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Cough variant asthma （CVA） is a chronic respiratory disease with cough as its main symptom. The occurrence of CVA is closely related to non-specific airway inflammation， and its pathogenesis involves environmental， genetic， immune， and other factors. In recent years， the advantages of traditional Chinese medicine （TCM） in the treatment of CVA have attracted the attention of experts and scholars in China and abroad， especially its prominent role in regulating immune balance， relieving cough symptoms in CVA patients， and reducing recurrence. T Helper cells 1 （Th1）， T helper cells 2 （Th2）， T helper cells 17 （Th17）， and regulatory T cells （Treg） are derived from CD4+ T cells. Immune imbalance of Th1/Th2 and Th17/Treg is a new hotspot in the pathogenesis of CVA and a potential key target in the treatment of CVA by TCM. Th cell subsets are in dynamic balance under physiological conditions， maintaining respiratory immune homeostasis in which pro-inflammatory cytokines and anti-inflammatory cytokines are balanced. Immature helper T cells （Th0） can be differentiated into Th1， Th2， Th17， Treg， and other cell subsets due to cytokine types in the microenvironment in the stage of CVA maturation. The proliferation of Th2 cells leads to eosinophilic airway inflammation. Excessive differentiation of Th17 cells induces neutrophil airway inflammation. Th1/Th2 and Th17/Treg cells are mutually restricted in number and function， and the immune imbalance of Th1/Th2 and Th17/Treg is easy to aggravate the generation of inflammatory response. Restoring immune balance is particularly important for the airway anti-inflammatory therapy of CVA. In this paper， the imbalance of Th1/Th2 and Th17/Treg and the pathogenesis of CVA were systematically expounded. Meanwhile， the latest research on the regulation of immune imbalance by TCM compound， single TCM， and its effective ingredients in the treatment of CVA was reviewed. It provides ideas and references for revealing the scientific connotation of TCM regulating immune balance therapy of CVA， as well as the development of clinical treatment and basic research of CVA.
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ObjectiveTo investigate effect of Maxing Shigantang and supplemented Guominjian decoction on symptoms and levels of inflammatory cytokines in induced sputum of children with cough variant asthma （CVA）. MethodA total of 118 CVA children who were treated in our hospital from January 2020 to January 2021 were enrolled and randomized into the control group and the observation group with the random number table method. Control group received routine western medicine and the observation group was treated by routine western medicine， Maxing Shigantang， and supplemented Guominjian decoction. In the one-month follow-up， the scores of cough and accompanying symptoms， levels of inflammatory cytokines ［interleukin-10 （IL-10）， interleukin-5 （IL-5）， tumor necrosis factor-α （TNF-α）， neutrophil， eosinophil］ in induced sputum， pulmonary function parameters ［forced vital capacity （FVC）， forced expiratory volume in one second （FEV1）， FEV1/FVC］， and treatment outcomes were compared between the two groups. Moreover， the frequency of acute asthma attacks during the three-month follow-up was also compared. ResultNo cases dropped out from this study. After treatment， the scores of cough and accompanying symptoms were decreased in both groups （P<0.05） and were lower in observation group than in control group （P<0.05）. After treatment， FVC， FEV1， and FEV1/FVC were raised in both groups and were higher in observation group than in control group （P<0.05）. The increase in the level of IL-10 along with the decrease in levels of IL-5， TNF-α， neutrophil， and eosinophil in induced sputum was found in both groups after treatment （P<0.05）， and observation group had higher level of IL-10 and lower levels of IL-5， TNF-α， neutrophil， and eosinophil than the control group （P<0.05）. The effective rate was 86.44% （51/59） in observation group， which was higher than the 69.49% （41/59） in control group （χ2=4.933， P<0.05）. No serious adverse reaction occurred in either group. The frequency of acute asthma attacks during the three-month follow-up was （1.09±0.18） in observation group， which was lower than the （2.83±049） in the control group （P<0.05）. ConclusionRoutine western medicine combined with Maxing Shigantang and supplemented Guominjian decoction can effectively and safely alleviate the airway inflammatory responses， control the clinical symptoms， improve pulmonary function， and reduce the frequency of acute recurrence in the treatment of CVA children.
