Bozek Andrzej, Warkocka-Szoltysek Barbara, Filipowska-Gronska Agata, Jarzab Jerzy
Clinical Department of Internal Disease, Dermatology and Allergology, Silesian University School of Medicine, Zabrze, Poland.
J Asthma. 2012 Jun;49(5):530-4. doi: 10.3109/02770903.2012.680638. Epub 2012 May 3.
Severe asthma remains a worldwide medical problem. However, this disease has not been adequately explored in the elderly. This study was performed to determine how the addition of montelukast to antiasthmatic therapy improves the control of severe asthma in elderly patients.
Elderly patients (>60 years old) with diagnoses of severe asthma were observed over 24 months of therapy: the first 12 months using inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) and the second 12 months with oral montelukast added in two-thirds of the patients, with the remaining third representing the control group. The primary efficacy endpoint of the study was the percentage of days without asthma symptoms in the first 12 months of treatment compared with the percentage after adding montelukast therapy.
A total of 512 elderly, asthmatic patients were included in the study: seventy-one (13.9%) patients had well-controlled asthma, 211 (41.2%) had partly controlled asthma, and 230 (44.9%) had uncontrolled asthma. During the first year of treatment using ICS and LABA, an increase in the median percentage of days without asthma was observed from 50.1% to 62.1%, as well as a decrease in the percentage of days with short beta-receptor agonist use, from 52.2% to 46.8%. These differences were significantly greater after 12 months, when montelukast was added to the therapy (78.4% and 39.5%, respectively). This improvement was not observed in the control group. After 2 years of observation, the median number of asthma exacerbation incidents per patient decreased from 1.6 per year to 1.2 per year when montelukast was added.
Severe asthma in elderly patients is very poorly treated, with this population exhibiting very low compliance with antiasthmatic therapy. Adding montelukast provides benefits and improved control; however, it does not resolve severe asthma control problems.
重度哮喘仍是一个全球性的医学问题。然而，这种疾病在老年人中尚未得到充分研究。本研究旨在确定在抗哮喘治疗中添加孟鲁司特如何改善老年重度哮喘患者的病情控制。
对诊断为重度哮喘的老年患者（>60岁）进行了24个月的治疗观察：前12个月使用吸入性糖皮质激素（ICS）和长效β受体激动剂（LABA），后12个月，三分之二的患者加用口服孟鲁司特，其余三分之一作为对照组。该研究的主要疗效终点是治疗前12个月无哮喘症状天数的百分比与添加孟鲁司特治疗后的百分比进行比较。
共有512名老年哮喘患者纳入研究：71名（13.9%）患者哮喘得到良好控制，211名（41.2%）患者哮喘得到部分控制，230名（44.9%）患者哮喘未得到控制。在使用ICS和LABA治疗的第一年，无哮喘天数的中位数百分比从50.1%增加到62.1%，同时使用短效β受体激动剂的天数百分比从52.2%下降到46.8%。在治疗12个月添加孟鲁司特后，这些差异显著更大（分别为78.4%和39.5%）。对照组未观察到这种改善。经过2年的观察，添加孟鲁司特后，每位患者每年哮喘发作事件的中位数从1.6次降至1.2次。
老年重度哮喘患者的治疗效果很差，该人群对抗哮喘治疗的依从性非常低。添加孟鲁司特可带来益处并改善病情控制；然而，它并不能解决重度哮喘的控制问题。
