白三烯拮抗剂在儿童过敏性疾病的应用.pptVIP

Slide 17 CysLTs and steroid-sensitive mediators are two important pathways of inflammation in asthma.7 Corticosteroids do not block the leukotriene-mediated pathway of inflammation.7,19 Therefore, treating dual pathways may provide complementary benefits—better control of inflammation and effective asthma control—compared with treating only the steroid-sensitive pathway.7,19 吸入型糖皮质激素对白三烯的体内合成几无抑制作用，其治疗哮喘的作用与白三烯无关。 白三烯受体拮抗剂实际上是通过另一条不受吸入型糖皮质激素影响的途径发挥抗哮喘作用的。在哮喘发病中以白三烯为主要介质时，糖皮质激素对这类哮喘的治疗不显著，而抗白三烯药物即能发挥作用，收到较好的效果。 Ref 7, p S37, C1, ?1, L3-6; p S38, C1, ?2, L1-3 ? Ref 7, p S39, C1, ?2, L1-8 Ref 19, p 9, C1, ?1, L3-7 ? Ref 7, p S37, C1, ?1,L3-6 Ref 19, p 10, C2, ?2, L1-13 * Slide 23 A wealth of clinical evidence points to a connection between allergic rhinitis and asthma. Increased BHR during the pollen season demonstrated by nonasthmatic patients with allergic rhinitis and increased BHR on nasal allergen challenge in patients with both conditions indicate that the expression of allergic symptoms, even when confined to the nose, is associated with inflammatory effects in the bronchial tissue.32,33 Studies showing that nasal eosinophils are significantly increased in patients with asthma and correlate with increases in bronchial eosinophils support the hypothesis that asthma and rhinitis may be clinical expressions of the same disease entity.34 Evidence of a systemic inflammatory link between these two disorders comes from a clinical study in which bronchial allergen challenge increased inflammatory cell numbers not only in the bronchial tissue but also in the nose and the systemic circulation.35 Finally, some of the same medications may benefit both allergic rhinitis and asthma: treating allergic rhinitis may improve asthma control, and antileukotrienes have demonstrated efficacy in both conditions.36-38 This observation suggests a therapeutic linkage. Because of its efficacy in both conditions, montelukast is useful in patients who have both al