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The wind, phlegm, and blood stasis are important pathogenic factors of cough variant asthma in children, and they are also the pathological products in the occurrence and development of this disease. They have typical pathogenic characteristics. The main pathogenesis characteristics of cough caused by wind, phlegm and blood stasis are as follows that external wind attacks the lungs and induces internal wind, phlegm and dampness accumulates in the lungs, and the lungs fail to declare and descend, and blood stasis obstructs the collaterals and stagnation of Qi. The wind, phlegm, and blood stasis have their own pathogenic characteristics, and their cough-causing also have their own pathogenic characteristics and clinical characteristics. Based on the characteristics of wind, phlegm, and blood stasis, the application of medicine based on the differentiation of symptoms and signs can effectively prevent and treat this disease, and provide theoretical basis and treatment ideas for the treatment of cough variant asthma in children with Chinese medicine.
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ObjectiveTo explore the effect and mechanism of Sangmei Zhike granule （SMZK） on airway inflammation in rats with cough variant asthma（CVA）. MethodSix-week-old male SD rats were randomly divided into normal group， model group， and SMZK （2.48 g·kg-1） group. The rats in the model group and the SMZK group received intraperitoneal injection of a mixed solution containing 10% ovalbumin （OVA） and aluminium hydroxide on the 1st and 8th days and aerosol inhalation of 1% OVA solution from the 15th day for CVA model induction. The intervention lasted for two weeks from the 15th day. At the end of animal manipulation， the lung function was detected and inflammatory cells in the peripheral blood were counted. The serum interleukin-4 （IL-4）， interleukin-5 （IL-5）， and interleukin-10 （IL-10） levels were determined. Hematoxylin-eosin （HE） staining was performed on the lungs. Western blot was used to detect the protein expression of nuclear factor kappa-B （NF-κB） and its inhibitor α（IκBα） in lung tissues. ResultCompared with the normal group， the model group showed reduced forced expiratory volume in the first 0.1 second （FEV0.1），FEV0.1/forced vital capacity （FVC），and forced expiratory flow 50% （FEF50%） （P<0.05， P<0.01）， increased white blood cells and eosinophils （P<0.01）， and up-regulated serum IL-4， IL-5， and IL-10 （P<0.01）. As revealed by HE staining， the model group displayed shed epithelial cells of the bronchus， airway stenosis， hyperplasia and expansion of mucous glands， disarrangement of layer structures， disorderly arranged cells， and extensive infiltration of inflammatory cells. The protein expression of NF-κB p65 was higher （P<0.01） and that of IκBα was lower （P<0.01） in the lung tissues of the model group than that in the normal group. Compared with the model group， the SMZK group showed increased FEV0.1，FEV0.1/FVC，and FEF50% （P<0.05）， decreased white blood cells and eosinophils in the peripheral blood （P<0.01）， and declining serum IL-4， IL-5， IL-10 （P<0.01）. HE staining demonstrated mild bronchial mucosal injury and relieved inflammatory cell infiltration， gland hyperplasia， and epithelial degeneration and necrosis in the SMZK group. The protein expression of NF-κB p65 was decreased （P<0.05） and that of IκBα was increased （P<0.05） in lung tissues of the SMZK group than that in the model group. ConclusionSMZK can improve lung function and inhibit airway inflammation in rats with CVA. The underlying mechanism may be related to the regulation of IκBα/NF-κB protein expression in the lungs.
