Department of Respiratory Medicine, The Children's Hospitals at Westmead, Sydney Children's Hospital Network, (Randwick & Westmead), Westmead, Australia.
Paediatr Respir Rev. 2011 Dec;12(4):250-2. doi: 10.1016/j.prrv.2011.05.008. Epub 2011 Sep 17.
Asthma is a heterogeneous disease and it is therefore unrealistic to expect that inhaled corticosteroids (ICS) would be appropriate first line preventer therapy for all children with asthma. There is good theoretical and clinical trial evidence demonstrating that leukotriene receptor antagonists (LTRAs) are more effective than ICS for viral induced wheezing and equivalent to ICS for mild persistent asthma in children. LTRAS do not have the systemic adverse effects of ICS, are generally well tolerated and their once daily oral administration enhances adherence. LTRAs should therefore be first line preventer therapy for children with frequent intermittent or mild persistent asthma while ICS should be reserved as first line treatment for children with moderate to severe persistent asthma. Given the skew in paediatric asthma severity towards the milder end, this effectively means that LTRAs should be tried first in 2 of every 3 children with asthma requiring preventer treatment.
哮喘是一种异质性疾病，因此，期望吸入皮质类固醇（ICS）成为所有哮喘儿童的一线预防治疗药物是不现实的。有充分的理论和临床试验证据表明，白三烯受体拮抗剂（LTRAs）在病毒诱导的喘息方面比 ICS 更有效，在儿童轻度持续性哮喘方面与 ICS 等效。LTRAS 没有 ICS 的全身不良反应，通常耐受性良好，每日一次口服给药可提高依从性。因此，LTRAs 应该是频繁间歇性或轻度持续性哮喘儿童的一线预防治疗药物，而 ICS 应该保留为中重度持续性哮喘儿童的一线治疗药物。鉴于儿科哮喘严重程度偏向较轻，这实际上意味着在需要预防治疗的 3 名哮喘儿童中，有 2 名应该首先尝试 LTRAs。
