Montelukast once daily inhibits exercise-induced bronchoconstriction in 6- to 14-year-old children with asthma☆☆☆★★★

Abstract Objective: To determine whether montelukast, a leukotriene receptor antagonist, attenuates exercise-induced bronchoconstriction (EIB) in 6- to 14-year-old children with asthma. Study design: Double-blind, multicenter, 2-period crossover study. Children (n = 27) with forced expiratory volume in 1 second (FEV 1 ) ≥70% of the predicted value and a fall in FEV 1 ≥ 20% after exercise on 2 occasions. Patients received montelukast (5-mg chewable tablet) or placebo once daily in the evening for 2 days in crossover fashion (at least 4 days between treatment periods). Standardized exercise challenges were performed 20 to 24 hours after the last dose in each period. End points included area above the postexercise percent fall in FEV 1 versus time curve (AAC 0-60min ), maximum percent fall in FEV 1 from pre-exercise baseline, and time to recovery of FEV 1 to within 5% of pre-exercise baseline. Results: Montelukast significantly reduced AAC 0-60min (265 vs 590 % · min for montelukast and placebo, respectively, P ≤ .05; ~59% protection relative to placebo) and the maximum percent fall (18% vs 26% for montelukast and placebo, respectively, P ≤ .05). Montelukast treatment resulted in a shorter time to recovery (18 vs 28 minutes for montelukast and placebo, respectively, P = .079). Conclusions: Montelukast attenuates EIB at the end of the dosing interval in 6- to 14-year-old children with asthma. (J Pediatr 1998;133:424-8)