Time-effect of montelukast on protection against exercise-induced bronchoconstriction

Introduction: Montelukast has been proven to assure a protective effect against exercise-induced bronchoconstriction. Aim: To verify exactly when montelukast begins protection in asthmatic children by evaluating different time intervals between dosing and challenge. Methods: In a double blind, placebo-controlled, three day doses, crossover study, patients were randomized to receive in sequence treatment with either a placebo or montelukast and assigned to one of seven groups that were tested 1, 2, 3, 4, 5, 6 and 8 h after drug administration, respectively. For each group, the exercise challenge was always performed at the same hour on the first and third days of treatment. Results: Sixty-nine asthmatic children took part in the study. On day 3, the mean FEV1 % fall from baseline was 25.54 (95% CI = 21.63/29.46) and 14.89 (95% CI = 11.85/17.92) for the placebo and active drug (p < 0.05), respectively. On day 1, the mean fall of FEV1 was 28.20 (95% CI = 24.46/31.94) and 19.01 (95% CI = 15.71/22.31) for the placebo and montelukast (p < 0.05), respectively. Clinical protection was achieved in 21(30%) and 33 (48%) subjects by montelukast on the first and third days, respectively. Conclusions: Montelukast assured protection against exercise-induced bronchoconstriction from the first through the eighth hour from thefirst day of treatment. However, individual susceptibility to protection was evident since some individuals were not protected at any time. We conclude that in clinical use individual responses to the drug should be carefully evaluated in the follow-up management. (C) 2011 Elsevier Ltd. All rights reserved.