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Objective: To observe and evaluate the clinical efficacy and safety of using pediatric Tuina (Chinese therapeutic massage), Tui-Pushing chest-back manipulation, in treating children with cough variant asthma (CVA).Methods: Seventy-two kids with CVA were divided into two groups using the random number table method, with 36 cases in each group. The control group received the conventional Tuina treatment, and the observation group received additional Tui-Pushing chest-back manipulation. The clinical efficacy and adverse reactions were observed and recorded for the two groups. Results: After three treatment courses, compared with the control group, the observation group showed advantages in the total effective rate, reducing the number and intensity of cough and improving the nature of cough (P<0.05). However, at the one-month follow-up, there were no significant differences between the two groups in these parameters (P>0.05). Regarding the adverse reaction rate, there was no significant between-group difference (P>0.05). Conclusion: It is effective and safe to use pediatric Tuina, Tui-Pushing chest-back manipulation, plus the conventional treatment protocol to treat CVA in children.
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In recent years, the prevalence and medical visits of chronic cough in children are increasing year by year, among which cough variant asthma is one of the main causes of chronic cough in children.The Global Initiative for Asthma points out that cough variant asthma is a disease in which cough is the main or only symptom and is associated with airway hyperresponsiveness.Cough variant asthma, a disease with repeated or persistent cough as the main clinical manifestation, is a subtype of asthma.Due to the lack of typical wheezing symptom, cough variant asthma is easy to be misdiagnosed or missed, leading to lack of standardized treatment.In addition, frequent coughing has a significant impact on the quality of life of children and their family members.In order to improve clinicians′ understanding of cough variant asthma in children, the advances in epidemiology, pathogenesis, diagnosis and treatment of this disease are explained.
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Objective:To observe the clinical efficacy of Erchentang combined with Sanzi Yangqintang in the treatment of cough variant asthma （CVA） in children with phlegm-evil accumulation lung syndrome and its influence on airway inflammation and airway hyperresponsiveness （AHR）. Method:A total of one hundred and sixteen children were randomly divided into observation group and control group 58 cases in each group. Patients in both groups took montelukast sodium chewable tablets orally， 5 mg/time， once daily， at night before bedtime. In observation group， patients took Erchentang and Sanzi Yangqintang modified granules orally. While patients in control group took Erchentang and Sanzi Yangqintang placebo granules orally. Treatment course continued six weeks for two groups. Before and after treatment， the cough symptom scores and phlegm evil accumulating lung syndrome scores were recorded every week. The cough remission time and cough disappearance time were recorded， followed up for 24 weeks to record cough recurrence. Leicester Cough quality of life questionnaire （LCQ） was scored before and after treatment. The ratio of induced sputum eosinophils （EOS） and the levels of interleukin-4 （IL-4）， IL-5， IL-12， IL-13 were measured before and after treatment. The cumulative doses of exhaled nitric oxide （FeNO） and methacholine （PD20） were measued before and after therapy. Safety evaluation was conducted. Result:The scores of cough symptom and phlegm-evil accumulation lung syndrome at different time points were decreased gradually in two groups of children after treatment （<italic>F</italic><sub>control group</sub>=5.277， <italic>F</italic><sub>observation group</sub>=7.636，<italic>P</italic><0.01）. The scores of cough symptom and phlegm-evil accumulation in the lung syndrome of observation group were lower than those in control group （<italic>P</italic><0.01） at the same period. The durations of cough relief and cough disappearance in observation group were shorter than those in control group （<italic>P</italic><0.01）. Within 24 weeks of follow-up， the recurrence rate of children in observation group was 68.97% （40/58）， lower than 84.48% （49/58） in control group （<italic>χ</italic><sup>2</sup>=3.917，<italic>P</italic><0.05）. Children in observation group had fewer relapses than those in control group （<italic>P</italic><0.01）. The total LCQ scores and scores of all dimensions in observation group were higher than those in control group （<italic>P</italic><0.01）. The EOS， IL-4， IL-5 and IL-13 levels in observation group were lower than the data in control group， and IL-12 level was higher than that in control group （<italic>P</italic><0.01）. FeNO of children in observation group was lower than that in control group （<italic>P</italic><0.01）， while PD20 was more than that of control group （<italic>P</italic><0.01）. The total effective rate of clinical curative effect of children in observation group was 96.55% （56/58）， which was higher than 82.76% （48/58） in control group （<italic>χ</italic><sup>2</sup>=5.948，<italic>P</italic><0.05）. Conclusion:Erchentang combined with Sanzi Yangqintang for children with CVA phlegm evil accumulation lung syndrome can further control the symptoms of cough， shorten the course of cough， improve the quality of life， and reduce airway inflammation and AHR， reduce the recurrence rate. The clinical efficacy is better than using montelukast only， and it is safe and has good clinical value.
