Hoshino Makoto, Akitsu Kenta, Ohtawa Junichi
a Division of Clinical Allergy, Department of Internal Medicine, Atami Hospital, International University of Health and Welfare , Atami , Japan.
b Department of Radiology, Atami Hospital, International University of Health and Welfare , Atami , Japan.
J Asthma. 2019 Sep;56(9):995-1003. doi: 10.1080/02770903.2018.1514047. Epub 2018 Sep 13.
: Asthma often remains uncontrolled despite treatment with inhaled corticosteroids (ICS) alone or with ICS plus a long-acting β-agonist (LABA). The recommended alternative is the addition of either montelukast or tiotropium. The aim of this study was to compare the effects of montelukast and tiotropium on airway inflammation and remodeling in persistent asthma. : Eighty-seven patients with asthma were treated with budesonide and formoterol (640/18 μg); then, the patients were randomly allocated to three groups to receive oral montelukast (10 mg/day), inhaled tiotropium (5 μg/day), or no add-on to the maintenance therapy for 48 weeks. Fractional exhaled nitric oxide (FeNO) and pulmonary function were measured, and quantitative computed tomography was performed. : Compared to the maintenance therapy, add-on montelukast significantly decreased FeNO ( < 0.05) and improved airflow obstruction ( < 0.05), whereas airway dimensions remained unchanged. Changes in FeNO were significantly correlated with changes in FEV ( = -0.71, < 0.001). In contrast, the addition of tiotropium significantly decreased airway wall area corrected for body surface area (WA/BSA) ( < 0.05), decreased wall thickness (T/√BSA) ( < 0.05) and improved airflow obstruction ( < 0.05) with no change in FeNO. Changes in WA/BSA and T/√BSA were significantly correlated with the change in percentage predicted FEV ( = -0.84, < 0.001 and = -0.59, < 0.01, respectively). :Adding either montelukast or tiotropium to ICS/LABA may provide additive benefits with respect to the pulmonary function and airway inflammation or remodeling in patients with asthma.
尽管单独使用吸入性糖皮质激素（ICS）或联合长效β受体激动剂（LABA）进行治疗，哮喘往往仍难以得到控制。推荐的替代方案是加用孟鲁司特或噻托溴铵。本研究的目的是比较孟鲁司特和噻托溴铵对持续性哮喘气道炎症和重塑的影响。87例哮喘患者接受布地奈德和福莫特罗（640/18μg）治疗；然后，将患者随机分为三组，分别接受口服孟鲁司特（10mg/天）、吸入噻托溴铵（5μg/天）或不添加额外治疗，维持治疗48周。测量呼出一氧化氮分数（FeNO）和肺功能，并进行定量计算机断层扫描。与维持治疗相比，加用孟鲁司特可显著降低FeNO（<0.05）并改善气流阻塞（<0.05），而气道尺寸保持不变。FeNO的变化与第一秒用力呼气容积（FEV）的变化显著相关（r=-0.71，P<0.001）。相比之下，加用噻托溴铵可显著降低经体表面积校正的气道壁面积（WA/BSA）（<0.05），降低壁厚度（T/√BSA）（<0.05）并改善气流阻塞（<0.05），而FeNO无变化。WA/BSA和T/√BSA的变化与预测FEV百分比的变化显著相关（分别为r=-0.84，P<0.001和r=-0.59，P<0.01）。在ICS/LABA基础上加用孟鲁司特或噻托溴铵可能对哮喘患者的肺功能和气道炎症或重塑具有附加益处。
