マツモト　エツコ   Matsumoto Etsuko   松本　悦子    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
言語種別	英語
発表タイトル	Comparable effect of a leukotriene receptor antagonist and inhaled corticosteroid in asthma patients complicated with allergic rhinitis
会議名	American Thoracic Society 2013
学会区分	国際学会及び海外の学会
発表形式	ポスター掲示
講演区分	一般
発表者・共同発表者	◎KIRISHI Saori, TAGAYA Etsuko, ISONO Kazuo, TAKEYAMA Kiyoshi, KONDO Mitsuko, TAMAOKI Jun
発表年月日	2013/05/19
開催地 （都市, 国名）	Philadelphia, USA
概要	RATIONALE: Allergic rhinitis (AR) and asthma are very common diseases that often present concurrently. The high prevalence of these diseases is associated with high morbidity and elevated health costs, and several studies have suggested that AR may also be an important risk factor for the development and severity of asthma. Both diseases have a number of characteristics in common, but they also differ substantially in certain aspects. METHODS: The study was designed to determine the difference in effectiveness of leukotriene receptor antagonist (LTRA) and inhaled corticosteroid (ICS) in the treatment of asthma patients who also had AR, we conducted randomized, controlled, parallel-group, multicenter trial. The prevalence and severity of AR and asthma were assessed by ARIA (Allergic Rhinitis and its Impact on Asthma) and VAS (Visual Analog Scale), respectively. After a 4-week run-in period, 49 patients with poorly controlled asthma having AR were assigned to add montelukast (10 mg/day, MK group) to the treatment or double the dose of previous ICS (ICS group) for 12 weeks. RESULTS: Among 154 patients with asthma, 105 (68%) had AR, and asthma control was significantly impaired in AR (+) patients compared with AR (-) patients. There was a positive correlation between AR and asthma VAS values. In the treatment period, 49 patients were enrolled, and 40 patients completed the trial and provided verifiable data (21 patients in the MK group and 19 patients in the ICS group). There were no significant differences between baseline characteristics of two treatment groups. During the 12-week treatment, the increase in FEV1 was greater in the MK group than in the ICS group (0.28 ± 0.04 L vs. 0.13 ± 0.04 L (p < 0.05). Mean morning peak expiratory flow (PEF) and evening PEF increased, and the use of supplemental beta2-agonist inhalation decreased in both groups, where the changes from the baseline were significantly greater in the MK group. Both treatment caused improvement in asthma control, and Asthma Control Test (ACT) score at the end of the study was higher in the MK group (19.3 ± 2.9) compared with ICS group (14.8 ± 3.3). CONCLUSIONS: Two-thirds of patients with asthma have AR, and the presence of AR may worsen asthma control. Addition of LTRA is superior to doubling the dose of ICS for the treatment of such patients.