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Montelukast in RSV-Bronchiolitis

We thank you for your valuable comments (1) accompanying the publication of our recent study on the effect of montelukast on respiratory syncytial virus (RSV) after bronchiolitis (2). One of the important questions raised in the Editorial pertains to our inclusion of children up to 36 months of age. Children with previous recurrent lung symptoms were excluded from the study, and previous asthma or RSV bronchiolitis therefore seems unlikely. Still, we agree that the older the child, the more likely other underlying causes become, which might confound the observed treatment response.

To illustrate such possible age dependency of the effect, we have split the intent-to-treat study group on the basis of median age in those younger than 9 months and those 9 months and older (Figure 1) . There was no significant treatment effect on the percent of symptom-free days within subgroups (p = 0.066 within children < 9 months), but the numeric advantage of montelukast was larger in the younger children compared with the older children. This suggests that the significant treatment effect on symptom-free days reported in the whole study group (2) was not driven selectively by the older children.

View larger version (14K): [in this window] [in a new window]   Figure 1. The intent-to-treat group is split on the basis of median age (*< 9 months, n = 53, p = 0.066; 9 months, n = 63, p > 0.1).

Hans Bisgaard, for the Study Group on Montelukast and Respiratory Syncytial Virus

Department of Pediatrics University Hospital of Copenhagen Copenhagen, Denmark

FOOTNOTES

Conflict of Interest Statement: H.B. has received research funding and honoraria for lectures within the last 5 years, is a member of pediatric advisory boards for Aerocrine, AstraZeneca, GlaxoSmithKline, Hoffman-La-Roche, Merck, Novartis, and Yamanouchi, and is a consultant to Aerocrine, GlaxoSmithKline, and Merck.

Dr. Stanley Szefler was given the opportunity to respond to this letter but declined to do so.

REFERENCES

1. Szefler SJ, Simoes EAF. Montelukast for respiratory syncytial virus bronchiolitis: significant effect or provocative findings? Am J Respir Crit Care Med 2003;167:290–291.[Free Full Text]
2. Bisgaard H. A randomized trial of montelukast in respiratory syncytial virus postbronchiolitis. Am J Respir Crit Care Med 2003;167:379–383.[Abstract/Free Full Text]

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