Momo Natsuki, Doi Kei, Tanaka Yuya
Department of Allergy, Kobe Children's Hospital.
Arerugi. 2022;71(3):248-253. doi: 10.15036/arerugi.71.248.
Long-acting muscarinic antagonists (LAMA) are used for long-term treatment of bronchial asthma in adults. Its use in the management of pediatric bronchial asthma, however, is currently not approved in Japan. Nonetheless, there have been a few reports of its use in children, particularly in cases of severe bronchial asthma or those without atopic disease that are refractory to existing treatment protocols. We report the progress of LAMA in infantile asthma patients.
Three out of four patients had LAMA introduced at 3 to 5 years of age after being diagnosed with asthma at 1 to 3 years old. Three patients had non-IgE-related asthma and an underlying disease, such as Apert and Noonan syndrome, while one patient had severe IgE-related asthma without a pre-existing disease. In all cases, conventional long-term medications such as medium to high-dose inhaled corticosteroids and long-acting beta-agonists, were given. However, severe bronchial asthma persisted, with some patients having uncontrolled secretions. Since uncontrolled severe-persistent bronchial asthma results in repeated hospitalization and intensive care unit admission, we introduced LAMA, specifically 2.5μg/day of tiotropium (Tio). After the introducing Tio, none of the patients had an acute exacerbation that required hospitalization and the frequency of wheezing was reduced. LAMA was administered for up to 19 months, with no adverse events.
The results of this series suggest that LAMA is an effective and safe option for uncontrolled infantile asthma.
长效毒蕈碱拮抗剂（LAMA）用于成人支气管哮喘的长期治疗。然而，其在儿童支气管哮喘管理中的应用目前在日本尚未获批。尽管如此，已有一些关于其在儿童中使用的报道，特别是在重度支气管哮喘或对现有治疗方案难治的非特应性疾病病例中。我们报告LAMA在婴幼儿哮喘患者中的应用进展。
四名患者中有三名在1至3岁被诊断为哮喘后，于3至5岁开始使用LAMA。三名患者患有非IgE相关哮喘并伴有潜在疾病，如Apert综合征和努南综合征，而一名患者患有重度IgE相关哮喘且无既往疾病。在所有病例中，均给予了常规的长期药物治疗，如中至高剂量吸入性糖皮质激素和长效β受体激动剂。然而，重度支气管哮喘持续存在，部分患者分泌物控制不佳。由于未控制的重度持续性支气管哮喘导致反复住院和入住重症监护病房，我们引入了LAMA，具体为每天2.5μg的噻托溴铵（Tio）。引入Tio后，所有患者均未出现需要住院治疗的急性加重，喘息频率降低。LAMA给药长达19个月，未出现不良事件。
本系列结果表明，LAMA是治疗未控制的婴幼儿哮喘的一种有效且安全的选择。
