No effect from montelukast on respiratory symptoms and lung function in wheezy infants

This study from Finland investigated the effectiveness of montelukast in recurrently wheezy infants and randomized 113 children (6–24-month-old) with recurrent wheezing to receive either placebo or montelukast daily for an 8-week period.

There was no significant difference in symptom-free days between the two groups, or the use of rescue medication, exhaled nitric oxide fraction (FeNO) or airway parameters measured by whole-body plethysmograph, squeeze technique, and methacholine challenge.

Montelukast therapy did not influence the number of symptom-free days, use of rescue medication, or lung function in recurrently wheezy, very young children.

Not all wheezing is asthma

Wheezing occurrences in children:

- single episode in 30% to 50% of children before 5 yr of age
- 40% who wheeze before 3 yr of age continue at 6 yr (“persistent wheezers”)
- 50% of infants who wheeze once will wheeze again within several months


Wheezing in Children - Phenotypes (click to enlarge the image).

Childhood asthma phenotypes:

- transient early wheezers - wheeze sometime during first year of life; risk factors include prematurity, history of parental smoking during pregnancy, and passive exposure to tobacco smoke; such patients do not respond to inhaled bronchodilators or inhaled corticosteroids (ICS); wheezing tends to remit as child’s airway gets larger (between ages 2-3 yr)

- nonatopic wheezers - 0 to 6 yr of age; wheeze associated exclusively with viral infection; usually no eczema or family history; wheezing tends to remit by 6 yr of age

- atopic wheezers - past 5 yr of age, allergic - have positive blood and skin testing to inhalant allergens; tend to present within 2 to 3 yr of age, and continue to wheeze; wheezing not related to URTI



Childhood asthma phenotypes (click to enlarge the image).

References:

The effect of montelukast on respiratory symptoms and lung function in wheezy infants. Anna S. Pelkonen et al. ERJ March 1, 2013 vol. 41 no. 3 664-670. http://erj.ersjournals.com/content/41/3/664.short
Image source: Montelukast, from Wikipedia, the free encyclopedia, public domain.