Montelukast may prevent wheezing after RSV bronchiolitis

Investigators conducted a multicenter study of the effect of montelukast on eosinophil degranulation and recurrent wheezing episodes after respiratory syncytial virus (RSV) bronchiolitis. The researchers assessed 150 infants aged 6 to 24 months who had been hospitalized in pediatric asthma and allergy centers with their first episode of RSV bronchiolitis. The infants were divided into 2 treatment groups: the first group received 4-mg montelukast oral granules once daily, and the other group received matching placebos. Treatment continued for 3 months, with a 12-month follow-up period; no additional asthma medication was prescribed except for short-acting beta₂-agonists when necessary. A control group comprised an additional 50 infants.

To determine the effect of montelukast on eosinophil degranulation, investigators measured eosinophil-derived neurotoxin (EDN) serum levels. After the 3-month treatment period, serum EDN levels had increased in the placebo group and decreased in the montelukast group, although not to the level in the control group. At 6 months, however, EDN concentrations in the montelukast group had decreased to levels similar to those in the control group. Despite a slight rebound in EDN levels in the montelukast group between 6 and 9 months, the levels remained significantly lower than the corresponding levels in the placebo group throughout the 12-month follow-up period. In addition, cumulative recurrent wheezing episodes were significantly lower in the montelukast group than in the placebo group, although this did not become evident until 9 to 12 months into the follow-up period(Kim C-K, et al. J Pediatr. 2010;156[5]:749-754).

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