The Clinical Utility of Montelukast in Paediatric Respiratory Diseases

The arachidonic acid metabolism via 5-lipoxygenase gives rise to a family of biologically active lipids known as leukotrienes. The role of cysteinyl leukotrienes in the pathogenesis of bronchial asthma is well established. Randomized controlled trials (RCTs) have confirmed the efficacy of leukotriene receptor antagonists (LTRAs), when used as monotherapy or added to inhaled corticosteroids (ICS), in improving bronchial outcome including lung function, symptoms, bronchial asthma exacerbation and health related quality of life. Although, current guidelines place LTRAs as therapeutic option at a range of levels of bronchial asthma severity, there is uncertainty among clinicians about their role in relation to other therapies. Montelukast is a potent, specific, oral cystinyl leukotrine1 (cysLT1) receptor antagonist which improves bronchial asthma control and reduces inhaled corticosteroids requirement.c This review provides an overview of evidence for the use of montelukast in patients with bronchial asthma and exercise induced asthma sleep disorder, respiratory syncytial virus (RSV), bronchiolitis and cystic fibrosis.