MONTELUKAST OR AZITHROMYCIN FOR REDUCTION OF INHALED CORTICOSTEROIDS IN CHILD

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Patients with persistent asthma requiring moderate to high dose inhaled corticosteroid (ICS) even when given in combination with long acting bronchodilator agonist (LABA) to maintain control are at high risk for side effects from the ICS. These side effects include decreases in growth velocity and an impact on adrenal function. These and other data have encouraged clinicians to seek ways to reduce the steroid burden in their patients. Here we study the steroid sparing effectiveness of two medications, a macrolide (Mac) and a leukotriene receptor antagonist (LTRA) in such patients. A role of Mac in augmenting the treatment for asthma has had a long history. Initial investigations in the 1950s and 1960s using troleandomycin were stopped with discovery of liver toxicity and drug metabolism interactions. Use of Mac has reappeared in the therapeutic armamentarium for asthma as newer forms of the antibiotic class with fewer side effects have been introduced and as treatment with Mac for diffuse panbronchiolitis and cystic fibrosis was established, and studies demonstrating anti-inflammatory activities of the drugs rather than simply their anti-bacterial properties. Another drug class with possible steroid sparing effects is leukotriene receptor antagonist (LTRA). Addition of montelukast to low dose ICS improved both markers of airway inflammation and pulmonary function, while reducing beta agonist use, exacerbations, and blood eosinophil counts (62, 63). In clinical practice, montelukast is added even to moderate dose ICS in an attempt to avoid use of higher doses of ICS. The capacity of leukotriene receptor antagonist (LTRA) to allow a decrease in ICS dosing has been studied using montelukast in adults requiring moderate to high doses of ICS to maintain asthma control and found to be effective.