GINA reiterates montelukast safety warning
The 2024 GINA guideline update reminds prescribers of the potential risk of neuropsychiatric adverse events in patients receiving montelukast, including:[3]
new-onset nightmares,
behavioral and mood problems (e.g., agitation, hyperactivity, irritability, nervousness, aggression), and
suicidal ideation.
Healthcare professionals should consider the benefits and risks before prescribing montelukast and have an open discussion with patients about potential adverse effects.
Healthcare professionals and patients should be alert to, and monitor for, serious behavior and mood-related changes during treatment.
Summary
Your Organizational Guidance
ebpracticenet urges you to prioritize the following organizational guidance:
Astma bij volwassenen: diagnose en monitoring in de eerste lijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2020Asthme chez l’adulte : diagnostic et surveillance en soins de santé primairesPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2020Definition
History and exam
Key diagnostic factors
- recent upper respiratory tract infection
- dyspnea
- cough
- expiratory wheezes
- nasal polyposis
Risk factors
- family history
- gene polymorphisms and epigenetics
- allergen/irritant exposure
- occupational exposure
- air pollution
- atopic disease history
- obesity
- cigarette smoking
- vaping
- early life respiratory viral infection and viral wheeze
- nasal polyposis
- aspirin and nonsteroidal anti-inflammatory drug (NSAID) use
- low socioeconomic status
- gastroesophageal reflux
- obstructive sleep apnea
- sex
- preterm birth
- polycystic ovary syndrome
- vitamin D deficiency
Diagnostic tests
Tests to consider
- chest x-ray
- CBC with differential
- fractional exhaled nitric oxide (FeNO)
- bronchial challenge test
- serum radioallergosorbent test (RAST) immunoassay for allergen-specific IgE
- skin-prick allergy testing
- high-resolution CT (HRCT) chest
- CT sinus
Treatment algorithm
Contributors
Authors
Lauren E. Eggert, MD
Clinical Assistant Professor
Division of Pulmonary, Allergy, and Critical Care Medicine
Department of Medicine
Stanford University School of Medicine
Stanford
CA
Disclosures
LEE has participated on advisory boards for Regeneron and AstraZeneca.
Sourav Majumdar, MD
Clinical Assistant Professor (Affiliated)
Division of Pulmonary and Critical Care Medicine
Department of Medicine
Stanford University School of Medicine
Stanford
CA
Disclosures
SM declares that he has no competing interests.
Acknowledgements
Dr Lauren E. Eggert and Dr Sourav Majumdar would like to gratefully acknowledge Dr Irwani Ibrahim, Dr Kay Choong See, Dr Francis Thien, and Dr Catherine Weiler, previous contributors to this topic.
Disclosures
II, KCS, FT, and CW declare that they have no competing interests.
Peer reviewers
Javed Sheikh, MD
Clinical Director
Division of Allergy and Inflammation
Beth Israel Deaconess Medical Center/Harvard Medical School
Boston
MA
Disclosures
JS is a consultant for Aventis, GSK, and Novartis/Genentech; is on the Speakers Bureau for Merck, Aventis, GSK, AstraZeneca, Pfizer, Novartis/Genentech, Inspire, and UCB; has had research sponsored by GSK; is an expert witness at Haemonetics; and has received publication honorarium at Emedicine.
Sheree M.S. Smith, PhD
Research Manager
Imperial College Healthcare Trust
NHLI Airways Division
Imperial College London (Honorary) Respiratory Research
Chest & Allergy
St Mary's Hospital
London
UK
Disclosures
SMSS declares that she has no competing interests.
Neil Thomson, MBChB, MD, FRCP
Professor of Respiratory Medicine
Respiratory Medicine Section
Division of Immunology, Infection & Inflammation
University of Glasgow
Glasgow
UK
Disclosures
NT declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
National Institutes of Health; National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. Expert panel report 3: guidelines for the diagnosis and management of asthma. Aug 2007 [internet publication].Full text
Global Initiative for Asthma. 2024 global strategy for asthma management and prevention. May 2024 [internet publication].Full text
Parsons JP, Hallstrand TS, Mastronarde JG, et al. An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am J Respir Crit Care Med. 2013 May 1;187(9):1016-27.Full text Abstract
Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC); Cloutier MM, Baptist AP, Blake KV, et al. 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-70.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available here.
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