Management of Asthma Exacerbations

Role of Montelukast in Asthma

Montelukast is a leukotriene receptor antagonist (LTRA) that acts as a long-term control medication, not a rescue medication for acute asthma attacks, with a dual mechanism of action as both a bronchodilator and anti-inflammatory, but with a delayed onset of action, making it unsuitable for treating acute exacerbations 1, 2
Montelukast is used as daily controller therapy for mild persistent asthma or as add-on therapy to inhaled corticosteroids 3

Primary treatment for asthma exacerbations consists of administering oxygen to maintain SaO2 >90%, short-acting beta-agonists (SABA) as first-line treatment, and systemic corticosteroids 4
Short-acting beta-agonists (such as albuterol) are the most effective medications for reversing airway obstruction during an asthma attack, with an initial strategy of 3 administrations at 20-30 minute intervals 4
In severe exacerbations, ipratropium bromide inhalation can be added to increase bronchodilation 4
Systemic corticosteroids are recommended for most patients with moderate to severe exacerbations, as they accelerate the resolution of airway obstruction and reduce the risk of relapse 4

Leukotriene antagonists, including montelukast, are not recommended for the treatment of acute asthma exacerbations 5

For the treatment of acute asthma exacerbations, use short-acting beta-agonist inhalers (such as albuterol) as first-line medication, systemic corticosteroids for moderate to severe exacerbations, and supplemental oxygen if saturation is low 4