Efficacy of Episodic Use of Montelukast in Preschool Children with Intermittent Wheezing SC04-SC07
Dr. Shefali Bhagubhai Patel,
B-504, Shubhlaxmi Heights, Near Badrinarayana Temple, Adajan, Surat, Gujarat, India.
Introduction: Acute intermittent wheezing illnesses are frequent occurrences in preschool children and need better management strategies. Montelukast, a leukotriene receptor antagonist has potent anti-inflammatory property with rapid onset of action and may be effective in reduction of asthma symptoms.
Aim: To examine the effectiveness of episodic use of montelukast in modifying the severity of an acute wheeze episode in preschoolers.
Materials and Methods: Children aged 1-5 years with acute wheezing were included in an observational prospective case control study. Montelukast, 4mg orally, was started on admission and continued until symptom resolution, maximum upto 14 days. Primary outcomes were duration of respiratory symptoms, severity of respiratory illness by Paediatric Respiratory Assessment Measure (PRAM) score and duration of hospital stay. Secondary outcomes were need for number of doses of bronchodilator, inhaled or systemic steroid or other medication (MgSO4 and/or Aminophylline). Chi-Square test, unpaired, two sided student t-test and Mann-Whitney U test were applied wherever applicable.
Results: Total 107 patients were enrolled, out of which 53 patients were given montelukast and 54 patients served as control. Montelukast resulted in early reduction in symptom of breathlessness (p=0.0226), sleep disturbance (p=0.0214), feeding difficulty (p=0.011), significant improvement in PRAM score at 24 hour (p=0.046) and significant reduction in hospital stay (p=0.0448) compared to control group. There was significant increase in number of doses of systemic steroid (p < 0.00001) and need for other medication (p=0.027) in control group as compared to cases. There was no significant difference in proportion of patients requiring systemic steroid between two groups.
Conclusion: Episodic use of short course montelukast is effective in reduction of symptoms, hospital duration and systemic steroid use.