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).


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.
Image source: Montelukast, from Wikipedia, the free encyclopedia, public domain.

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