ABSTRACT

Chronic airway inflammation is a major characteristic of asthma. Montelukast is a class of leukotriene receptor antagonists (LTRA) which has the most widely used anti-inflammatory properties because it shows the best effectiveness and safety. Many in vitro and in vivo experimental clinical studies have been published in the last 10 years covering the effectiveness and safety of montelukast in childhood asthma of varying degrees of severity. Montelukast is used as an alternative monotherapy for the ICS class or as an adjunct to enhance the anti-inflammatory and sparing effects of corticosteroids. montelukast as a treatment for asthma in children can be given in cases of mild to moderate persistent asthma, wheezing due to viruses, asthma due to exercise, and intolerance of steroid use in children. The advantages of montelukast as monotherapy are fast onset in controlling asthma, low side effects, given once daily oral administration without the need for an inhaler thereby increasing pediatric patient compliance.         

Keyword: Asthma, Children, Montelukast, Cysteinyl Leukotriene Receptor Antagonist.

ABSTRAK

Inflamasi saluran napas kronis merupakan karakteristik utama asma. Montelukas merupakan golongan antagonis reseptor leukotrien (LTRA) memiliki sifat antiinflamasi yang paling banyak digunakan karena menunjukkan efektivitas dan keamanan terbaik. Penelitian klinis eksperimental baik in vitro maupun in vivo sudah banyak diterbitkan dalam 10 tahun terakhir mencakup efektivitas dan keamanan montelukas pada asma anak dengan derajat keparahan berbeda-beda. Montelukas digunakan sebagai monoterapi alternatif untuk golongan ICS atau sebagai tambahan untuk meningkatkan efek antiinflamasi dan meminimalisir penggunaan kortikosteroid. Montelukas sebagai pengobatan asma pada anak dapat diberikan pada kasus asma ringan sampai dengan persisten sedang, sesak oleh karena virus, dan asma akibat aktivitas berat, serta kondisi intoleransi steroid. Keuntungan montelukas sebagai monoterapi antara lain memiliki waktu onset cepat dalam mengendalikan asma dengan efek samping rendah pada pemberian oral sehari sekali tanpa penggunaan inhaler sehingga meningkatkan kepatuhan pasien anak.

Kata Kunci: Asma, Anak, Montelukas, Cysteinyl Leukotriene Receptor Antagonist.

Arnold DH, Bowman N, Reiss TF, Hartert TV, Seger DL., 2018. Adverse events are rare after single-dose montelukast exposures in children. Clinical toxicology (Philadelphia, Pa.). 56(1): 25–29.

Bernstein JM, Lehman H, Lis M, Sands A, Wilding GE, Shultz L, Bankert R and Bobek L., 2012. Humanized mouse model used to monitor MUC gene expression in nasal polyps and to preclinically evaluate the efficacy of montelukast in reducing mucus production. Ann Otol Rhinol Laryngol. 121:307-316.

BNF. British National Formulary 73rd ed. BMJ Publishing Group. p155.

Cui A-H, Zhao J, Liu S-X and Hao Y-S., 2017. Associations of IL-4, IL-6, and IL-12 levels in peripheral blood with lung function, cellular immune function, and quality of life in children with moderate-to-severe asthma. Medicine (Baltimore). 96 (6265).

Dahl en SE, Dahl en B, Drazen JM., 2011. Asthma treatment guidelines meet the real world. New England Journal of Medicine, 364(18): 1769-1770.

Debelleix S, Siao-Him Fa V., 2018. Montelukast reverses airway remodeling in actively sensitized young mice. Pediatr Pulmonol. 53 (701-9).

Dharmage SC, Perret JL, Custovic A., 2019. Epidemiology of asthma in children and adults. Frontiers in Pediatrics, 7(JUN): 1–15.

Global Initiative for Asthma (GINA). 2021. Global strategy for asthma management and prevention. [Diakses 2021 May 15]. Available from: http://www.ginasthma.org.

Jian Lv, Zhefeng Z., 2019. Effect of leukotriene receptor antagonist on clinical symptoms, Th1/Th2 cytokines and pulmonary function in children with bronchial asthma. Int J Clin Exp Med. 12(12):13890-13895.

