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ARE LEUKOTRIENE RECEPTOR ANTAGONISTS EFFECTIVE IN PREMENSTRUAL ASTHMA?

ARE LEUKOTRIENE RECEPTOR ANTAGONISTS EFFECTIVE IN PREMENSTRUAL ASTHMA?. GÜLDEN PAŞAOĞLU *, DİLŞAD MUNGAN**, ÖZNUR ABADOĞLU***, ZEYNEP MISIRLIGİL** * * Hospital of Acibadem, Istanbul ** Ankara University, Medical School, Allergic Diseases Department, Ankara,

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ARE LEUKOTRIENE RECEPTOR ANTAGONISTS EFFECTIVE IN PREMENSTRUAL ASTHMA?

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  1. ARE LEUKOTRIENE RECEPTORANTAGONISTS EFFECTIVE IN PREMENSTRUAL ASTHMA? GÜLDEN PAŞAOĞLU *, DİLŞAD MUNGAN**, ÖZNUR ABADOĞLU***, ZEYNEP MISIRLIGİL** ** Hospital of Acibadem, Istanbul ** Ankara University, Medical School, Allergic Diseases Department, Ankara, *** Cumhuriyet University, Medical School, Allergic Diseases Department, Sivas, Turkey

  2. INTRODUCTION • Recently, several studies suggest that some female asthmatic patientshave an increase in asthma symptoms during the premenstrual period. This occasion has been named as premenstrual asthma (PMA). • The vast majority of women with perimenstrual worsening of asthma are treated like all asthmatic patients. • However, forty percent of asthmatic patientshave perimenstrual exacerbations of asthma uncontrolled by steroid therapy.

  3. Stepwise therapy in chronic asthma • Controller: • Inhaled steroid • Long-acting inhaled β2-agonist plus (if needed) • Controller: • Inh. steroid + long-acting inh. β2-agonist or • İnh. steroid + Theophylline,or • Inh. steroid + oral b2 agonist • Inh. steroid + LTRA • High-dose inh. Steroid • Once control of asthma is achieved, Step down • Controller: • Inhaled steroid or • Theophylline • Chromone • LTRA Controller: none -Theophylline (sustained-release) -LTRA -Long-acting oral β2- agonist -Oral steroid -Anti-IgE LTRA To relieve symptom: as needed rapid-acting inhaled β2-agonist Mild Intermitan Severe persistent Step down Mild persistent Moderate persistent GINA, 2005

  4. INTRODUCTION • Nowadays the efficacy of Leukotriene Receptor Antagonists (LTRAs) on treatment of asthma is known well. • Only a two studies have shown that premenstrual exacerbation of asthma is better controlled by the addition of a leukotriene modifiying agents to regimen containing inhaled steroids.

  5. PURPOSE • The aim of this study was to investigate the effects of leukotriene receptor antagonists on premenstrual exacerbation of asthma.

  6. PMA (+) (n=14) Asthmatic woman n=29 PMA (-) (n=15) STUDY DESIGN IS IS+PL IS+Montelukast 1. menstrual cycles (run-in) 2. menstrual cycles 3. menstrual cycles PFTs, Es,Pg,FSH,LH PFTs, Es,Pg,FSH,LH PFTs, Es,Pg,FSH,LH • Symptom scores • Morning and evening PEFR

  7. RESULTS Mean age: 36.6±6.1(25-47) Mild persistent asthmatic woman n=25 PMA (+) (n=12) PMA (-) (n=13)

  8. PEF variabilities of groups p=0.005

  9. Symptom scores of groups p=0.002

  10. PFTs and hormone levels

  11. PFTs Levels p>0.05 FEV1 PEF

  12. Hormone levels p>0.05 p>0.05

  13. Hormone levels p=0.05 p>0.05

  14. DISCUSSION Prevention of severe premenstrual asthma attack by leukotriene receptor antagonist 5 patients with PMA and 5 controls: During 3 menstrual cycles • Morning PEFR • Symptom scores • Histamine • Cytokines (IL-1, IL-4,IL-5, IL-6 VE GM-CSF) • LTC4, LTB4 ve PAF Nakasato et al. JACI 1999;104:585-8.

  15. Prevention of severe premenstrual asthma attack by leukotriene receptor antagonist Nakasato et al. JACI 1999;104:585-8.

  16. Prevention of severe premenstrual asthma attack by leukotriene receptor antagonist • The level of LTC4 significantly increased during menstruation (69.016.0 pg/mL vs 24.0 9.5 pg/mL,p<0.05). • Histamin • IL-1, • IL-6 • LTB4 • PAF Ø Nakasato et al. JACI 1999;104:585-8.

  17. CONCLUSION • Based on the data in hand it could be stated that LTRAs have ensured the control of symptoms and improved PEFR variability in patients with PMA by supressing inflamation. • We are of the view that LTRAs would be a right choice in therapy for patients with PMA.

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