哮喘的异质性.pptVIP

Slide 47 As shown on the graph on the left, in the total group of patients treated in the COMPACT study, montelukast + budesonide had effects on lung function similar to those of budesonide alone. Morning PEF increased by 33.5 L/min (8.6%) from baseline in the montelukast + budesonide group and by 30.1 L/min (7.7%) in the budesonide alone group (p=0.36).66 In contrast, as shown in the graph on the right, in the subgroup of asthma patients with allergic rhinitis, the mean increase from baseline in morning PEF was significantly (p0.03) higher in the montelukast + budesonide group (36.4 L/min; 9.2%) than in the budesonide alone group (24.1 L/min; 6.0%).66 In PRAACTICAL, adding montelukast improved long-term asthma control, reducing the incidence of asthma attacks by 68%. Before the initiation of montelukast therapy, 31.8% of patients experienced asthma attacks every year, versus 10.1% of patients after the initiation of montelukast therapy. Therefore, the proportion of patients experiencing asthma attacks was reduced from 1 in 3 patients to 1 in 10 patients. This difference was statistically significant (p=0.001). Montelukast reduced the incidence of asthma attacks regardless of baseline asthma severity (i.e., mild vs. moderate asthma) and baseline asthma therapy (i.e., ICS vs. ICS + LABAs).1 Reference Borderias L, Mincewicz G, Paggiaro P et al. Improvement in asthma control and reduction in medical resource use following treatment with montelukast (Patient-level Review of Asthma and Allergy Care Therapy Including Corticosteroids and Anti-Leukotrienes—PRAACTICAL Study). Presented at the 15th Annual Congress of the European Respiratory Society, Copenhagen, Denmark, September 17–21, 2005. Poster 3692. 2007 版 ARIA指南强调在哮喘和AR这两大重要疾病的临床管理中提高LTRAs的地位，包括孟鲁司特。 3 ARIA指南认为哮喘和AR之间的关系支持“一个气道”的概念。因此建议评估哮喘患者是否有AR的病史和体征。合并有上下气道疾病的患者，应采用联合治疗以达到理想的效果和用药安全。3 在AR要素的循证学回顾中，ARIA提出LTRAs对哮喘和鼻炎同样有效。LTRAs推荐用于所有严重程度AR（轻至中/重度间歇性症状以及轻至中/重度持续性症状），并且LTRAs对鼻炎的所有症状和眼部症状均有效。3 ARIA治疗建议是以充分的临床依据为基础的；