© 2005 American Thoracic Society
Montelukast for Viral Respiratory Infection–induced Exacerbations of AsthmaTo the Editor:The publication of the PREvention of Viral Induced Asthma (PREVIA) study by Dr. Bisgaard and colleagues indicates that it was designed to investigate the role of montelukast in the prevention of viral respiratory–induced asthma exacerbations in children 2–5 years of age (1). However, during this 12-month-long study, only an average of 2.3 asthma exacerbations occurred with the placebo regimen. This compares with an average of more than 6 episodes over 6 months, with each lasting an average of more than 8 days, in the study by Doull and coworkers (Reference 6 in the article by Bisgaard and colleagues) (2), and an average of 2.5 episodes lasting an average of 8 days in the 4-month-long study by Wilson and coworkers (Reference 7 in the article by Bisgaard and colleagues) (3), both of which found no difference between inhaled corticosteroids and placebo in preventing viral respiratory infection–induced asthma exacerbations. The small decrease in exacerbations observed by Bisgaard and coworkers, from an average of 2.3 to 1.6 over the course of a year, was not accompanied by any significant decrease in the need for courses of oral corticosteroids. In fact, the magnitude of effect was on the order of that seen in a previous study of montelukast in children of the same age with reportedly persistent asthma (Reference 15 in the article by Bisgaard and colleagues) (4). In contrast to the claim that the patients in the PREVIA study exclusively had intermittent respiratory symptoms due to viral respiratory infection, a baseline frequency of asthma symptoms more than twice weekly was present in 17% of the patients. Moreover, more than 30% of those patients had a history of atopic dermatitis, allergic rhinitis, and evidence for specific IgE to an inhalant allergen as shown by a positive RAST test, characteristics associated with a greater likelihood of persistent asthma (5). This study would have been cleaner if patients with specific IgE to inhalant allergens had been excluded, with inclusion criteria limited to those who had a history of being completely free of symptoms for extended periods between apparent viral respiratory infections. As currently designed, the data of the PREVIA study do not support the hypothesis that viral respiratory infection–induced asthma exacerbations will be prevented with montelukast.
University of Iowa, Iowa City, Iowa FOOTNOTES Conflict of Interest Statement: M.W. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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