Montelukast in Virus-Induced Wheezing
What is the role of montelukast in virus-induced wheezing?
Montelukast has proven to be an effective controller medication for the treatment of mild persistent asthma. In addition to reducing chronic symptoms, montelukast reduces the frequency of asthma exacerbations. Information about the effects of montelukast, or other controller medications, on exacerbations caused by specific stimuli are not completely understood.
Wheezing in very young children is predominantly caused by viruses such as respiratory syncytial virus (RSV), and may or may not be related to early childhood asthma. The finding that leukotriene levels are increased in the airway secretions of infants with RSV bronchiolitis suggests that these mediators also play a role in airway obstruction caused specifically by viruses, and this concept has been tested in a controlled clinical trial. In this trial, 130 infants who were hospitalized for RSV bronchiolitis were treated with either montelukast or placebo for 28 days beginning within 7 days of the onset of illness. The clinical course of the illness was evaluated during the acute illness and also during the recovery period. Although montelukast did not lessen respiratory symptoms during the acute illness, several benefits were demonstrated during the recovery period, including an increase in symptom-free days (22% montelukast vs 4% in the placebo group) and a delay in the onset of relapses of wheeze. Although these effects were modest, they suggest the possibility that inhibiting effects of leukotrienes during the acute illness may have benefits that lead to an accelerated recovery. Additional clinical studies are needed, and are in fact in progress, to clarify the role of leukotriene inhibitors in the treatment of virus-induced wheeze.
What is the role of montelukast in virus-induced wheezing?
Montelukast has proven to be an effective controller medication for the treatment of mild persistent asthma. In addition to reducing chronic symptoms, montelukast reduces the frequency of asthma exacerbations. Information about the effects of montelukast, or other controller medications, on exacerbations caused by specific stimuli are not completely understood.
Wheezing in very young children is predominantly caused by viruses such as respiratory syncytial virus (RSV), and may or may not be related to early childhood asthma. The finding that leukotriene levels are increased in the airway secretions of infants with RSV bronchiolitis suggests that these mediators also play a role in airway obstruction caused specifically by viruses, and this concept has been tested in a controlled clinical trial. In this trial, 130 infants who were hospitalized for RSV bronchiolitis were treated with either montelukast or placebo for 28 days beginning within 7 days of the onset of illness. The clinical course of the illness was evaluated during the acute illness and also during the recovery period. Although montelukast did not lessen respiratory symptoms during the acute illness, several benefits were demonstrated during the recovery period, including an increase in symptom-free days (22% montelukast vs 4% in the placebo group) and a delay in the onset of relapses of wheeze. Although these effects were modest, they suggest the possibility that inhibiting effects of leukotrienes during the acute illness may have benefits that lead to an accelerated recovery. Additional clinical studies are needed, and are in fact in progress, to clarify the role of leukotriene inhibitors in the treatment of virus-induced wheeze.
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