Abstract
Nocturnal worsenings of asthma affect the vast majority of the asthmatic population at some point in the course of their disease and are significant contributors both to the morbidity and mortality associated with asthma [1]. However, many of the pathophysiologic reasons for this worsening remain unknown. The advent of the leukotriene (LT)-modulating drugs has allowed the LTs to be definitively included as causative mediators in this syndrome. As with any other mediator, cytokine or cell type, the identification of their definitive role in a particular disease is dependent on the fulfillment of Koch’s postulates. These postulates were set out approximately 100 years ago by Robert Koch to identify the role of bacteria in infections, such as tuberculosis, but clearly the principles behind them are widely applicable today. In a modified format appropriate to LTs, they can be outlined as follows. The leukotrienes must (i) be able to cause the symptoms and pathophysiologic changes of nocturnal asthma, (ii) be made by the cells present in the airways of nocturnal asthmatics, (iii) be measured in asthmatics at night during symptoms and correlate with disease severity and (iv) be blocked by antagonists or inhibitors leading to improvement in the symptoms and/or physiologic changes of asthma. This chapter will outline the fulfillment of these hypotheses by the LTs, both the cysteinyl LTs and LTB4.
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Wenzel, S.E. (1999). Leukotrienes in nocturnal asthma. In: Folco, G., Samuelsson, B., Murphy, R.C. (eds) Novel Inhibitors of Leukotrienes. Progress in Inflammation Research. Birkhäuser, Basel. https://doi.org/10.1007/978-3-0348-8703-8_12
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DOI: https://doi.org/10.1007/978-3-0348-8703-8_12
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