Divisions of Pulmonary and Critical Care Medicine, Department of Medicine, National Jewish Health, University of Colorado-Denver, CO 80206, USA.
Curr Opin Pulm Med. 2012 Jan;18(1):76-84. doi: 10.1097/MCP.0b013e32834daff8.
This review summarizes the importance of macrolide therapy in the treatment of asthma, discusses macrolide mechanisms of action, and outlines new clinical data supporting their use. The effects of macrolides on both the innate and adaptive immune responses are discussed.
Subacute bacterial infection with both typical and atypical organisms contributes to poor asthma control. Identification of pathogens using polymerase chain reaction (PCR) and cultures from bronchoscopic samples directs antibiotic therapy and improves asthma control. PCR identification of Mycoplasma pneumoniae and Chlamydophila pneumoniae in asthmatics best identifies the macrolide responsive phenotype.
Because of their effect on protein synthesis, macrolides have both antimicrobial and anti-inflammatory properties. Both mechanisms appear to be important in their clinical efficacy in treating a wide variety of pulmonary disorders, including asthma.
本文总结了大环内酯类药物在哮喘治疗中的重要性，讨论了大环内酯类药物的作用机制，并概述了支持其应用的新临床数据。文中还讨论了大环内酯类药物对固有免疫和适应性免疫反应的影响。
典型和非典型病原体的亚急性细菌感染可导致哮喘控制不佳。使用聚合酶链反应 (PCR) 和支气管镜样本培养物鉴定病原体可指导抗生素治疗并改善哮喘控制。PCR 鉴定出的肺炎支原体和肺炎衣原体在哮喘患者中可识别出对大环内酯类药物有反应的表型。
由于大环内酯类药物对蛋白质合成的影响，它们具有抗菌和抗炎特性。这两种机制在治疗包括哮喘在内的各种肺部疾病的临床疗效中似乎都很重要。
