Leigh Richard, Vethanayagam Dilini, Yoshida Makoto, Watson Richard M, Rerecich Tracy, Inman Mark D, O'Byrne Paul M
Asthma Research Group, Firestone Institute for Respiratory Health and Department of Medicine, St. Joseph's Healthcare-McMaster University, Hamilton, Ontario, Canada.
Am J Respir Crit Care Med. 2002 Nov 1;166(9):1212-7. doi: 10.1164/rccm.200206-509OC.
Inhaled corticosteroids are effective antiinflammatory therapy for asthma; however, they do not completely abolish allergen-induced airway inflammation. Leukotriene modifiers attenuate both early and late allergen responses and have antiinflammatory properties. We reasoned that treatment with budesonide and montelukast in combination might provide greater antiinflammatory effects than either drug alone, and the purpose of this study was to compare the effects of treatment with budesonide and montelukast, alone or in combination, on outcome variables after allergen inhalation. Ten subjects with asthma with dual responses after allergen inhalation were included in this randomized, double-blind, crossover study. Outcomes included early and late asthmatic responses, and changes in airway responsiveness and sputum eosinophilia, measured before and after challenge. Treatment with montelukast attenuated the maximal early asthmatic response compared with placebo (p < 0.001) and budesonide (p = 0.002). Both budesonide and montelukast, alone and in combination, attenuated the maximal late asthmatic response compared with placebo (p < 0.01). Budesonide and montelukast, alone and in combination, afforded protection against allergen-induced airway hyperresponsiveness (p < 0.05), although the treatment effect of budesonide was greater than that of montelukast (p < 0.05). Treatment with budesonide and montelukast, alone and in combination, also attenuated allergen-induced sputum eosinophilia. Thus, montelukast and budesonide attenuated allergen-induced asthmatic responses, airway hyperresponsiveness, and sputum eosinophilia, although combination treatment did not provide greater antiinflammatory effects than either drug alone.
吸入性糖皮质激素是治疗哮喘的有效抗炎疗法；然而，它们并不能完全消除变应原诱导的气道炎症。白三烯调节剂可减轻变应原早期和晚期反应，并具有抗炎特性。我们推测，布地奈德和孟鲁司特联合治疗可能比单独使用任何一种药物具有更强的抗炎作用，本研究的目的是比较布地奈德和孟鲁司特单独或联合治疗对变应原吸入后结局变量的影响。本随机、双盲、交叉研究纳入了10名变应原吸入后出现双重反应的哮喘患者。结局包括早期和晚期哮喘反应，以及激发前后气道反应性和痰液嗜酸性粒细胞增多的变化。与安慰剂（p < 0.001）和布地奈德（p = 0.002）相比，孟鲁司特治疗可减轻最大早期哮喘反应。与安慰剂相比，布地奈德和孟鲁司特单独及联合使用均能减轻最大晚期哮喘反应（p < 0.01）。布地奈德和孟鲁司特单独及联合使用均可预防变应原诱导的气道高反应性（p < 0.05），尽管布地奈德的治疗效果大于孟鲁司特（p < 0.05）。布地奈德和孟鲁司特单独及联合使用也可减轻变应原诱导的痰液嗜酸性粒细胞增多。因此，孟鲁司特和布地奈德可减轻变应原诱导的哮喘反应、气道高反应性和痰液嗜酸性粒细胞增多，尽管联合治疗并未比单独使用任何一种药物产生更强的抗炎作用。
