Zedan M, Attia G, Zedan M M, Osman A, Abo-Elkheir N, Maysara N, Barakat T, Gamil N
Allergy, Clinical Immunology and Respiratory Medicine Unit, Faculty of Medicine, Mansoura University, P.O. 35516 Box 50, Mansoura, Egypt.
ISRN Pediatr. 2013 Mar 31;2013:824781. doi: 10.1155/2013/824781. Print 2013.
Asthma is a heterogeneous disease that means not all asthmatics respond to the same treatment. We hypothesize an approach to characterize asthma phenotypes based on symptomatology (shortness of breath (SOB), cough, and wheezy phenotypes) in correlation with airway inflammatory biomarkers and FEV1. We aimed to detect whether those clinical phenotypes have an impact on the response to asthma medications. Two hundred three asthmatic children were allocated randomly to receive either montelukast (5 mg at bed time) or fluticasone propionate (100 ug twice daily) for 8 consecutive weeks. Serum concentrations of IL-2Rs, ICAM-1, VCAM-1, total IgE, eosinophilic %, eosinophil cationic protein (ECP), and FEV1 were done before and after treatment to patients and once to controls. Children who have SOB were found to have higher levels of total sIgE, older age, and longer disease duration, and they responded to fluticasone alone. Cough group was found to have higher levels of eosinophilic % and sECP, younger age, shorter disease duration and responded to montelukast alone. Wheezy group showed mixed pattern and responded to both medications. Conclusion. Although there is variability in response to ICS and LTRAs, we did identify characteristics of patient that should guide the clinician in the choice of asthma medications.
哮喘是一种异质性疾病，这意味着并非所有哮喘患者对相同的治疗都有反应。我们假设一种基于症状学（呼吸急促（SOB）、咳嗽和喘息症状）与气道炎症生物标志物及第一秒用力呼气容积（FEV1）相关性来表征哮喘表型的方法。我们旨在检测这些临床表型是否对哮喘药物的反应有影响。203名哮喘儿童被随机分配，连续8周接受孟鲁司特（睡前5毫克）或丙酸氟替卡松（每日两次，每次100微克）治疗。在治疗前后对患者进行白细胞介素-2受体（IL-2Rs）、细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）、总免疫球蛋白E（total IgE）、嗜酸性粒细胞百分比、嗜酸性粒细胞阳离子蛋白（ECP）及FEV1的血清浓度检测，对对照组检测一次。发现有呼吸急促的儿童总特异性免疫球蛋白E（total sIgE）水平较高、年龄较大、病程较长，且他们仅对丙酸氟替卡松有反应。咳嗽组的嗜酸性粒细胞百分比和可溶性嗜酸性粒细胞阳离子蛋白（sECP）水平较高、年龄较小、病程较短，且仅对孟鲁司特有反应。喘息组表现出混合模式，对两种药物均有反应。结论。尽管对吸入性糖皮质激素（ICS）和白三烯调节剂（LTRAs）的反应存在差异，但我们确实确定了患者的特征，这些特征应指导临床医生选择哮喘药物。
