Infants often develop reactive airway diseases subsequent to respiratory syncytial virus (RSV)
bronchiolitis. Cysteinyl
leukotrienes (cysLTs), 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, PubMed, China National Knowledge Infrastructure (CNKI) periodical databases were screened for studies related to use of
montelukast for preventing post-
bronchiolitis wheezing published up to 31 December 2012. Randomized controlled trials (RCTs) and quasi-RCTs 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 Cochrane Collaboration. The meta-analyses were performed using the Cochrane statistical package RevMan5.0.0. 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.