Nocturnal Drug Therapy Could Replace Adenoid Surgery

An asthma drug could replace surgery for children suffering from obstructive sleep apnea (OSA) due to chronically inflamed tonsils or adenoids, claims a new study.

Researchers at Ben-Gurion University (Beer Sheva, Israel) and Soroka University Medical Center (Beer Sheva, Israel) conducted a double-blind, randomized, placebo-controlled study involving 46 children with nonsevere OSA. The children were randomized to receive daily oral montelukast--a leukotriene receptor antagonist (LTRA)--or placebo for 12 weeks. polysomnographic assessments, parent questionnaires, and radiographs were used to assess adenoid size before and after therapy.

The results showed that compared with the 23 children that received placebo, the 23 children that received montelukast showed significant improvements in polysomnographic measures of respiratory disturbance, with the obstructive apnea index decreasing by more than 50% in 65.2% of treated children. Children’s symptoms improved, as did adenoid size. No attrition or side effects occurred. The study was published in the September 2012 issue of Pediatrics.

“This research presents an additional, and important, layer in the ongoing research on the importance of the inflammatory process in children with breathing disorders,” said lead author Aviv Goldbart, MD. “When approved for such use, Montelukast will be an effective treatment for children whose conditions are not so severe and cannot undergo surgery.”

Montelukast is an LTRA used for the maintenance treatment of asthma and to relieve symptoms of seasonal allergies; it is usually administered orally. It works by blocking the action of leukotriene D4 (and secondary ligands LTC4 and LTE4) on the cysteinyl leukotriene receptor CysLT1 in the lungs and bronchial tubes by binding to it. This reduces the bronchoconstriction otherwise caused by the leukotriene and results in less inflammation.

Related Links:
Ben-Gurion University
Soroka University Medical Center