Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy.
Clin Interv Aging. 2013;8:1329-37. doi: 10.2147/CIA.S35977. Epub 2013 Oct 2.
Asthma is a disease of all ages. This assumption has been challenged in the past, because of several cultural and scientific biases. A large body of evidence has accumulated in recent years to confirm that the prevalence of asthma in the most advanced ages is similar to that in younger ages. Asthma in the elderly may show similar functional and clinical characteristics to that occurring in young adults, although the frequent coexistence of comorbid conditions in older patients, together with age-associated changes in the human lung, may lead to more severe forms of the disease. Management of asthma in the elderly follows specific guidelines that apply to all ages, although most behaviors are pure extrapolation of what has been tested in young ages. In fact, age has always represented an exclusion criterion for eligibility to clinical trials. This review focuses specifically on the safety and efficacy of leukotriene modifiers, which represent a valid option in the treatment of allergic asthma, both as an alternative to first-line drugs and as add-on treatment to inhaled corticosteroids. Available studies specifically addressing the role of montelukast in the elderly are scarce; however, leukotriene modifiers have been demonstrated to be safe in this age group, even though cases of acute hepatitis and occurrence of Churg-Strauss syndrome have been described in elderly patients; whether this is associated with age is to be confirmed. Furthermore, leukotriene modifiers provide additional benefit when added to regular maintenance therapy, not differently from young asthmatics. In elderly patients, the simpler route of administration of leukotriene modifiers, compared with the inhaled agents, could represent a more effective strategy in improving the outcomes of asthma therapy, given that unintentional nonadherence with inhalation therapy represents a complex problem that may lead to significant impairment of asthma symptom control.
哮喘可发生于各个年龄段。过去，由于受到一些文化和科学偏见的影响，人们曾对这一观点提出质疑。近年来，大量证据证实，高龄人群哮喘的发病率与年轻人群相似。老年人哮喘的功能和临床特征可能与年轻人相似，但老年患者常合并多种合并症，且肺部随年龄增长而发生变化，这些因素可能导致疾病更为严重。老年人哮喘的管理遵循适用于所有年龄段的具体指南，但大多数行为都是基于在年轻人中进行测试的结果进行纯粹推断。事实上，年龄一直是临床试验入组的排除标准。本综述专门关注白三烯调节剂的安全性和疗效，此类药物是治疗过敏性哮喘的有效选择，可作为一线药物的替代药物，也可作为吸入性皮质类固醇的附加治疗药物。目前专门针对老年患者孟鲁司特作用的研究很少；然而，白三烯调节剂在该年龄组中已被证实是安全的，尽管有报道称在老年患者中出现了急性肝炎和变应性肉芽肿性血管炎；但这种关联是否与年龄有关还需要进一步证实。此外，与在常规维持治疗中添加吸入性药物不同，白三烯调节剂可带来额外的益处。与吸入性药物相比，白三烯调节剂的给药途径更简单，在改善哮喘治疗结果方面可能是一种更有效的策略，因为无意不依从吸入治疗是一个复杂的问题，可能会导致哮喘症状控制显著恶化。
