Asthma therapy worsens symptoms in some kids

Salmeterol, an inhaled, long-acting beta-2 agonist commonly prescribed to treat asthma in children, can actually worsen symptoms for those with the arginine-16 beta-2 receptor genotype, says new research from the United Kingdom.

Investigators compared different treatments given to children with asthma who continued to experience symptoms after using inhaled corticosteroids. Sixty-two children with asthma who were found to have the genotype were randomized to receive either salmeterol or montelukast once daily as an add-on to inhaled fluticasone for 1 year. All the children had either missed school or presented for treatment at a hospital because of asthma symptoms, even though they were taking prescribed inhaled corticosteroids.

Using school absences as the primary outcome, researchers found that absences were significantly reduced for children taking montelukast compared with children taking salmeterol. In addition, they found significant improvement in symptoms (eg, less coughing and wheezing) and in quality-of-life scores with montelukast versus salmeterol. The montelukast group also reduced their use of inhaled relievers.

The benefits of montelukast treatment were evident within the first 3 months of the study and persisted through the full year.

Researchers say that their findings provide evidence that montelukast is effective second-line controller therapy for children with the arginine-16 genotype and demonstrate support for personalized medicine based on genotype to improve long-term outcomes for children with asthma.