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OBJECTIVES@#To study the expression levels of microRNA-138 (miR-138) and Runt-related transcription factor 3 (RUNX3) in peripheral blood of children with cough variant asthma (CVA) and their regulatory effects on Th1/Th2 balance.@*METHODS@#Sixty-five children with CVA (CVA group) and 30 healthy children (control group) were enrolled. Peripheral venous blood samples were collected for both groups, and CD4@*RESULTS@#Compared with the control group, the CVA group showed significantly decreased levels of IFN-γ and IL-2 from CD4@*CONCLUSIONS@#MiR-138 regulates Th1/Th2 balance by targeting RUNX3 in children with CVA, providing a new direction for the treatment of CVA.
Subject(s)
Child , Humans , Asthma , Core Binding Factor Alpha 3 Subunit/genetics , Cough , Interleukin-13 , MicroRNAs/genetics , Th1 Cells , Th1-Th2 Balance , Th2 CellsABSTRACT
Montelukast sodium is an effective and well-tolerated anti-asthmatic drug. Long non-coding RNAs (lncRNAs) are involved in the treatment of asthma. Therefore, this study aimed to investigate the effect of montelukast sodium on children with cough-variant asthma (CVA) and the role of lncRNA prostate cancer gene expression marker 1 (PCGEM1) in drug efficacy. The efficacy of montelukast sodium was evaluated by assessing the release of inflammatory factors and pulmonary function in CVA children after a 3-month treatment. An ovalbumin (OVA)-sensitized mouse model was developed to simulate asthmatic conditions. PCGEM1 expression in clinical peripheral blood samples and lung tissues of asthmatic mice was determined. Asthmatic mice experienced nasal inhalation of PCGEM1 overexpression with simultaneous montelukast sodium to investigate the roles of PCGEM1 in asthma treatment. The NF-κB axis after PCGEM1 overexpression was detected to explore the underling mechanisms. Consequently, montelukast sodium contributed to reduced levels of pro-inflammatory factors and improved pulmonary function in CVA children. PCGEM1 was poorly expressed in OVA-sensitized asthmatic mice and highly expressed in CVA children with response to the treatment. PCGEM1 overexpression enhanced the anti-inflammatory effects and promoted effects on pulmonary function of montelukast sodium in CVA children and OVA-sensitized asthmatic mice. Furthermore, PCGEM1 inhibited the activation of the NF-κB axis. This study demonstrated the anti-inflammatory and lung-protective effects of montelukast sodium on CVA, which was strengthened by overexpression of PCGEM1. Findings in this study highlighted a potential anti-asthmatic target of montelukast sodium.
Subject(s)
Quinolines/therapeutic use , Asthma/drug therapy , Anti-Asthmatic Agents/therapeutic use , Protective Agents/therapeutic use , Cough/drug therapy , RNA, Long Noncoding/metabolism , Acetates/therapeutic use , Asthma/blood , Cough/blood , Disease Models, Animal , Mice, Inbred BALB CABSTRACT
OBJECTIVES: To evaluate the quantitative changes and diagnostic performance of volumetric capnography (VCap) parameters in patients with cough variant asthma. METHODS: This cross-sectional study enrolled 31 patients with cough variant asthma and 30 patients with chronic cough without asthma between November 2010 and March 2012. VCap measurements were recorded at baseline, during the five steps of the histamine challenge, and after bronchodilation with salbutamol. They were then compared between the baseline and histamine challenge, and between the two groups. Receiver operating characteristic curve analysis was performed for different VCap measurements. RESULTS: The slope of phase III (dc/dv3) and the ratio of phase III slope to phase II slope (SR23%) decreased from baseline upon challenge with 1.1 mg histamine in cough variant asthma patients but increased in patients with chronic cough without asthma. Additionally, the change upon challenge with 1.1 mg histamine in dc/dv3 from baseline (S6-S1dc/dv3) in cough variant asthma patients had the largest area under the curve (AUC) (0.814, 95% CI: 0.697-0.931; p<0.001). The AUC for change upon challenge with 1.1 mg histamine in SR23% from baseline was 0.755 (95%CI: 0.632-0.878; p<0.001). At a cutoff of 19.8, S6-S1 dc/dv3 had a sensitivity of 74.2% and specificity of 90.0% and at a cutoff of 40.7, S6-S1 SR23% had a sensitivity of 48.4% and specificity of 96.7%. CONCLUSION: Patients with cough variant asthma exhibit distinct VCap responses for dead space parameters upon challenge with histamine in comparison to patients with chronic cough. VCap parameters like phase III slope and phase III/phase II slope ratio could be used to aid the diagnosis of cough variant asthma.
