DrWhite2Q: What is montelukast (Singulair) and how is it different from using inhaled corticosteroids? Can my son use it to manage his asthma? 

Martha White, MD: Montelukast (Singulair) is an oral medication taken daily to treat asthma and allergic rhinitis, or nasal allergies. It’s available by prescription for adults and children ages 6 and older.

It is a leukotriene modifier – not a corticosteroid – with mild anti-inflammatory properties. Leukotriene modifiers can help prevent asthma flares, as well as manage allergic rhinitis, by blocking leukotrienes that cause airway muscles to constrict and produce mucus. Montelukast is often used by itself or in combination with an inhaled corticosteroid. In my experience, young children are more likely than adults to have their asthma controlled by montelukast.

Inhaled corticosteroids are anti-inflammatories that treat the airway inflammation that causes asthma flares. Since the medication is inhaled, it travels directly to the airways where it treats the inflammation. Taken daily, inhaled corticosteroids tend to be more effective anti-inflammatory medications for asthma and allergies, however some people with very mild asthma can keep symptoms under control on montelukast alone, without the need for inhaled corticosteroids. People with moderate asthma or who have asthma flares while on montelukast usually require inhaled corticosteroids to maintain good asthma control.

Montelukast (Singulair) is available in both sprinkles and a chewable pill. Every child is different, so ask your doctor whether it is an appropriate medication for your child and if it should be taken alone or with an inhaled corticosteroid.

Martha White, MD, FACAAI, is a board-certified allergist at the Institute of Asthma and Allergy in Wheaton, Md., a member of Allergy & Asthma Network’s Board of Directors, and a fellow of the American College of Allergy, Asthma & Immunology.

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