Kings College London, Kings Health Partners, Asthma-UK Centre in Allergic Mechanisms of Asthma, Department of Asthma, Allergy and Respiratory Science, Guys Hospital, London, UK.
Paediatr Drugs. 2012 Oct 1;14(5):317-30. doi: 10.2165/11599930-000000000-00000.
At present, the main indications for leukotriene receptor antagonists (LTRA) in pediatric asthma are as add-on therapy to inhaled corticosteroids (ICS) and as initial controller therapy in children with mild asthma, especially those who cannot or will not use ICS. LTRA are also useful for patients who have concomitant rhinitis, and patients with viral-induced wheeze and exercise-induced asthma. It should be noted that the benefits of LTRA therapy have been demonstrated in children as young as 6 months of age and recent clinical trials have further proven the benefits of LTRA in acute asthma exacerbations. However, considering the important pro-inflammatory effects that leukotrienes (LT) have in experimental models of asthma, it may seem surprising that LTRA treatment outcomes are not better and that in some clinical trials only a minority of patients could be classified as full responders. This could be explained by potential additional LT receptors that are not affected by LTRA. Such receptors could represent new therapeutic targets in asthma. Furthermore, progress in differentiating between asthma phenotypes that result from different pathogenic mechanisms, some of which may involve LT to a lesser degree, should lead to an improved, personalized use of LTRA for treating asthma.
目前，白三烯受体拮抗剂（LTRA）在儿科哮喘中的主要适应证为吸入皮质类固醇（ICS）的附加治疗，以及轻度哮喘儿童的初始控制治疗，尤其是那些不能或不愿使用 ICS 的儿童。LTRA 也可用于伴有鼻炎的患者，以及病毒诱导的喘息和运动性哮喘的患者。值得注意的是，LTRA 治疗的益处已在 6 个月大的儿童中得到证实，最近的临床试验进一步证明了 LTRA 在急性哮喘加重中的益处。然而，考虑到白三烯（LT）在哮喘实验模型中具有重要的促炎作用，LTRA 治疗效果并不更好，并且在一些临床试验中只有少数患者可被归类为完全缓解者，这似乎令人惊讶。这可能是由于 LT 受体的其他潜在作用不受 LTRA 影响。这些受体可能代表哮喘的新治疗靶点。此外，区分不同发病机制导致的哮喘表型的进展，其中一些可能涉及 LT 的程度较小，这将导致 LTRA 治疗哮喘的个性化使用得到改善。
