The scale of the problem

Children who wheeze represent a major public health issue and an ongoing clinical challenge in paediatrics. Around a third of all preschool children experience at least one episode of wheeze and 10% of school-aged children in the UK are prescribed asthma medication. Pertinently, difficult to control or severe asthma in individual children is still associated with substantial morbidity and sometimes preventable mortality on an unacceptable number of occasions in well-developed healthcare systems.

It is imperative that we manage children in the most effective way possible. In the broadest sense, this starts with the accurate diagnosis of wheeze, something in itself demonstrated to be not as straightforward as perhaps we would like to imagine. Then optimal treatment and educational strategies are required to prevent or minimise the severity of future episodes. Accurate phenotyping is necessary to determine the best treatment strategy as the causes and pathogenic mechanisms of wheezing in children are multifactorial. So, where does montelukast fit in to this model of care that we aspire to deliver?

Scientific rationale for the use of montelukast and possible adverse effects

Most would agree that the science underpinning leukotriene receptor antagonists (LTRAs) is intuitively sound. LTRAs block cysteinyl leukotriene receptors that are expressed on the surface of a range of effector cells known to be pivotal in the pathophysiology of wheeze. Leukotrienes are proinflammatory lipid mediators, principally released by mast cells, which trigger bronchoconstriction, eosinophil chemotaxis and mucus secretion in the airway. LTRAs are free of many of the adverse effects associated with (oral) corticosteroids in children. A daily tablet that may be chewable is also attractive to …