Objective To systematically evaluate the efficacy and safety of montelukast in the treatment of acute asthma in adults.Methods Randomized controlled trials ( RCTs) of montelukast in the treatment of acute asthma compared with placebo were searched in Pubmed, Embase, OVID, and Cochrane Library. The quality of included RCTs was evaluated and the data were extracted. Meta-analyses were performed with RevMan 5. 1 software, and the GRADE system was applied to rate the level of evidence and strength of recommendation. Results Five RCTs ( n = 947) were included. Meta-analyses showed that montelukast could statistically improve peak expiratory flow ( PEF) ( MD = 10. 65 [ 2. 81, 18. 49] , P = 0. 008) , reduce the number of patients with oral corticosteroids ( RR=0. 75[ 0. 62, 0. 92] , NNT= 7[ 4, 46] , P =0. 005) , but there were no statistical differences in decreasing the number of patients with hospitalizations ( RR= 0. 78[ 0. 57, 1. 06] , NNT = 19[ 9, + ∞] , P = 0. 110) and treatment failure ( RR = 0. 85[ 0. 67, 1. 09] , NNT=17[ 9, +∞] , P =0. 314) compared with the placebo. Based on GRADE, the level of evidence was low or moderate, and the strength of recommendation was weak. Conclusion Our study suggests montelukast can improve the lung function and reduce the use of systematic corticosteroids in acute asthma, but the potency to reduce the number of patients with hospitalization and treatment failure need to be explored in future.
Objective To study the efect of montelukast for improving bronchial hyperresponsiveness (BHR) in treatment of bronchiolitis. Methods Four hundreds infants, 3 to 24 months old, hospitalized with acute bronchiolitis in three Hospitals (Urumqi Children’s Hospital, Pediatrics Department of First Ailiated Hospital of Xinjiang Medical University, and Pediatrics Department of Army General Hospital) from January, 2007 to January, 2008, were randomly assigned into four groups: placebo group (n=92), budesonide group (n=91), montelukast short-course group (7 days, n=88), and montelukast long-course group (28 days, n=90). Main outcome measure was BHR ater treatment, including recurrent bronchiolitis wheezing and asthma incidence rate. Secondary measures were changes in serum T-IgE level and eosinophilic cationic protein (ECP) level. Results All four groups were comparable at baseline. No signiicant diferences were observed between placebo group and budesonide group in changes of serum T-IgE (F=6.17, P=0.00), ECP (F=8.13, P=0.00), recurrent post-bronchiolitis-wheezing (χ2=49.46, P=0.00) and asthma incidence rate (χ2=27.21, P=0.00). Ater treatment with montelukast, there was statistical signiicance in T-IgE and ECP level, times of recurrent bronchiolitis wheezing and asthma incidence rate, as follows, montelukast short-course group versus placebo group (F=12.56, P=0.00), montelukast short-course group versus budesonide group (F=7.22, P=0.00), montelukast long-course group versus placebo group (F=20.48, P=0.00), montelukast long-course group versus budesonide group (F=13.56, P=0.00), montelukast short-course group versus montelukast long-course group (F=1.04, P=0.00). Conclusions Budesonide treatment for 7 days can not improve bronchial hyperresponsiveness induced by bronchiolitis, while montelukast does, that is, montelukast can decrease both the times of bronchiolitis wheezing and asthma incidence rate. Long-course treatment of montelukast is superior to that of short-course.
Objective To investigate the effects of montelukast ( MK) on the airway inflammation and the risk of the recurrence of wheezing in the treatment of infants with RSV bronchiolitis.Methods 60 infants ( aged 6-24 months) with RSV bronchiolitis admitted between December 2010 and December 2011 were recruited in the study. They were randomly assigned into a conventional group and a MK group ( n =30 in each group) . All patients received conventional treatments including inhalation of budsonide and so on.The subjects in the MK group received oral montelukast ( 4 mg qn for 12 weeks) additionally. The levels of serum cysteinyl leukotrienes ( CysLTs ) , total immunoglobuline E ( T-IgE) , eosinophil cationic protein ( ECP) and fractional exhaled nitric oxide ( FeNO) were assayed before and after the treatments. Thenumber of recurrence of wheezing was recorded through outpatient and telephone follow-up for 12 months. 30 healthy infants participating the health examination in outpatient were selected as control, and those who got atopic disease or respiratory tract infections recently were excluded. Results The levels of CysLTs, ECP and FeNO of the patients with RSV bronchiolitis before treatment were significantly higher than those in the normal control group, and the levels of CysLTs and FeNO were significantly decreased after treatment ( P lt;0. 05) . The levels of CysLTs and FeNO after treatment in the MK group was significantly lower than those in the conventional group. The level of ECP was significantly decreased after treatment in the MK group ( P lt;0. 05) ,·186· Chin J Respir Crit Care Med, March 2013 , Vol. 12 , No. 2 http: / /www. cjrccm. com which was not significantly changed in the conventional group( P gt; 0. 05) . The number of recurrence of wheezing in the MK group was more less that that in the conventional group ( P lt; 0. 05) . Conclusion Maintenance treatment with montelukast after the treatment of the acute phase of bronchiolitis can prevent recurrence of wheezing by suppressing airway inflammation in infants with RSV bronchiolitis.
Objective To explore the effect of leukotriene receptor antagonist montelukast on physicochemical property of sputum and airway mucus hypersecretion in patients with acute exacerbation of bronchiectasis. Methods Eighty-four inpatients with acute exacerbation of bronchiectasis were randomly divided into a control group and an experiment group, with 42 cases in each group. The control group received conventional therapy and the experiment group took orally montelukast 10 mg before sleep every day based on conventional therapy for two weeks. At admission and 15 days after admission, the amount in 24 hours, dry/wet weight ratio and viscosity of sputum were observed while the levels of neutrophil elastase (NE) and mucin MUC5ac in sputum were determined by ELISA. The pulmonary ventilation function, airway resistance and blood gas analysis were also measured. Results The sputum amount in 24 hours, dry/wet weight ratio and viscosity of sputum, NE and MUC5ac of sputum, pulmonary ventilation function, blood gas analysis and airway resistance were declined or improved remarkably after treatment compared with before treatment in two groups (P<0.05). Meanwhile, the sputum amount in 24 hours [(5.62±1.83) g vs. (7.53±2.32) g], NE [(3.85±0.97) μg/ml vs. (4.54±1.03) μg/ml], MUC5ac [(0.65±0.21) μg/ml vs. (0.82± 0.29) μg/ml] and the airway resistance [(119.16±11.76)% vs. (128.37±12.08)%] were declined remarkably in the experiment group compare with the control group after treatment (all P<0.05). The viscosity of sputum between the two groups after treatment showed no significant difference. Conclusion In patients with acute exacerbation of bronchiectasis, montelukast can reduce amount of sputum and airway resistance, reduce expression of mucin MUC5ac through down-regulation of NE, thus inhibit airway mucus hypersecretion.