Effects of treatment with montelukast alone, budesonide/formoterol alone and a combination of both in cough variant asthma

Abstract

Background Whether cysteinyl-leukotriene receptor antagonists (LTRAs) have a similar antitussive effect to inhaled corticosteroids and long-acting β2-agonist (ICS/LABA), and that LTRA plus ICS/LABA is superior to LTRAs alone or ICS/LABA alone in treating cough variant asthma (CVA) remain unclear. This study aimed to investigate and compare the efficacy of montelukast alone, budesonide/formoterol alone and the combination of both in the treatment of CVA. Methods Ninety-nine CVA patients were assigned randomly in a 1:1:1 ratio to receive montelukast (M group: 10 mg, once daily), budesonide/formoterol (BF group: 160/4.5 μg, one puff, twice daily), or montelukast plus budesonide/formoterol (MBF group) for 8 weeks. The primary outcomes were changes in the cough visual analogue scale (VAS) score, daytime cough symptom score (CSS) and night-time CSS, and the secondary outcomes comprised changes in cough reflex sensitivity (CRS), the percentage of sputum eosinophils (sputum Eos%) and fractional exhaled nitric oxide (FeNO). CRS was presented with the lowest concentration of capsaicin that induced at least 5 coughs (C5). The repeated measure was used in data analysis. Results The median cough VAS score (median from 6.0 to 2.0 in the M group, 5.0 to 1.0 in the BF group and 6.0 to 1.0 in the MBF group, all p < 0.001), daytime CSS (all p < 0.01) and night-time CSS (all p < 0.001) decreased significantly in all three groups after treatment for 8 weeks. Meanwhile, the LogC5 and sputum Eos% improved significantly in all three groups after 8 weeks treatment (all p < 0.05). No significant differences were found in the changes of the VAS score, daytime and night-time CSSs, LogC5 and sputum Eos% among the three groups from baseline to week 8 (all p > 0.05). The BF and MBF groups also showed significant decreases in FeNO after 8 weeks treatment (p = 0.001 and p = 0.008, respectively), while no significant change was found in the M group (p = 0.457). Treatment with MBF for 8 weeks significantly improved the FEV1/FVC as well as the MMEF% pred and decreased the blood Eos% (all p < 0.05). Conclusions Montelukast alone, budesonide/formoterol alone and a combination of both were effective in improving cough symptom, decreasing cough reflex sensitivity and alleviating eosinophilic airway inflammation in patients with CVA, and the antitussive effect and anti-eosinophilic airway inflammation were similar. Trial registration ClinicalTrials.gov, number NCT01404013.

The Effects of Budesonide Inhalation Treatment on the Expression Levels of Serum IL-6, TGF-β1, and IgE and Pulmonary Function in Patients with Cough Variant Asthma and an Evaluation of Treatment Efficacy

“…16 After budesonide is inhaled into the lungs, it specifically binds to glucocorticoid receptors expressed in the cytoplasm of target cells to affect the transcription of various inflammatory factors, thereby exerting its anti-inflammatory effect. 17 In retrospective studies, after budesonide treatment, the relevant inflammatory indicators significantly normalized, with improvements in the remission group being more significant than those in the control group at different time points. These findings indicate that inflammatory cytokines are involved in the CVA progression and are consistent with the findings of published reports in China and abroad.…”

“… 16 After budesonide is inhaled into the lungs, it specifically binds to glucocorticoid receptors expressed in the cytoplasm of target cells to affect the transcription of various inflammatory factors, thereby exerting its anti-inflammatory effect. 17 …”

Eosinophilic Cationic Protein and Immunoglobulin E: Unraveling Biomarkers in Chronic Pediatric Cough

“…Ninety-nine children, randomly assigned to different treatment regimens, showed improvement in the cough visual analog scale daytime and night-time cough symptom scores after 8 weeks in the three therapy regimens but not before this period. Moreover, the three therapeutic regimens effectively alleviated eosinophilic airway inflammation [42].…”

Role of Leukotriene Antagonists in the Treatment of Asthma Exacerbations

“…Leukotriene is an inflammatory mediator that is produced by eosinophils and mast cells in the respiratory system and leads to inflammatory responses such as bronchospasm by contracting the smooth muscles, bronchial hyperresponsiveness, and increased vascular leakage leading to edema and airway remodeling. Its production can also be boosted by respiratory viruses, especially rhinoviruses, and allergens [7,8].…”