Subject(s)
Humans , Asthma/diagnosis , Asthma/drug therapy , Capnography , Cross-Sectional Studies , ROC Curve , Cough/diagnosisABSTRACT
OBJECTIVES@#Cough variant asthma (CVA) is the main cause of obstinate cough. This study aimed to observe the therapeutic effect of Xiaochuan pill on CVA in a rat model, and to explore the mechanisms.@*METHODS@#The rats were sensitized and challenged with 4% ovaibumin (OA) and 2% Al(OH) to establish the CVA models. They were treated with Xiaochuan pill (at the dose of 0.9, 1.8, 3.6 g/kg) or montelukast sodium once a day for 14 days. After 7 and 14 days of intervention, 5 and 10 rats were randomly selected from each group to collect bronchoalveolar lavage fluid (BALF), trachea, and lungs. The number of white blood cells (WBC) and eosinophils (EOS), and the levels of IL-1β, TNF- α, and IFN-γ in BALF were detected. Histopathological examination of lung tissue was performed to observe the histomorphological changes. The expressions of TLR4, MyD88, NF-κBp65, and p-p65 in lung tissue were detected by Western blotting.@*RESULTS@#The numbers of WBC and EOS in BALF of CVA rats were significantly decreased by Xiaochuan pill (<0.05 or <0.01). The hyperplasia of tracheal, bronchial mucosa and the infiltration of inflammatory cells in lung were alleviated obviously. After 14 d of intervention, high dose of Xiaochuan pill significantly increased the level of IFN- γ (<0.01), reduced the levels of IL-1β (<0.05) and TNF-α (<0.05), and decreased the expressions of TLR4, MyD88, p65, and p-p65 (<0.05 or <0.01).@*CONCLUSIONS@#Xiaochuan pill exerts the significant therapeutic effect on obstinate cough in rats. The mechanism of action may be related to the regulation of TLR4-MyD88-NF-κBp65 signaling pathway as well as the inflammation and immune response.
Subject(s)
Animals , Rats , Cough , Myeloid Differentiation Factor 88 , NF-kappa B , Signal Transduction , Toll-Like Receptor 4 , Tumor Necrosis Factor-alphaABSTRACT
Cough-variant asthma is the most common cause of chronic cough. It may progress to classic asthma and therefore requires adequate treatment intervention. We experienced two cases of cough-variant asthma that was refractory to standard drug therapy but improved after additional administration of kumibinroto. In Case 1, the patient was a 46-year-old woman receiving hormone therapy after breast cancer surgery. She developed cough-variant asthma 5 years ago, and though she has received drug therapy, the symptoms aggravated. Cough continued to appear at night without improvement of asthma symptoms. However, the symptoms improved with subsequent administration of kumibinroto. In Case 2, the patient was a 47-year-old woman who developed cough-variant asthma after childbirth, which repeatedly worsened and improved. The cough-variant asthma aggravated after change of workplace and did not improve with drug therapy. However, asthma symptoms improved with oral administration of kumibinroto and hangekobokuto, and subsequent administration of kumibinroto alone. In both patients, the asthma was seasonal. These cases suggest that kumibinroto administration may contribute to the improvement of cough-variant asthma.
