Respiratory syncytial virus (RSV) b...

Respiratory syncytial virus (RSV) bronchiolitis is the greatest in quantity common cause of pneumonia and bronchiolitis in infants and accounts for individual in six infant hospitalizations. Acute infections with RSV bronchiolitis frequently are followed by periods of reactive airway disease, perhaps partly because of the release of leukotriene mingles which can cause bronchial obstruction, mucosal edema, and bronchial hyperresponsiveness. The studious mood Group on Montelukast and Respiratory Syncytial Virus bearinged a randomized, double-blind, placebo-controlled trial of montelukast for post-RSV reactive airway disease.

During a four-week treatment period, 130 infants from three to 36 month of age were randomized to receive montelukast or placebo. The median age was nine month (the mean age of the typical infant with RSV is three months) Children with documented asthma were not eligible. A total of 116 infants complet the required treatment and initial follow-up and 87 infants complet the two-month follow-up Primary [i]finale[/i] points were 24-hour symptom-free periods scored through the following criteria: night cough day cough wheezing, dyspnea, and activity even Secondary outcomes were exacerbations, difficulty department visits, and hospitalizations.

Acute RSV symptoms were moderate to severe; postbronchiolitis symptoms were mild. The treatment benefit became apparent after couple weeks of treatment. Infants in the treatment assign places to had five more symptom-free days and nights than infants in the placebo clump (six of 28 days for treatment, single in kind of 28 days for placebo). The treatment form into groups experienced a significant reduction in daytime cough and delayed time to exacerbations. However, there were no significant differences at the two-month follow-up assessment.

The authors deduce that treatment with leukotriene-receptor antagonists leads to improved clinical symptoms in RSV postbronchiolitis. Benefits likely are becoming to effects on reactive airway disease after bronchiolitis rather than drifts on the acute inflammatory phase. The authors also note that the average symptom score was mild in the two groups, leaving limited room for improvement following treatment.

EDITOR'S NOTE: A report released in January 2003 from the Agency for Healthcare Research and Quality conclud that there is insufficient evidence demonstrating the effectiveness of a number of RSV treatments, including inhaled bronchodilators, inhaled corticosteroids, and inhaled epinephrine. Larger, better-designed trials of these interventions are commended before their efficacy can be established. This trial present to views promise for a new sign of treatment for the sequelae of RSV In this case, larger prospective trials of a more diverse and symptomatic population are necessityed to better evaluate leukotriene-receptor antagonist treatment after RSV infection.--c.c.

Bisgaard H for the consideration Group on Montelukast and Respiratory Syncytial Virus. A randomized trial of montelukast in respiratory syncytial virus postbronchiolitis. Am J Respir Crit Care M March 2003;167:379-83

COPYRIGHT 2003 American Academy of Family Physicians

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