I Agache, I M Adcock, C A Akdis, M Akdis, G Bentabol-Ramos, M van den Berge, C Boccabella, W G Canonica, C Caruso, M Couto, I Davila, D Drummond, J Fonseca, A Gherasim, S Del Giacco, D J Jackson, M Jutel, A Licari, S Loukides, A Moreira, M Mukherjee, I Ojanguren, O Palomares, A Papi, L Perez de Llano, O J Price, M Rukhazde, M H Shamji, D Shaw, S Sanchez-Garcia, A Testera-Montes, M J Torres, I Eguiluz-Gracia
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引用次数: 0
Abstract
As cholinergic innervation is a major contributor to increased vagal tone and mucus secretion, inhaled long-acting muscarinic antagonists (LAMA) are a pillar for the treatment of chronic obstructive pulmonary disease and asthma. By blocking the muscarinic receptors expressed in the lung, LAMA improve lung function and reduce exacerbations in asthma patients who remained poorly controlled despite treatment with inhaled corticosteroids and long-acting β2 agonists. Asthma guidelines recommend LAMA as a third controller to be added on before the initiation of biologicals. In addition to bronchodilation, LAMA also exert anti-inflammatory and anti-fibrotic effects by inhibiting muscarinic receptors present in neutrophils, macrophages, fibroblasts and airway smooth muscle cells. Thus, besides bronchodilation, LAMA might provide additional therapeutic effects, thereby supporting an endotype-driven approach to asthma management. The Position Paper, developed by the Asthma Section of the European Academy of Allergy and Clinical Immunology, discusses the main cholinergic pathways in the lung, reviews the findings of significant clinical trials and real-life studies on LAMA use in asthma, examines the placement of these drugs in asthma clinical guidelines, and considers the potential for personalised medicine with LAMA in both adult and paediatric asthma patients.
胆碱能神经支配是迷走神经张力和粘液分泌增加的主要原因,因此吸入长效毒蕈碱拮抗剂(LAMA)是治疗慢性阻塞性肺病和哮喘的支柱。通过阻断肺部表达的毒蕈碱受体,长效毒蕈碱拮抗剂可改善哮喘患者的肺功能并减少病情恶化,这些患者在使用吸入式皮质类固醇和长效β2受体激动剂治疗后病情仍未得到有效控制。哮喘指南建议在开始使用生物制剂之前,将 LAMA 作为第三种控制药物。除支气管扩张作用外,LAMA 还能抑制中性粒细胞、巨噬细胞、成纤维细胞和气道平滑肌细胞中的毒蕈碱受体,从而发挥抗炎和抗纤维化作用。因此,除了支气管扩张作用外,LAMA 还可能提供其他治疗效果,从而支持以内型为导向的哮喘治疗方法。这份由欧洲过敏与临床免疫学会哮喘分会编写的立场文件讨论了肺部的主要胆碱能通路,回顾了有关 LAMA 用于哮喘的重要临床试验和实际生活研究的结果,研究了这些药物在哮喘临床指南中的位置,并考虑了在成人和儿童哮喘患者中使用 LAMA 进行个性化治疗的潜力。
期刊介绍:
Allergy is an international and multidisciplinary journal that aims to advance, impact, and communicate all aspects of the discipline of Allergy/Immunology. It publishes original articles, reviews, position papers, guidelines, editorials, news and commentaries, letters to the editors, and correspondences. The journal accepts articles based on their scientific merit and quality.
Allergy seeks to maintain contact between basic and clinical Allergy/Immunology and encourages contributions from contributors and readers from all countries. In addition to its publication, Allergy also provides abstracting and indexing information. Some of the databases that include Allergy abstracts are Abstracts on Hygiene & Communicable Disease, Academic Search Alumni Edition, AgBiotech News & Information, AGRICOLA Database, Biological Abstracts, PubMed Dietary Supplement Subset, and Global Health, among others.