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Objective:To explore the effect of modified Xiongxiesan on the proliferation of airway smooth muscle tissues and the expressions of matrix metalloproteinase-9（MMP-9）， tissue inhibitor of metalloproteinase-1 （TIMP-1） in cough variant asthma （CVA） model rats. Method:A total 48 male SD rats were randomly divided into the normal control group （8 rats） and model group （40 rats）. CVA model of rats were established through the intraperitoneal administration with 2 mg ovalbumin （OVA） and 100 mg Al（OH）3， and then aerosol inhalation of 1％ OVA 15 days later. The same volume of sterile saline was given to the normal group through the intraperitoneal injection. Then 40 rats in the modeling group were randomly divided into model group， modified Xiongxiesan group （TCM group， 6 g·kg-1·d-1）， montelukast group （0.4 mg·kg-1·d-1）， chemokine receptor1/2 （CXCR1/2） inhibitor group （G31P group injected subcutaneously via the neck with a dose of 0.5 mg·kg-1 every other day）， and CXCR1/2 inhibitor and modified Xiongxiesan group （G31P+TCM group）， with 8 rats in each group. The control group and the model group were orally given distilled water 10 mL·kg-1·d-1. Then the rats were sacrificed， and lung samples were collected. Histological changes were examined by hematoxylin-eosin（HE）. Basement membrane perimeter （PBM），wall area of bronchial tube （WAt），wall area of bronchial smooth muscle （WAm） and the number of smooth muscle cells （N） were measured using image pro-plus software and standardized based on PBM. The expressions of PCNA， MMP9 and TIMP1 were detected by immunohistochemistry. Result:Compared with the control group， there were a large number of inflammatory cells infiltration and moderate hyperplasia of smooth muscle area in the model group， which however were alleviated in other groups. The expressions of PCNA and MMP-9，TIMP1 were higher in the model group，which were reduced in other groups significantly. Conclusion:Modified Xiongxiesan can reduce the thickness of airway smooth muscle tissue in the CVA model rats， which may be correlated with the inhibition of the CXCR1/2 pathway， thereby reducing the proliferative activity of smooth muscle tissue and inhibiting the expression of related matrix metalloproteinases.
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Objective:To explore the clinical effect of the application of modified Dingchuantang in the treatment of children with cough variant asthma (CVA). Method:Totally 142 children with CVA admitted by our hospital from June 2016 to June 2018 were selected and randomly divided into observation group (71 cases) and control group (71 cases) according to the random number table method. Patients in control group were treated with inhaled budesonide powder inhalation+oral montelukast sodium chewable tablets, while patients in observation group were treated with modified Dingchuantang. All children were treated for 8 weeks. The two groups' clinical effects, changes of levels of airway function parameters[percentage of forced expiratory volume in the first second (FEV1%) and expiratory flow rate of forced expiratory in 50% and 75% vital capacity (FEF50, FEF75)], sputum induction indexes[nerve growth factor (NGF), percentage of eosinophile (EOS), substance P (SP), inflammatory factors[hypersensitivity C reactive protein (hs-CRP), interleukin (IL)-17 and IL-23], and the occurrence of adverse reactions were compared. Result:The total effective rate of observation group was 93.0% (66/71), which was significantly higher than that of control group[81.7% (58/71), PP1%, FEF50 and FEF75 of two groups were increased significantly after treatment (PPPPConclusion:Modified Dingchuantang can effectively relieve cough and other symptoms in children with CVA, reduce airway inflammation, down-regulate the expressions of inflammatory factors in blood and improve airway function, with a definite curative effect, safety and reliability.
