The Research Of LTRA In The Treatment And The Inflammatory Mechanisms Of Atopic Cough

Chronic cough is a common type of respiratory disease of respiratory medicine.A prospective multicenter epidemiological study in China showed that the chronic cough ranking in the top four were cough variant asthma,upper airway cough syndrome,eosinophilic bronchitis and atopic cough.With the intensifying environmental pollution,China's haze days increased and the atopic cough incidence,accounting for13.2% of chronic cough disease,increased year by year.As we know,most atopic cough patients are misdiagnosed and mistreated because of the difficulty of identifying the atopic cough and upper respiratory tract infection.However,the etiology of atopic cough is not clear.At present,some people confirmed that the main pathogenesis of atopic cough is eosinophilic inflammation,cough sensitivity,and Th1/Th2 immune imbalance.Leukotrienes are metabolites of arachidonic acid and it is involved in the inflammatory response to a variety of allergic diseases.It can increase the permeability of blood vessel wall,stimulate bronchial mucus secretion and increase the airway resistance.In addition,it can improve the activity of neural pathway related to airway and increase the sensitivity of cough as well.As a consequence of this,we speculate that leukotrienes may participate ininflammation of atopic cough.Thus blocking inflammation produced by the combination of leukotriene and leukotriene receptor,will be beneficial for the treatment of atopic cough.In this study,we will compare the difference of leukotrienes level in induced sputum between patients with atopic cough and healthy adults by ELISA and analysis the efficacy in the treatment of atopic cough using leukotriene receptor antagonist in XiJing hospital.Objective:To improve the inflammatory mechanism of atopic cough,and to provide clinical basis for the application of leukotriene receptor antagonists in atopic cough.Methods:To compare the difference of leukotriene C4 and D4 level in induced sputum between 23 patients with atopic cough and 20 healthy adults by ELISA.And,a retrospective analysis was conducted in the treatment of atopic cough about the curative effect using leukotriene receptor antagonist in XiJing hospital,from December 2014 to November 2016.Results:There are 23 patients with atopic cough were enrolled in this study,including12 males(52%)and 11 females(48%),age(44.9±12.8)year,BMI(21.84±1.66)kg/m2,FENO(22.26±7.85)ppb,61%AC patients with allergic history,74%AC patients with total IgE>200IU/ml,30.4%AC patients with smoking history.The cough score of daytime and nighttime was 1(1~2).The physiological score,psychological score,social score and total score of LCQ in AC patients were(4.77±0.83),(4.30±0.79),(5.05±0.74),and(14.12±1.87).The levels of LTC4 and LTD4 in patients with AC were(637.62±402.89)pg/ml and(142.32±58.82)pg/ml.There were 20 healthy adults were enrolled in this study,including 11 males(55%)and 9 females(45%),age(37.95±10.15)year,BMI(21.11±1.76)kg/m2.The levels of LTC4 and LTD4 in healthy adults were(149.86±119.20)pg/ml and(113.56±70.54)pg/ml.Compared with heathy adults group,the level of leukotriene C4 in patients with atopic cough group were significantly increased(P<0.05),however,the level of leukotriene D4 had no significant change(P>0.05).The physiological score,psychological score,social score and total score of LCQ in patients with AC were significantly lower than that in healthy adults(P<0.05).The retrospective clinical study showed that the effective rate of antihistamines in t he treatment of AC was 48%,the effective rate of antihistamines combined with leukotriene receptor antagonist in the treatment of AC was 88.2%,and the effective rat e of glucocorticoid in the treatment of AC was 97.2%.Compared with antihistamine group,the effective rate of glucocorticoid group and antihistamines combined with leukotriene receptor antagonist group were significantly higher,and the curative effec t differences were statistically significant(P<0.0125).However,there was no significant d ifference between antihistamines combined with leukotriene receptor antagonist grou p and glucocorticoid group(P>0.05).Conclusion:Compared with heathy adults group,the level of leukotriene C4 in patients with atopic cough group were significantly increased(P<0.05),however,the level of leukotriene D4 had no marked change(P>0.05).Thus,leukotrienes may be one of the mechanisms of inflammation in atopic cough.And,the treatment of atopic cough using glucocorticoid or antihistamines combined with leukotriene receptor antagonist is better than single antihistamine drug.Antihistamines combined with leukotriene receptor antagonist has the same efficacy as glucocorticoid in the treatment of atopic cough.