A 5-year-old boy with asthma has mood changes and anxiety. Which medicine should be avoided when selecting treatment?

A 5-year-old boy with asthma has mood changes and anxiety. Which medicine should be avoided when selecting treatment?

• A. Salbutamol inhaler
• B. Montelukast
• C. Budesonide inhalation
• D. Theophylline

Answer: (B)

Neuropsychiatric side effects in children are a key consideration here. Montelukast, a leukotriene receptor antagonist used for asthma, has been linked to mood changes, anxiety, irritability, and other behavioral changes in pediatric patients. When a 5-year-old already shows mood changes and anxiety, avoiding a medication with this potential adverse effect helps prevent worsening those symptoms, making it the best choice to avoid. The other options don’t carry the same direct risk for mood or anxiety in this context. A short-acting beta-agonist inhaler can cause tremor or jitters but not primarily mood disturbance; an inhaled corticosteroid like budesonide is mainly limited by growth effects with long-term use and other routine corticosteroid concerns rather than acute mood effects; theophylline can cause CNS stimulation and other toxicity but is less commonly used nowadays and its psychiatric effects are not as specifically tied to mood changes in this scenario.

Neuropsychiatric side effects in children are a key consideration here. Montelukast, a leukotriene receptor antagonist used for asthma, has been linked to mood changes, anxiety, irritability, and other behavioral changes in pediatric patients. When a 5-year-old already shows mood changes and anxiety, avoiding a medication with this potential adverse effect helps prevent worsening those symptoms, making it the best choice to avoid.

The other options don’t carry the same direct risk for mood or anxiety in this context. A short-acting beta-agonist inhaler can cause tremor or jitters but not primarily mood disturbance; an inhaled corticosteroid like budesonide is mainly limited by growth effects with long-term use and other routine corticosteroid concerns rather than acute mood effects; theophylline can cause CNS stimulation and other toxicity but is less commonly used nowadays and its psychiatric effects are not as specifically tied to mood changes in this scenario.