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Airway allergic diseases are characterized by chronic inflammatory responses in airways. Leukotriene antagonists have been recently recommended as the first-line medication for respiratory allergic diseases, along with nasal glucocorticoids and antihistamines, due to their prominent efficacy and safety in allergic inflammation. This review summarized the clinical application of Montelukast, the representative drug of leukotriene antagonists, to treat allergic rhinitis, bronchial asthma, cough variant asthma, eosinophilia bronchitis and other diseases, in order to further explore the advantages and prospect of Montelukast in the application of airway allergic inflammation.
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OBJECTIVE： To observe the improvement effects of ethanol extract of the root of Anacyclus pyrethrum （EEAP） on cough variant asthma （CVA） model rats. METHODS： Male SD rats were randomly divided into control group， model group， prednisone acetate group （positive control， 250 mg/kg）， EEAP low-dose， medium-dose and high-dose groups （160， 320， 640 mg/kg， by the weight of EEAP）， with 10 rats in each group. Except for control group， other group was given 1 mg/mL ovalbumin （OVA）-Freunds adjuvant complete solution subcutaneously， and aerosol inhalation of 1％ OVA-normal saline （once a day， 20 min each time， 15 d） to induce CVA. After last inhalation， control group and model group were given constant volume of water intragastrically； administration groups were given relevant medicine intragastrically， once a day， for consecutive 30 d. General symptoms of rats were observed in each group during experiment. The airway sensitivity of rats in each group was investigated by capsaicin cough provocation test， and the cough times were recorded. The contents of SOD and TNF-α in serum were determined by ELISA. The morphological characteristics of lung tissue were observed by HE staining. The number of eosinophils and leucocytes in alveolar lavage fluid was recorded by Rayleigh staining. RESULTS： Rats in the control group breathed smoothly， responded quickly and had glossy coat. The rest of the groups showed restlessness， cough， shortness of breath and other symptoms after antigen stimulation. Compared with control group， the congestion and edema of bronchial wall and infiltration of inflammatory cells in the lung tissue were observed in model group； the cough times increased significantly； serum content of TNF-α， eosinophil and leukocyte counts in alveolar lavage fluid increased significantly， and serum content of SOD decreased significantly （P＜0.05）. After treatment， above symptoms of rats were alleviated to varying degrees in administration groups， and the cough times were significantly reduced； the serum contents of TNF-α as well as eosinophil and leukocyte counts in alveolar lavage fluid were significantly reduced； the serum contents of SOD was increased significantly， but the cough times of EEAP groups were significantly higher than that of prednisone acetate group （P＜0.05）. CONCLUSIONS： EEAP may show the anti-inflammatory and antiasthmatic effects by inhibiting the secretion of TNF-α， increasing the content of SOD and inhibiting inflammatory cell infiltration.
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Objective To explore the value of simple exercise provocation test ( 6?minute running test) combined with small airway function test in early diagnosis of cough variant asthma ( CVA ) in children.Methods Ninety?four children with chronic cough from September 2017 to September 2018 in the pediatric clinic of the Affiliated Hospital of Xuzhou Medical University were selected for routine pulmonary ventilation function examination,simple exercise stimulation test and questionnaire survey.The differences of pulmonary function,clinical manifestations and allergens between positive and negative children with simple exercise stimulation test were compared and analyzed.Results The forced expiratory volume in one second (FEV1) of 94 children with chronic cough were all more than 70% by routine pulmonary function test,and the exercise provocation test was successfully completed.Among them,32 (34.04%) were positive in simple exercise provocation test.Among the positive patients,30 cases ( 93.75%) were diagnosed as CVA after further examination,clinical treatment and follow?up.In CVA group, FEV1 ( 81.52 ± 14.22)%,forced vital capacity (FVC) (89.00 ± 14.31)%, peak expiratory flow ( PEF) ( 65.05 ± 15.10)%, one?second rate (FEV1／FVC) (92.18±13.59)%,and instantaneous flow at 50% forced expiratory flow were observed after exercise.The vital capacity ( FEF50 ) ( 57.57 ± 22.49 )%, forced expiratory flow at 75% vital capacity (FEF75) (41.15±18.28)%,maximum expiratory flow ( MMEF75／25) (53.14±22.53)% were significantly lower than those before exercise ((94.07±9.69)%,( 92.30± 13.60)%,(80.73± 17.85)%,(101.07± 13.79)%,(66.71±19.29)%,(51.32±18.38)%,(63.75±19.43)%),(t values were 8.592 ,2.617 , 10.246 ,5.428,3.590 ,3.646 ,3.687 ,respectively,all P＜0.05)) In routine examination of pulmonary ventilation function,FEF50 (66.71 ± 19.29)% and FEF75 ( 51.32 ± 18.38)% in the positive group were significantly lower than those in the negative group (( 79.75 ± 21.94)%、( 69.08 ± 29.28)%),( t values were －2.841,－3.123,all P＜0.01).The proportion of night cough,morning cough and severe dry cough in positive group was significantly higher than that in negative group,while the proportion of day cough and wet cough was significantly lower than that in negative group ( P＜0.01).The proportion of eczema history in positive group was significantly higher than that in negative group ( P＜0.01).Conclusion Patients with CVA have high airway responsiveness and small airway dysfunction.Combination of simple motor stimulation test and small airway function test has important clinical value in the early diagnosis of CVA.
