McMaster University, Internal Medicine Residency Program, 1200 Main Street West, Hamilton, Ontario, Canada.
Expert Opin Pharmacother. 2011 Sep;12(13):2119-28. doi: 10.1517/14656566.2011.600689. Epub 2011 Jul 22.
Asthma is a complex process that results from airway inflammation and manifests as bronchoconstriction. Infiltration of the airway mucosa and lumen by activated inflammatory cells, along with release of mediators, can occur extensively. Chemical mediators known as leukotrienes are believed to play a major role in this process. At present, inhaled corticosteroids (ICS) are the pharmacologic cornerstone of asthma management. However, asthma control may remain suboptimal when relying on ICS because of problems with compliance, poor inhaler technique and concerns about the side effects of steroids; additional agents are often required to control symptoms. Leukotriene receptor antagonists (LTRA), namely montelukast, provide a safe and effective additional anti-inflammatory treatment option. There is particular benefit for patients with asthma and concomitant allergic rhinitis.
Montelukast has been well studied through rigorous clinical trials. A thorough review of the literature has been undertaken to assess the evidence supporting the use of LTRAs. This review focuses on the role of montelukast not only as monotherapy but also as add-on therapy to ICS in the adult asthma population, as well as adult asthmatics with concomitant allergic rhinitis. In addition, there is often some discrepancy between the evidence generated in the idealized asthma patients recruited into randomized clinical trials and results obtained in the real-life setting. This review assesses recent clinical trials evaluating the real-life evaluation of montelukast, achieved mainly through open-label observational studies.
Oral LTRA bring remarkable ease of anti-inflammatory treatment administration and symptom improvement with minimal side effects to the management of adult asthma. Basic asthma mechanisms and much-valued scientific groundwork has been identified by exploring target asthma treatment with anti-leukotriene therapy. This will have a significant impact in the future development of targeted asthma therapies as well as the current management of asthma and other inflammatory medical conditions.
哮喘是一种复杂的过程，由气道炎症引起，并表现为支气管收缩。气道黏膜和管腔被激活的炎症细胞浸润，同时释放介质，可能广泛发生。化学介质，如白三烯，被认为在这个过程中起主要作用。目前，吸入性皮质类固醇（ICS）是哮喘管理的药理学基石。然而，由于依从性问题、吸入器技术不佳以及对类固醇副作用的担忧，仅依靠 ICS 可能无法实现哮喘的良好控制；通常需要额外的药物来控制症状。白三烯受体拮抗剂（LTRA），即孟鲁司特，为安全有效的额外抗炎治疗提供了选择。对于同时患有哮喘和过敏性鼻炎的患者，尤其有益。
孟鲁司特已通过严格的临床试验得到充分研究。对文献进行了全面审查，以评估支持使用 LTRAs 的证据。这篇综述重点关注孟鲁司特不仅作为单一疗法，而且作为 ICS 的附加疗法在成年哮喘患者中的作用，以及同时患有过敏性鼻炎的成年哮喘患者中的作用。此外，在理想的哮喘患者中进行的随机临床试验中产生的证据与在现实环境中获得的结果之间通常存在一些差异。这篇综述评估了最近评估孟鲁司特现实生活评估的临床试验，主要通过开放标签观察性研究进行评估。
口服 LTRA 为成人哮喘的管理带来了显著的抗炎治疗方便性和症状改善，同时副作用最小。通过探索抗白三烯治疗作为靶向哮喘治疗的基本哮喘机制和宝贵的科学基础，为未来靶向哮喘治疗的发展以及哮喘和其他炎症性疾病的当前管理产生了重大影响。
