Role of montelukast in multitrigger wheezers attending chest clinic in Punjab, India

Abstract

Background Wheeze is seen in 40% of preschool children, one‐third of these may develop recurrent wheeze. Montelukast is an oral, once a day, easy to give therapy but there is no definite evidence to support its use in a recent meta‐analysis. Present study was done to evaluate role of daily montelukast and various factors affecting the outcome after therapy in multitrigger wheeze (MTW). Methods A prospective study conducted in Pediatric chest clinic over 18 months at DMCH, Ludhiana. Children from 6 months to 5 years, diagnosed cases of MTW were started on montelukast. Diagnosis based on symptoms of recurrent wheeze triggered by various allergens/precipitants was made by pediatrician in charge of chest clinic. Children were followed up at 1 and 3 months. They were labeled as controlled, partially controlled, or uncontrolled as per global initiative for asthma guidelines. Data were used to compare the outcome related to various factors. Results Total 139 out of 150 children came for regular follow‐up. At the end of 3 months, 94 (67.7%) were controlled, 8 (5.7%) partially controlled, and 37 (26.6%) children remained uncontrolled on montelukast. Factors associated with poor control were onset of symptoms at younger age (<6 months of age), family history of allergies, prior multiple visits or hospitalizations due to MTW, use of MDI in the past. No significant side effects were reported by parents. Conclusion Symptomatically two‐third of children became better after starting montelukast. There were few factors which resulted in poorer control in subset of patients.

Management of Preschool Wheezing: Guideline from the Emilia-Romagna Asthma (ERA) Study Group

“…Regarding MTW, a study by Kahlon and colleagues reported that daily montelukast was effective in about two thirds of children in a cohort of preschoolers in terms of symptom control [ 23 ]. Interestingly, children who had developed symptoms earlier in life had the worst symptom control.…”

“…Kooi and colleagues reported that montelukast reduced symptoms within 3 months from the beginning of therapy [ 99 ]. A prospective study by Kahlon and colleagues assessed the clinical response to montelukast in a cohort of preschoolers with MTW [ 23 ]. Nearly 70% achieved good control within 1 month of daily treatment, and almost all reported good symptom control after 3 months of treatment.…”

“…The following supporting information can be downloaded at: , Supplementary Material S1: PICO questions and literature analysis [ 6 , 9 , 17 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 32 , 41 , 42 , 43 , 46 , 47 , 49 , 50 , 51 , 52 , 55 , 57 , 59 , 60 , 61 , 62 , 67 , 68 , 69 , 70 , 72 , 73 , 74 , 75 , 85 , 86 , 87 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , …”

An Overview on the Primary Factors That Contribute to Non-Allergic Asthma in Children

“…In addition, montelukast in mice models has been shown to block and reverse the asthmatic chronic inflammation-induced airway remodeling [ 107 ]. In certain Asian nations, asthmatic preventative treatment is started at a younger age—for instance, at six months—than in Western countries [ 108 , 109 ]. However, there are few research on cohorts of such young children, and those that do exist are regionally focused.…”