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《2010NAC在兒童哮喘管理的白三烯受體拮抗劑》內容預覽

Introduction

This ***rmation paper outlines the current position of leukotriene receptor antagonists(LTRAs) in the treatment of children with asthma.

The leukotrienes are a family of pro-inflammatory mediators that play an important rolein the pathophysiology of asthma. Leukotrienes are derived from cell membranes andreleased following activation of resident airway cells (mast cells) and infiltrating cells(eosinophils and neutrophils). They are involved in both early and late asthmatic airwayresponses to allergen challenge. Leukotrienes are potent bronchoconstrictors and alsocause airway oedema, mucus secretion and recruitment of eosinophils into the airway.

Leukotriene receptor antagonists bind to and inhibit specific receptors within the airway.Montelukast (Singulair) is the only LTRA registered in Australia for use in children aged2 and older (see Box 1). Montelukast is an orally active, specific LTRA that protectsagainst early- and late-phase bronchoconstriction response to allergen challenge, andagainst exercise-induced bronchoconstriction.

Diagnostic considerations in children

Asthma management in children should be based on a careful assessment of the clinicalpattern. Childhood asthma is classified as infrequent intermittent, frequent intermittent,mild persistent, moderate persistent or severe persistent (Figure 1). This classificationis based mainly on clinical ***rmation, but spirometry and peak expiratory flow (PEF)variability can provide useful additional ***rmation in children older than 7 years. Theinitial assessment should be reviewed regularly.

Intermittent asthma accounts for up to 95% of childhood asthma.2Because episodesare usually triggered by a viral upper respiratory tract infection, the terms “intermittentasthma” and “virus-associated wheeze” or “viral-induced wheeze” are sometimes usedsynonymously in clinical literature.3Montelukast is currently recommended as a treatmentoption for children with frequent intermittent asthma or mild persistent asthma.

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