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Systematic review of montelukast's efficacy for preventing post‐bronchiolitis wheezing
Author(s) -
Peng WanSheng,
Chen Xin,
Yang XiaoYun,
Liu EnMei
Publication year - 2014
Publication title -
pediatric allergy and immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.269
H-Index - 89
eISSN - 1399-3038
pISSN - 0905-6157
DOI - 10.1111/pai.12124
Subject(s) - montelukast , bronchiolitis , medicine , asthma , randomized controlled trial , leukotriene , pediatrics , respiratory system
Infants often develop reactive airway diseases subsequent to respiratory syncytial virus ( RSV ) bronchiolitis. Cysteinyl leukotrienes (cys LT s), a class of lipid mediators that have been implicated in the pathogenesis of allergic rhinitis and asthma, are released during RSV infection, thereby contributing to the pathogenic changes in airway inflammation. Many pediatric patients, especially those of very young age, continue to have recurrent episodes of lower airway obstruction after bronchiolitis treatment. This study was to systematically review and assessed the efficacy of montelukast for preventing wheezing in patients with post‐bronchiolitis. The Cochrane library, P ub M ed, C hina N ational K nowledge I nfrastructure ( CNKI ) periodical databases were screened for studies related to use of montelukast for preventing post‐bronchiolitis wheezing published up to 31 D ecember 2012. Randomized controlled trials ( RCT s) and quasi‐ RCT s using montelukast alone as an active intervention in infants up to 24 months of age with post‐bronchiolitis were selected. Two authors independently extracted data and assessed trial quality using the recommendations published by the C ochrane C ollaboration. The meta‐analyses were performed using the C ochrane statistical package R ev M an5.0.0. Four trials, containing 1430 infants with confirmed diagnosis of acute bronchiolitis, were analyzed. Patients were administered montelukast at post‐bronchiolitis. Three trials showed no effects of montelukast on reducing the incidence of recurrent wheezing risk ratios ( RR = 0.78, 95% CI : 0.55–1.12, p = 0.17), while two trials found that montelukast did reduce the frequency of recurrent wheezing and another two trials demonstrated no effects of montelukast on symptom‐free days. The pooled montelukast treatment group showed no significant effect on reducing the usage of corticosteroids, as compared to the placebo group ( RR = 1.11, 95% CI : 0.85–1.44, p = 0.45). Two trials showed that montelukast significantly decreased serum eosinophil‐derived neurotoxin levels, as compared to the control group. In general, the side effects of rash, vomiting, and insomnia caused by montelukast occurred in 1.5% of patients analyzed. The recent evidences indicate that montelukast may reduce the frequency of post‐bronchiolitic wheezing without causing significant side effects but that it has no effects on decreasing incidences of recurrent wheezing, symptom‐free days, or the associated usage of corticosteroid in post‐bronchiolitis patients. The small number of enrolled participants and the inability to pool all clinical outcomes precludes us from making solid recommendations.