My Son's Experience with Asthma and Singulair

My seven-year-old son has had three asthma attacks. The first occurred in March, shortly after Zachary turned two. His dad has mild asthma, and recognized the symptoms right away: wheezing, shortness of breath. I took Zachary to the doctor immediately. A breathing treatment in the doctor's office considerably improved Zachary's symptoms. Our doctor prescribed Singulair (montelukast sodium)-the 4-mg chewable pill-and Albuterol, a fast-acting inhaler. Zachary has taken Singulair once a day ever since.

Singulair is not a fast-acting, "rescue" medication for asthma. But we found that, after Zachary's first asthma attack ceased and his breathing was back to normal, Zachary rarely needed to use his Albuterol inhaler to relieve acute asthma symptoms. Zachary never experienced any negative side effects from the Singulair; he remained a curious, active, healthy, easygoing two-year-old. It was never a challenge getting him to take his Singulair every night before bed. The 4-mg chewable Singulair pills are quite small and taste "like cherry," according to Zachary. In addition to keeping Zachary's asthma under control, the Singulair treated his seasonal allergy symptoms, which are worst in spring and fall. No more runny nose or sneezing.

On April Fool's Day, almost exactly one year after Zachary's first relatively mild asthma attack, Zachary had a severe asthma attack. Again, his asthma attack was triggered by acute seasonal allergies. When his Albuterol inhaler didn't seem to improve his breathing, I called his doctor.

The Singulair-plus-Albuterol regimen was not enough to prevent the worst asthma attack of Zachary's life. I expected the doctor to administer a breathing treatment in our pediatrician's office, and then send us home. But Zachary was in no shape to go home. In fact, he needed a shot of epinephrine and an oxygen mask! A typical three-year-old boy, Zachary loved the attention he received from the wonderful firefighters and paramedics who soon arrived at our pediatrician's office to take us by ambulance to Children's Mercy Hospital in downtown Kansas City.

Zachary spent the night in the hospital, where he was closely monitored and given regular breathing treatments (and Spaghetti-O's-his favorite-for supper). The doctors at Children's Mercy recommended that we add Flovent, another inhaler, to Zachary's asthma medications. Zachary continued taking Singulair and two puffs of Flovent every day, and did not have another asthma attack for three years.

Zachary's asthma had become such a non-issue that, by age five, with his pediatrician's consent, we cut back on his Flovent. He still took Singulair (he'd switched to the 5-mg chewable Singulair pill by that time) every night to treat allergies and asthma, but only took Flovent during fall and spring, when his allergies were likely to trigger asthma symptoms. The asthma attack Zachary had last fall, at age six, was not severe enough to require hospitalization. I am certain that it could have been prevented entirely if we'd just started him on his Flovent a couple of weeks earlier. The combination of Singulair and Flovent has proven very effective in preventing Zachary's asthma symptoms, even during allergy season.

In our experience, the only downside of Singulair as an allergy and asthma treatment is the cost. Currently there is no generic substitute for Singulair. I pay $50 for a one-month supply of 5-mg chewable Singulair pills-that's $1.66 per pill. Singulair is more expensive upfront and needs to be refilled more often than Zachary's Flovent or Albuterol inhalers. But we are, overall, very pleased with Singulair. Zachary's allergies rarely bother him, and his asthma is so well-controlled that he almost never needs to use his Albuterol inhaler.

I was disturbed, to say the least, when I heard that Singulair was being blamed for some recent teen suicides. The FDA has now added "suicidal thoughts" to the list of possible side effects of Singulair. According to the FDA's most recent update, on January 13, 2009, found at this link (click on "FDA update"), "FDA has not yet reached a definitive conclusion regarding the clinical trial data on mood and behavioral adverse events associated with montelukast, zafirlukast, and zileuton. We will communicate our conclusions and any resulting recommendations to the public at the conclusion of the review, which may take months to complete."

Obviously, if your child's mood and behavior changes drastically after starting a new medication, you need to talk to your doctor immediately! My son is a pain in the butt and an annoying know-it-all sometimes, but he is a very happy, confident, outgoing, smart kid. Singulair has never affected his mood or his positive outlook on life as far as I can tell. If I ever notice any disturbing changes in his behavior or demeanor, you can bet that I'll call his pediatrician right away. But, for now, Singulair is helping to keep his asthma and allergies in check, and that makes all of us happy.

Sources:

Personal experience

http://www.rxlist.com/singulair-drug.htm

http://www.singulairfacts.com/singfacts/singulairfacts/index.jsp

http://www.usatoday.com/money/industries/health/2008-03-27-suicide-link_N.htm