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A case with persistent asthma symptoms despite fluticasone treatment in which concomitant treatment with montelukast and perilla seed oil-rich supplementation significantly improved asthma control

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A 25-year-old woman had the chief complaint of recurrent episodes of dyspnea and wheeze. Asthma had been diagnosed at infant years and sometimes experienced asthma attacks. She graduated senior high school and entered technical school in Tokyo. She received fluticasone (400μg daily) but exacerbation continued after she became an office clerk. She returned Kurashiki in October 2001 but had wheeze and asthma exacerbations. She was admitted to our hospital for evaluation and treatment of bronchial asthma on August 2, 2002. After admission, her symptoms subsided within some days. She was treated with montelukast and perilla seed oil-rich supplementation . The number of eosinophils decreased, decrease was observed in leukotriene (LT) B4 generation and in LTC4 generation, and pulmonary function improved following montelukast and perilla seed oil-rich supplementation for 4 weeks. The patient had no exacerbation under treatment and was discharged from the hospital on September 2, 2002. For some patients with persistent asthma, inhaled corticosteroids may fail to achieve adequate control possibly because corticosteroids do not completely inhibit the synthesis and release of cysteinyl leukotrienes (cysLTs) in the lung. Montelukast blocks the interaction of cysLTs with their receptor and resulting downstream events and perilla seed oil-rich diet suppresses LT generation. Combination therapy with montelukast and perilla seed oil-rich diet is more effective than montelukast or perilla seed oil-rich diet alone because of additive effects of montelukast with perilla seed oil-rich diet. We suggest that montelukast and perilla seed oil-rich supplementation are effective options when bronchial asthma patients receive inhaled corticosteroid but exacerbation continues.

症例は25歳女性, 主訴は呼吸困難, 喘鳴。乳児期気管支喘息発症し, 以後も喘息発作を認めた。 高校卒業後上京し, 就職後fluticasone propionate400μg投与にもかかわらず, 喘息発作が続いていた。2001年10月倉敷に帰郷後も喘鳴, 発作を認め, 2002年8月2日精査加療目的で当院入院となっ た。入院後速やかに喘鳴は消退した。エゴマ油食,montelukast sodium投与開始し, 血中好酸球, 白血球leukotriene B4, leukotriene C4低下, 呼吸機能改善を認めた。その後喘息発作, 喘鳴などは再発せず, 9月2日退院となった。吸入ステロイド薬単独治療では症状を十分に管理できない患者が存在する。その原因としてステロイド薬はロイコトリエンの産生を完全に抑制できないことが挙げられる。ロイコトリエンによる気道炎症は,montelukastをはじめとするロイコトリエン受容体拮抗薬によって特異的に抑制され, エゴマ油食もロイコトリエン産生を抑制すると報告されている。本症例ではmontelukastおよびエゴマ油食の相加効果により, 各々の単独投与より良好な結果が得られた。従って吸入ステロイドで喘息コントロール不良な症例に対してmontelukastおよびエゴマ油食を併用することが望まれる。



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