Montelukast Effective in Post-RSV Bronchiolitis

Laurie Barclay, MD

February 14, 2003

Feb. 14, 2003 — Montelukast is effective in treating bronchiolitis which develops after respiratory syncytial virus (RSV) infection, according to the results of a randomized, double-blind trial reported in the February issue of the American Journal of Respiratory and Critical Care Medicine. The investigators suggest that these results have implications for all postviral bronchospastic conditions in children and adults.

"Infants often develop reactive airway disease after RSV bronchiolitis," write Hans Bisgaard, from the Copenhagen University Hospital, Rigshospitalet, in Denmark, and colleagues. "Cysteinyl-leukotrienes (cys-LT) are released during RSV infection and may contribute to the inflammation. We hypothesized that a cys-LT receptor antagonist would ameliorate reactive airway disease subsequent to RSV bronchiolitis."

In this parallel comparison study, 130 infants hospitalized with acute RSV bronchiolitis received 5-mg montelukast chewable tablets or matching placebo for 28 days, starting within seven days of symptom onset. Median age was 9 months (range, 3 - 36 months), and infants with a suspected history of asthma were excluded.

During treatment, diary card data were available for 116 subjects. Infants receiving montelukast were free of any symptoms on 22% of the days and nights, compared with 4% of the days and nights in infants receiving placebo (P = .015). Compared with the placebo group, the montelukast group had less daytime cough (P = .04) and delayed exacerbations (P < .05).

"In conclusion, cys-LT antagonist treatment reduces lung symptoms subsequent to RSV bronchiolitis," the authors write. "The implications of these findings may not be restricted to RSV bronchiolitis but may reflect a general effect on postviral hyperresponsive airway symptoms [in] exacerbations of asthma and perhaps other chronic obstructive airway diseases in children and adults."

Am J Respir Crit Care Med. 2003;167:379-383

Reviewed by Gary D. Vogin, MD

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