Cysteinyl leukotrienes are inflammatory bioactive lipids produced by various cells. They are present in increased amounts in airway secretions of all different asthma phenotypes and can induce all the inflammatory changes observed in the airways of asthmatic patients. For this reason, an attempt to inhibit the actions of these mediators through the use of cysteinyl receptor antagonists appears rational. Montelukast belongs to this new class of drugs, which has been proved effective in asthmatic children and its safety profile is comparable with that of placebo. The major advantages of this drug are its once-daily oral administration, which increases adherence to the therapeutic regimen; its long-term persistent efficacy in the prevention of exercise-induced bronchoconstriction; its possible preventive activity on viral-induced asthma exacerbations; and its complementary and additive effects when used with inhaled corticosteroids. As established for all drugs commonly used in the treatment of asthma, there is an interindividual variability also in response to montelukast. Therefore, it is important that caregivers evaluate treatment effect objectively in every asthmatic child to provide the single patient with a therapeutic regimen allowing the best quality of life.
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