Montelukast therapy does not effectively treat or prevent respiratory complications resulting from lung contusions, according to study findings published in the Chinese Journal of Traumatology.
Researchers sought to examine the efficacy of montelukast, an anti-inflammatory, in reducing pulmonary complications among patients with trauma. The primary endpoint was volume of pulmonary contusion at the end of the trial. Ventilation days, multi-organ failure, hospital and intensive care length of stay, and in-hospital mortality rate were secondary measured outcomes.
Researchers in Iran conducted a randomized, double-blind, placebo-controlled trial that included 65 patients with blunt traumas and lung contusions detected by CT scan. Individuals with cardiopulmonary disease, hypersensitivity to montelukast, or less than 16 years of age were excluded.
Patients were randomly assigned to a treatment group receiving montelukast 10 mg once per day for up to 1 week (n=31; mean [SD] age, 43.61 [20.54] years; mean injury severity score, 17.19 [8.57]) or placebo group (n=34; mean [SD] age, 42.06 [17.53] years; mean injury severity score, 20.17 [10.27]). The mean number of documented rib fractures incurred in the treatment vs placebo groups were 1.22 (2.09) vs 1.29 (1.96), respectively, on the right side and 1.29 (2.19) vs 1.74 (2.15), respectively, on the left side.
At baseline, clinical and demographic characteristics showed no statistically significant differences between groups (all P >.05). Researchers also found no statistically significant differences at baseline between the treatment vs control groups in mean pulmonary contusion volume on the right side (68,726.97 mm3 [93,656.54] vs 59,730.27 mm3 [76,551.00], respectively) or left side (67,501.71 mm3 [91,514.00] vs 46,502.21 mm3 [80,604.21], respectively).
After the treatment period, researchers still found no statistically significant difference between the treatment vs control groups in mean pulmonary contusion volume on the right side (116,748.74 [361,705.12] vs 40,051.26 [64,081.56]; P =.228), or left side (64,522.03 [117,266.20] vs 25,929.12 [47,417.13]; P =.082).
No statistically significant difference was noted between the treatment vs control groups in hospital length of stay (10.87 vs 13.05 days), ventilator days (3.32 vs 3.62 days), or intensive care length of stay (7.16 vs 7.82 days).
Likewise, researchers noted no statistically significant difference between the treatment vs control groups in frequency of in-hospital complications, including acute respiratory distress syndrome (ARDS) (12.9% vs 8.8%; P =.71), multi-organ failure (12.9% vs 17.6%; P =.58), pneumonia (19.4% vs 17.6%; P =.85), or mortality (22.6% vs 14.7%; P =.41). Notably, these findings are inconsistent with previous studies.
The current study also reported no statistically significant difference in C-reactive peptides at baseline (12.16 vs 10.85; P =.76) or after 3 days of treatment (25.58 vs 24.61; P =.84), and the change was not significant in either group, which is also inconsistent with previous studies. Previous studies also concluded montelukast decreased ventilator days, in contrast to the current study.
Significant study limitations include underpowered sample size, the inability to assess the serum levels of procalcitonin and inflammatory cytokines, and the inability to assess montelukast with respect to the extent of neutrophil infiltration within the alveolar cavity.
“Montelukast administration did not significantly affect the assessed clinical, radiological outcomes among patients with multiple blunt traumas,” the researchers concluded, adding that “Administrating montelukast has no preventive or therapeutic effects on lung contusion or its complications.”
Heydari S, Khoshmohabat H, Taheri Akerdi A, Ahmadpour F, Paydar S. Evaluating the effect of montelukast tablets on respiratory complications in patients following blunt chest wall trauma: a double-blind, randomized clinical trial. Chin J Traumatol. Published online October 13, 2022. doi:10.1016/j.cjtee.2022.10.002