The Role of Singulair in Asthma

Can Singulair help?

Singulair (montelukast) and other leukotriene modifiers can be used as an alternative therapy for the treatment of mild persistent asthma and adjunctive therapy in combination with inhaled steroids. Singulair (montelukast) and other leukotriene modifiers can also be used for the prevention of exercise-induced asthma, and in the treatment of allergic rhinitis.

Woman putting asthma medication in her pill box
Blend Images / Peter Dressel / Getty Images

How It Works

Leukotrienes are released from mast cells, eosinophils, and basophils and lead to increased inflammation, secretions and airway narrowing that causes symptoms such as:

  • Wheezing
  • Chest tightness
  • Shortness of breath
  • Cough


Because Singulair (montelukast) and other leukotriene modifiers are not as effective as inhaled steroids, they are not considered a first-line treatment for asthma. However, Singulair (montelukast) and other leukotriene modifiers can be useful if inhaled steroids alone do not control your asthma symptoms.

Singulair (montelukast) and other leukotriene modifiers are also one potential option if you don't want to or cannot take inhaled steroids. One potential advantage of Singulair (montelukast) and other leukotriene modifiers is that they are oral medication and may be much easier for you to take. Singulair (montelukast) and other leukotriene modifiers:

  • Decrease bronchoconstriction
  • Decrease mucus production
  • Decrease inflammation

In clinical studies, Singulair (montelukast) and other leukotriene modifiers:

  • Provide clinical benefit when added to an inhaled steroid
  • Have allowed for a lower dose of an inhaled steroid
  • Improve FEV1
  • Decrease nocturnal asthma symptoms
  • Improved quality of life

However, there is some evidence that long-acting beta-agonists may provide more clinical benefits when added to an inhaled steroid compared to Singulair (montelukast) and other leukotriene modifiers. Talk to your doctor about what "add-on" therapy is best for you.

Currently Available Modifiers

The currently available leukotriene modifiers are:

  • Singulair (montelukast sodium)
  • Accolate (zafirlukast)
  • Zyflo (zileuton)

Dosages and availability for use in children will vary.

Side Effects

While Singulair (montelukast) and other leukotriene modifiers are generally well tolerated, the most common side effects include:

  • Stomach upset
  • Headaches
  • Upper respiratory infection
  • Cough
  • Ear inflammation

Additionally, Singulair (montelukast) and other leukotriene modifiers have changed their labeling to make providers and patients aware of potential mental health side effects noted with this class of drugs.

Other Options

For kids there is another option for adjunctive treatment when inhaled steroids are not sufficient for your asthma control, you do not want to take inhaled steroids or you do not want to increase your steroid dose. Surprisingly it is not even medication, but rather a medical food.

Lunglaid decreases leukotriene production and has been associated with decreased inflammation and improved quality of life in clinical trials. Medical foods may cause fewer side effects compared to medications and parents may want to have a preference for medical food over a medication.

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Article Sources
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  2. U.S. National Library of Medicine. MedlinePlus. Montelukast. Revised March 15, 2019.

  3. UpToDate. Patient education: asthma treatment in adolescents and adults (Beyond the Basics). Updated January 8, 2019.

  4. Baig S, Khan RA, Khan K, Rizvi N. Effectiveness and Quality of Life with Montelukast in Asthma - A double-blind randomized control trial. Pak J Med Sci. 2019;35(3):731-736. doi:10.12669/pjms.35.3.42

  5. Merck Manual Consumer Version. Drugs for preventing and treating asthma. Revised August 2019.

Additional Reading