2). Although there was not a statistically significant difference in the second half of the study, a continued tendency for fewer exacerbations with the use of MLK, was observed. We believe this was due to the small number of patients.

Bottom Line: For the three and six months time points the difference between placebo and Montelukast was found to be significant (p < 0.03 and p < 0.04, respectively).Such trends continued for the rest of the year, but without statistical significance, due to patient attrition.This real-life pilot study shows that a simplified strategy with oral Montelukast was practical and effective in controlling exacerbations in an asthmatic population of a vulnerable community from Caracas.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centro Médico de Caracas; Centro Médico Docente La Trinidad y Programa de Medicina Comunitaria; Allergology Unit, Hospital San, Juan de Dios, Caracas, Venezuela.

ABSTRACT

Background: Asthma affects mainly Venezuela's urban and poor majority. Exacerbations bring about a high demand in health services, thus becoming a significant public health problem. In general, asthma control programs (GINA) with use of inhaled steroid medications have proven effective, although their implementation in real life remains cumbersome. Montelukast could be a useful and practical tool for these deprived socioeconomic sectors.

Methods: This real-life pilot study was conducted in a prospective, double blinded, placebo-controlled manner with randomized and parallel groups. Asthmatics that had never used leukotriene modifiers were recruited and followed-up every three months. The main outcome was the number of exacerbations meriting use of nebulized bronchodilators administered by the health care system.

Results: Eighty-eight asthmatic patients were enrolled, between children and adults. Groups were comparable in: demographic data, previous use of other medications, ACT scores, pulmonary functions (Wright Peak Flow meter), allergy status (Skin Prick Test) as well as adherence to the prescribed Montelukast treatment. By an intention to treat (ITT), a total of 64 patients were included for analysis. For the three and six months time points the difference between placebo and Montelukast was found to be significant (p < 0.03 and p < 0.04, respectively). Such trends continued for the rest of the year, but without statistical significance, due to patient attrition.

Conclusions: This real-life pilot study shows that a simplified strategy with oral Montelukast was practical and effective in controlling exacerbations in an asthmatic population of a vulnerable community from Caracas. Such an approach reinforces the role of primary care in asthma treatment.

No MeSH data available.


Related in: MedlinePlus