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THE USE (MISUSE?) OF MONTELUKAST IN WHEEZY PRE-SCHOOL CHILDREN
  1. E Abrahamson1,
  2. H Abubakar-Waziri2,
  3. A Wilson2
  1. 1Paediatric EM, Chelsea & Westminster Hospital, London, UK
  2. 2Imperial College School of Medicine, London, UK

    Abstract

    Objectives & Background The role of montelukast in the rescue treatment of acute wheeze in pre-school children has come under increasing scrutiny. It has gradually entered clinical practice but without robust scientific data to support its use. Our department was an early adopter and we performed this review to compare clinical features and outcome between those treated and those not.

    Methods We performed a retrospective case note review of the management of all pre-school wheezers aged 0-5 years presenting to our Paediatric Emergency Department (PED) over a 12 month period. Cases were identified from the database using the Business Objects Tool©.

    Results 391 cases were identified, of which 231 (59%) received montelukast (G1) and 160 (41%) did not (G2). The mean age (months) of cases was similar in G1 32.41 (7–60) versus G2 29.01 (4–59). 191 (82.7%) cases in G1 had at least one previous episode of wheeze vs 108 (67.5%) in G2, p=0.0005.

    G1 were more likely to have received montelukast previously 67 (29%) vs G2 22 (13.8%), p=0.0004. They were also more likely to show signs of respiratory distress G1 179 (77%) vs G2 100 (62.5%), p=0.0013. 40 (17%) cases in G1 had no prior history of wheeze. G2 were more likely to receive steroids 38 (23.8%) vs G1 29 (12.6%) p=0.0039.

    There was no difference in the number of cases with a history of atopy, G1 75 (32.5%) vs G2 58 (36.2%), or already on inhaled steroids G1 24 (10.4%) vs G2 18 (7.8%).

    Treatment with montelukast did not reduce overall admissions, G1 103 (45%) vs G2 65 (41%), nor did it reduce average length of stay (days) G1 1.52 vs G2 1.95. Further there was no significant difference in re-attendance rates to the ED within 7 days, G1 22 (9.95%) vs G2 21 (14.4%).

    Conclusion Treatment with montelukast had no significant impact on admission rates, length of stay or reattendance to hospital in children <5 yrs presenting with wheeze.

    Existing departmental guidelines were poorly adhered to, with some children receiving treatment despite no prior history of wheeze whilst many with previous wheeze did not receive it. Instead, we observed a tendency towards treating those who had previously received the drug and those with signs of respiratory distress.

    This study raises further questions regarding the use of montelukast in pre-school acute wheeze, and whilst limited as a retrospective study, it supports the doubts over its use as rescue therapy in these children.

    • emergency departments

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