Drugs for asthma
Drugs for asthma
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DOI：
10.1038/sj.bjp.0706437
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发表时间：
2006-01-01
影响因子：
7.3
通讯作者：
Barnes, PJ
中科院分区：
文献类型：
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作者：
Barnes, PJ
目前的哮喘药物治疗是非常有效的，并已从自然发生的物质，通过合理的制药发展。药理学在哮喘药物开发中发挥了关键作用，一些关键的实验观察结果已在该杂志上发表。了解有效药物治疗的药理学也教会了我们很多关于哮喘的潜在机制。β（2）-肾上腺素受体激动剂是最有效的支气管扩张剂，由肾上腺髓质的儿茶酚胺进化而来，而来自肾上腺皮质的皮质类固醇是迄今为止气道中潜在炎症过程的最有效控制剂。目前哮喘治疗的“金标准”是一种含有长效β 2受体激动剂和皮质类固醇的组合吸入剂-一种肾上腺提取物的改进形式。从植物中提取的色甘酸盐和茶碱（一种膳食甲基黄嘌呤）也被广泛用于哮喘的治疗，但我们仍然不了解它们的分子机制。药理学在改善天然产物以使其成为有效、持久和安全的哮喘疗法方面发挥了重要作用，但迄今为止，在产生新的抗哮喘疗法方面仍面临挑战。在过去的30年里，唯一的新型抗哮喘治疗是白三烯拮抗剂，它比现有的治疗方法效果差。靶向特定细胞因子的新的、更特异性的疗法不如皮质类固醇有效，而更有效的疗法具有可能不可接受的副作用的风险。看来，药理学，而不是分子遗传学，将仍然是进一步改善哮喘治疗的主要途径。
Current drug therapy for asthma is highly effective and has evolved from naturally occurring substances through logical pharmaceutical developments. Pharmacology has played a critical role in asthma drug development and several key experimental observations have been published in this journal. Understanding the pharmacology of effective drug therapies has also taught us much about the underlying mechanisms of asthma. beta(2)-Adrenoceptor agonists are the most effective bronchodilators and evolved from catecholamines from the adrenal medulla, whereas corticostcroids, from the adrenal cortex, are by far the most effective controllers of the underlying inflammatory process in the airways. The current 'gold standard' of asthma therapy is a combination inhaler containing a long-acting beta(2)-agonist with a corticosteroid - an improved form of adrenal gland extract. Cromoglycate, derived from a plant product and theophylline, a dietary methyl xanthine, have also been extensively used in the therapy of asthma, but we still do not understand their molecular mechanisms. Pharmacology has played an important role in improving natural products to make effective long lasting and safe asthma therapies, but has so far been challenged to produce new classes of antiasthma therapy. The only novel class of antiasthma therapy introduced in the last 30 years are leukotriene antagonists, which are less effective than existing treatments. New, more specific, therapies targeted at specific cytokines are less effective than corticosteroids, whereas more effective therapies carry a risk of side effects that may not be acceptable. It seems likely that pharmacology, rather than molecular genetics, will remain the main approach to the further improvement of treatment for asthma.