The effect of leukotriene-modifier drugs on aspirin-induced asthma and rhinitis reactions
The effect of leukotriene-modifier drugs on aspirin-induced asthma and rhinitis reactions
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DOI：
10.1046/j.1365-2745.2002.01501.x
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发表时间：
2002-10-01
影响因子：
6.1
通讯作者：
Stevenson, DD
中科院分区：
文献类型：
--
作者：
Berges-Gimeno, MP;Simon, RA;Stevenson, DD
研究背景：白三烯（LTs）是阿司匹林（阿萨）诱导下呼吸道反应的重要介质。因此，这是合乎逻辑的假设，白三烯修饰剂药物（LTMD）可能会阻止这些reaction.Objective本研究的目的是确定是否伴随治疗LTMD与阿司匹林加重呼吸道疾病（AERD）患者ASA引起的下呼吸道反应的减少，当AERD患者谁没有用LTMD治疗。其次，如果在LTMD治疗的患者中预防了ASA诱导的下呼吸道反应，那么上呼吸道反应的发生率是否更高，或者阻断反应的发生率是否更高方法271例疑似AERD患者，在口服阿萨激发时，96例服用cys-LT受体拮抗剂（cys-LTRA），12例服用齐留通。163名患者的匹配对照组未接受LTMD。所有受试者都接受了标准口服阿萨挑战。反应分类如下：经典[鼻眼合并1秒用力呼气量（FEV 1）下降20%或>];单纯低通气（FEV 1下降20%或>，无鼻眼）;部分哮喘（鼻-眼+FEV 1下降15-20%）;仅上部（鼻眼型，FEV 1下降< 15%）;负结果在接受cys-LTRAs治疗的患者中，ASA诱导的支气管痉挛反应的患者数量显著减少，同时上呼吸道反应增加。两组阿萨的平均激发剂量或FEV 1值的百分比变化无显著差异。在12例接受齐留通治疗的患者中，阿萨无反应（16%）与cys-LTRA治疗组（11%）和对照组（15%）相似。结论在口服阿萨挑战期间，LTMD治疗似乎将靶器官反应从上呼吸道和下呼吸道转移到上呼吸道。整个呼吸道的LTMD阻塞似乎没有发生。
Background Leukotrienes (LTs) appear to be crucial mediators of aspirin (ASA)-induced lower respiratory tract reactions. Therefore, it is logical to assume that leukotriene-modifier drugs (LTMDs) might block these reactions.Objective The aim of this study was to determine whether concomitant treatment with LTMDs was associated with a reduction of ASA-provoked lower respiratory tract reactions in patients with aspirin-exacerbated respiratory disease (AERD), when compared to AERD patients who were not treated with LTMDs. Secondly, if ASA-induced lower respiratory tract reactions were prevented in LTMD-treated patients, was there then a higher prevalence of upper respiratory reactors or, alternatively, a higher prevalence of blocked reactions ('non-reactors') in this group.Methods Of 271 patients suspected by history of having AERD, 96 were taking cys-LT receptor antagonists (cys-LTRAs) and 12 were taking zileuton at the time of oral ASA challenges. A matched control group of 163 patients was not receiving LTMDs. All subjects underwent standard oral ASA challenges. Reactions were classified as follows: classic [naso-ocular combined with a 20% or > decline in forced expiratory volume of 1 s (FEV1)]; pure lower (20% or > decline in FEV1 without naso-ocular); partial asthma (naso-ocular + 15-20% decline in FEV1); upper only (naso-ocular with < 15% decline in FEV1); negative (no reactions).Results In patients treated with cys-LTRAs, there were significant reductions in numbers of patients with ASA-induced bronchospastic reactions and a concomitant increase in upper respiratory reactors. There were no significant differences in mean provoking doses of ASA or the percent changes in FEV1 values in both groups. In the 12 patients receiving zileuton, no reactions to ASA (16%) were similar to the cys-LTRA-treated group (11%) and the control group (15%).Conclusion During oral ASA challenges, LTMD treatment appeared to shift target organ responses from both upper and lower respiratory tracts to upper tract alone. LTMD blocking of the entire respiratory tract did not appear to occur.