Milanese M, Passalacqua G, Pasquali M, Baiardini I, Canonica G W
Department of Internal Medicine, University of Genoa, Italy.
Monaldi Arch Chest Dis. 2001 Dec;56(6):508-13.
To date the position of Leukotriene Receptor Antagonists (LTRAs) in asthma is not yet fully established. Recent asthma guidelines consider LTRAs as 'alternative' to low doses of inhaled corticosteroids (ICS) for treatment of patients with mild persistent asthma, while in Europe LTRAs are licensed as additional therapy to ICS. Our aim in this paper is to review comparative studies between ICS and antileukotrienes in mild to moderate asthma, looking at their efficacy on asthma outcomes and on patient expectations (compliance, quality of life, and safety). Some studies report a superior efficacy of ICS, while others, in particular in patients aged < 12 years, found no differences. When considering patients' expectations LTRAs seem to be superior, with higher compliance and quality of life. Even if no differences in adverse effects have been found between ICS and LTRAs, whose safety profiles are not different from placebo, some concerns exist on long term treatment with ICS, even at low doses, in children and postmenopausal women. For this reason, even if ICS are superior to LTRAs in controlling asthma outcomes and in improving pulmonary function, in children and elderly patients LTRAs can be considered an alternative to low-dose ICS.
迄今为止，白三烯受体拮抗剂（LTRA）在哮喘治疗中的地位尚未完全确立。近期的哮喘指南将LTRA视为治疗轻度持续性哮喘患者时低剂量吸入性糖皮质激素（ICS）的“替代药物”，而在欧洲，LTRA被批准作为ICS的附加疗法。本文的目的是回顾ICS与抗白三烯药物在轻至中度哮喘治疗中的对比研究，观察它们对哮喘治疗效果以及患者期望（依从性、生活质量和安全性）的影响。一些研究报告称ICS疗效更佳，而其他研究，尤其是针对12岁以下患者的研究，未发现差异。在考虑患者期望方面，LTRA似乎更具优势，其依从性和生活质量更高。即使ICS与LTRA在不良反应方面未发现差异，且它们的安全性与安慰剂无异，但对于儿童和绝经后女性长期使用ICS，即便低剂量使用，仍存在一些担忧。因此，即使ICS在控制哮喘病情和改善肺功能方面优于LTRA，但对于儿童和老年患者，LTRA可被视为低剂量ICS的替代药物。
