Clinical setting

A 3-year-old girl presents to the emergency department with a severe wheeze and tachypnoea. Her mother reports that she experienced coryzal symptoms a few days prior to the onset of the wheeze and that she previously had three similar wheezing episodes that were also triggered by viral upper respiratory tract infections in the past year. Each wheezing episode lasts 2–4 days and have all been clinically severe, requiring medical attention. Between upper respiratory tract infections, she is asymptomatic with no wheeze, and she has no history of atopy.

She has viral induced wheeze (also known as episodic viral wheeze (EVW)) and is usually managed with an inhaled short-acting beta-2 agonist and inhaled or oral corticosteroids. Having heard that there are some concerns over corticosteroids causing stunted growth, her physician wonders if a leukotriene receptor antagonist (LTRA), such as Montelukast, which does not suppress growth, would be effective at preventing wheezing episodes.

Clinical question

In preschool children with EVW (patient), is Montelukast (intervention) effective at preventing or decreasing the …