Kahnt AS, Rorsch F, Diehl O., 2013. Cysteinyl leukotriene-receptor-1 antagonists interfere with PGE2 synthesis by inhibiting mPGES-1 activity. Biochem Pharmacol. 86 (286-96).

Kanaoka Y, Boyce JA., 2014. Cysteinyl leukotrienes and their receptors; emerging concepts. Allergy Asthma Immunol Res. 6 (288-95).

Kianmehr M, Haghmorad D, Nosratabadi R, Rezaei A, Alavinezhad A and Boskabady MH., 2017. The effect of Zataria multiflora on Th1/Th2 and Th17/T regulatory in a mouse model of allergic asthma. Front Pharmacol. 8(458).

Kim Chang-Keun, Zak C, jin-Sung P., Hisashi N, Tikatoshi O, izuho N, Takao F., 2018. Montelukast reduces serum levels of eosinophil-derived neurotoxin in preschool asthma. Allergy Asthma Immunol Res. 10(6):686-697.

Liu AH, Covar RA, Spahn JD, Leung DY., 2007. Childhood asthma. In: Kliegman RM, Behrman RE, Jenson HB, Stanton B, editors. Nelson textbook of pediatrics. 18th ed. Philadelphia (PA): Saunders. 953-70.

Maslan J, Mims JW., 2014.What is asthma? Pathophysiology, demographics, and health care costs. Otolaryngol Clin North Am. 47(1):13-22.

Morina N, Boçari G, Iljazi A., 2016. Maximum time of the effect of antileukotriene - zileuton in treatment of patients with bronchial asthma. Acta informatica medica. 24 (16-9).

Morina N, Haliti A, Iljazi A, Islami D, Bexheti S, Bozalija A and Islami H., 2018. Comparison of effect of leukotriene biosynthesis blockers and in-hibitors of phosphodiesterase enzyme in pa¬tients with bronchial hyperreactivity. Maced J Med Sci. 6: 777-781.

Myers TR, Tomasio L., 2011. Asthma: 2015 and beyond. Respiratory Care, 56(9):1389-1407.

Nagao Mizuho, Masanori I, Norimasa F, Chizu H, Tetsuro K, Toshio K, Takao F., 2017. Early control treatment with montelukast in preschool children with asthma: A randomized controlled trial. Allergology International.

Qu Xiaoting, Yuan C, Chaoyang Y., 2018. Effect of montelukast on the expression of CD4+CD25+ regulatory T cells in children with acute bronchial asthma. Experimental And Therapeutic Medicine. 16: 2381-2386.

Rolfes MC, Juhn YJ, Wi C-I and Sheen YH., 2017. Asthma and the risk of rheumatoid arthritis: An insight into the heterogeneity and phenotypes of asthma. Tuberc Respir Dis (Seoul). 80: 113-135.

Soh JY, Ng B, Tan Z,. 2014. Ten-year prescription trends of asthma medications in the management of childhood wheeze. Allergy Asthma Proc 35: e1– e8.

Sweetman S. 2009. Martindale The Complete Drug Reference 36th ed. Pharmaceutical Press. p1126.

Sweetman S. 2014. Martindale The Complete Drug Reference 38th ed. Pharmaceutical Press. p1233.

Tenero L, Michele P, Marco S, Annachiara A, Iolanda C, Diego P, Attilio B, Giorgio P., 2016. Effect of montelukast on markers of airway remodeling in children with asthma. Allergy Asthma Proc 37: e77–e83.

Theron AJ, Steel HC, Tintinger GR., 2014. Cysteinyl leukotriene receptor-1 antagonists as modulators of innate immune cell function. J Immunol Res. 2014 (608930).

Trinh HKT, Pham DL, Choi Y., 2018. Epithelial folliculin enhances airway inflammation in aspirin-exacerbated respiratory disease. Clin Exp Allergy. 48 (1464-73).

Wang S, Tu J and Song Y., 2018. Evaluation of pulmo¬nary reexpansion in a porcine model of bron¬chial foreign body. Pediatr Pulmonol. 53: 278-283.

Wolthers OD., 2009. Anti-inflammatory treatment of asthma: Differentiation and trial-and-error. Acta Paediatrica, 98: 1237-1241.

Yokomizo T, Nakamura M, Shimizu T., 2018. Leukotriene receptors as potential therapeutic targets. J Clin Invest. 128 (2691-701).