Efficiency Of Montelukast Sodium Combines Seretide In The Treatment Of Asthma-COPD Overlap Syndrome

Objectives:This research aims at the changes in patients of ACOS,whose observed indicators such as hs-CRP in serum,EOS% in blood and pulmonary function test(FEV1% predicted value、FEV1/FVC%),which between before and after the treatment of montelukast sodium combines seretide and the seretide only. To clarify the clinical significance of the two methods for treatment of this new phenotype, namely drug combination and seretide only. Thus to provide new methods and thoughts of drug choosing for clinical doctors in the treatment of ACOS.Methods: Choose 208 patients with the first diagnosis of asthma or COPD,who have hospitalization in the department of respiratory in Yan’an University Affiliated Hospital from July 2014 to February 2016. All the patients were selected with the 5 steps of the GINA and GOLD combined guidelines in 2014 for diagnosis and treatment of ACOS. Then to choose 60 patients with ACOS at last. Randomly divide the 60 patients with asthma-COPD overlap syndrome into two groups. There were 30 patients in the observation group. There were 16 males and 14 females, with an average age of 55.53±10.68 years old(range:38 to 77 years old).There were 30 patients in the control group. There were 21 males and 9 females,with an average age of 59.80±10.30 years old(range:39 to 75 years old);Before the treatment, the two groups of patients have no statistically significant differences in terms of age, sex composition(P>0.05). Then to test and record the observation indicators of the patients such as hs-CRP in serum、EOS% in blood、FEV1% predicted value、FEV1/FVC% after entering the hospital,the two groups of patients have no statistically significant differences(P>0.05). The patients of two groups were given the same treatment of low flow oxygen, antispasmodic, anti infection, cough expectorant and necessary mechanical ventilation. Meanwhile the observation group was given Seretide 50 ug / 250 ug to inhale 2 times a day,also was given Montelukast sodium 10 mg to take 1 time a day. The control group was given Seretide 50 ug / 250 ug to inhale 2 times every day. The patients were treated by these two methods for one month,then to observe the changes such as hs-CRP in serum, EOS% in blood and FEV1% predicted value,FEV1/FVC% of lung function test in the patients with asthma-COPD overlap syndrome before and after treatment.Results:1.The observation group and the control group both have 30 patients,the two groups of patients have no statistically significant differences in terms of age, sex composition(P>0.05).2. Count the research indicators of patients with asthma-COPD overlap syndrome(60 cases) after entering the hospital, that is hs-CRP in serum、EOS% in blood、FEV1% predicted value、FEV1/FVC%. After calculation, the same indicators of the observation group and the control group were done with the independent samples t-test. The research indicators of two groups have no statistically significant differences before the treatment(P>0.05).3. The data shows that the hs-CRP in serum of the selected patients were risen 194.61%.The EOS% in blood were risen 46.20%.The FEV1% predicted value were declined 28.13%.The FEV1/FVC% were declined 28.13%. The hs-CRP in serum was negatively correlated with FEV1% predicted value(r=-0.672,P<0.05),and was negatively correlated with FEV1/FVC%(r=-0.643,P<0.05).EOS% has no statistically significant correlated with FEV1% predicted value(r=-0.249,P>0.05),and has no statistically significant correlated with FEV1/FVC%(r=-0.123,P>0.05).4. The observed indicators that is hs-CRP in serum、EOS% in blood、FEV1% predicted value、FEV1/FVC% of observation group,the outcomes of before and after the treatment were done with paired-samples t-test. The outcomes of before and after the treatment have statistically significant differences(P<0.05). The research indicators that is hs-CRP in serum、EOS% in blood、FEV1% predicted value、FEV1/FVC% of control group,the outcomes of before and after the treatment were done with paired-samples t-test. The outcomes of before and after the treatment have statistically significant differences(P<0.05).5. The indicators such as hs-CRP in serum、EOS% in blood、FEV1% predicted value、FEV1/FVC% after the treatment of the two groups were done with independent samples t-test. The research indicators of two groups have statistically significant differences after the treatment(P<0.05).The hs-CRP in serum and EOS% in blood in the observation group were lower than those in the control group. The FEV1% predicted value and FEV1/FVC% in the observation group were higher than those in the control group.6.The statistical data shows, after calculating of differences of research indicators before and after the treatment(before the treatment-after the treatment),the differences were done with independent samples t-test, the outcomes have statistically significant differences(P<0.05).Conclusion:1.The inflammation related factors of patients with ACOS like hs-CRP in serum and EOS% in blood were higher than normal value. The airflow limitation factor, that is pulmonary function test(FEV1% predicted value、FEV1/FVC%) were lower than normal value. The hs-CRP in serum was negatively correlated with FEV1% predicted value、FEV1/FVC%. The EOS% in blood has no statistically significant correlated with FEV1% predicted value、FEV1/FVC%. So, the aggravation of airway inflammation in patients with ACOS may further aggravate the situation of airflow limitation. The hs-CRP in serum can indirectly reflect the airflow limitation. The EOS% can not obviously reflect the airflow limitation. After the combined anti-inflammatory treatment, the indicators of patients were better than before, indicating that ACOS patients with airway inflammation,Cys LT1 participated in the airway inflammatory response. The combined anti-inflammatory can significantly reduce airway inflammation in patients with ACOS.2. The using of Montelukast sodium combines Seretide and the using of Seretide only can both reduce the hs-CRP in serum、EOS% in blood,and can also significantly improve the FEV1% predicted value,FEV1/FVC% in pulmonary function test. But compared with the Seretide only,the Montelukast sodium combines Seretide can much more effectively reduce the hs-CRP in serum、EOS% in blood in curing patients with ACOS. It can also much more effectively improve the FEV1% predicted value,FEV1/FVC% in pulmonary function test.