A Meta-analysis About The Efficacy Of Treating Eosinophilie Bronchitis With The Combination Of Montelukast And Budesonide

Objective:Eosinophilic bronchitis is one of the most common causes of chronic cough,and its commonly used treatments are oral use of leukotriene receptor antagonists(LTRA)and / or inhalation of cortisol.Clinically,single oral treatment with LTRA such as montelukast(MONT)is usually used to treat EB,and inhalation treatment with cortisol hormone,such as budesonide(BUN)is also commonly used.In addition,there are also some situations in which the above two drugs are used in combination.Studies have shown that the combination of montelukast and budesonide has a better efficacy than that of the same dose of the two medicine used individually to treat EB,but until now no evidence-based medicine support has been found.This study intends to investigate relevant literature of the domestic and foreign studies,and use meta-analysis method to explore the efficacy of treating EB with the combination of MONT and BUN.Methods:This paper has used reliable databases to collect randomized controlled trials(RCTs)about the efficacy of the combined treatment of EB with MONT and BUN.These databases include PubMed 、 The Cochrane Library(Issue 1,2017)、EMBase、Wan Fang、CNKI、VIP、CBM.The time span of search was set from the establishment date of each database to February 2017.This paper also uses the assessment tools of the Cochrane collaboration to evaluate the quality of studies which have met the criterion,and uses RevMan5.3.5(Mac version)software for data processing in the end.Results:9 RCTs had been involved in this study.Because the interventions of the control group were two heterogeneous different drugs,it was divided into two subgroups: A subgroup included 6 tests,and the control group of this subgroup used MONT alone,which was referred to as MONT group.B subgroup included 4 studies,and the control group of this subgroup used BUN alone,which was referred to as BUN group.The intervention groups in both subgroups were MONT combined with BUN,referred to as combination group.A subgroup results suggested that compared with the MONT group,the total effective rate of the combination group was higher than that of the control group.The levels of sputum eosinophil(sputum Eos),sputum eosinophil cationic protein(sputum ECP),sputum leukotriene C4(sputum LTC4)were significantly reduced.The level of peripheral blood eosinophils(peripheral Eos)had no significant decline.There was no significant difference in adverse reaction rate;B subgroup results suggested that compared with the BUN group,the total effective rate of the combination group was also higher than that of the control group.The levels of sputum Eos,peripheral Eos,fractional exhaled nitric oxide(FeNO)were significantly reduced.The recurrence rate after six months also decreased significantly.There was no significant difference in adverse reaction rate.Conclusion:The efficacy about MONT combined with BUN treatment of EB is more obvious than that of oral use of MONT alone or inhalation of BUN alone.However,due to the limited quantity and quality of included tests,more large-scale,high-quality and multi-center RCTs are needed.In addition,there has no literature comparing the efficacy of oral use of MONT alone with inhalation of BUN alone in the treatment of EB.