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Objective To investigate the mechanism of action of Huanbei Zhike Recipe on the cough variant asthma model (CVA) of guinea pigs by 1H-NMR metabolomics methods. Methods The CVA model was induced by ip 4% OVA and ip 2% Al(OH)3 in guinea pigs abdominal cavity, and the effects of Huanbei Zhike Recipe (5, 10, and 20 g/kg) on the cough induced by capsaicine was investigated. After the administration, the lung of right middle lobe in guinea pigs were taken out and determinated by 1H-NMR, and multivariate statistical analysis was used to investigate the intervention effects of Huanbei Zhike Recipe on CVA. Results The cough latency of guinea pigs can be significantly prolonged and the frequency of cough were reduced (P < 0.01), and the inflammatory factors in lung lavage fluid were obviously reduced (P < 0.05). Compared with the blank group, the levels of leucine, isoleucine, valine, alanine, α-glucose, acetic acid, glutamic acid, methionine, pyruvic acid, succinic acid, 3-hydroxybutyrate (3-HB), GSSG, creatine, ethanolamine, cholic acid, glycine, glycerophosphoryl choline (GPC), glutamine, betaine, phosphorylethanolamine (PE), β-glucose, and arginine were increased, while the levels of lactate and methyl-phosphate were decreased. These 24 potential metabolites could be reversely regulated in different degree after treatment with Huanbei Zhike Recipe. Conclusion Huanbei Zhike Recipe could prevent CVA diseases likely through the regulation of energy metabolism and amino acid metabolism.
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Objective@#To evaluate the efficacy and safety of Yupingfeng powder in conjunction treatment of western medicine on cough variant asthma (CVA).@*Methods@#We searched CNKI, Wanfang database, VIP database and PubMed through computer from the database building to October 31st 2017. The randomized controlled trails (RCT) with the comparison in the treatment of CVA with Yupingfeng powder and western medicinal were identified and included. The quality of RCTs was assessed by Jadad scores, and meta-analyses were performed by Review Manager 5.3 software.@*Results@#Totally 15 RCTs involving 1 318 patients were included into the study, which all belonged to the low methodological quality. The meta-analysis results showed that compared with the western medicine alone, the treatment in conjunction of Yupingfeng powder can significantly improve the clinical effective rate [OR=3.45, 95% CI (2.38-5.02), P<0.01], reduce the recurrence rate [OR=0.25, 95% CI (0.16-0.38), P<0.01]. There were no statistical significant differences with untoward effect between above two treatment groups [OR=0.70, 95% CI (0.34-1.46), P=0.35].@*Conclusions@#The Yupingfeng powder combined with the routine therapy may improve the clinical effective rate, and reduce the recurrence rate for CVA patients. However, we need more high-quality RCTs to comfirm such results.
ABSTRACT
ObjectiveFew studies are reported on the sublingual immunotherapy with dermatophagoides farinae drops (DFD) for mite-allergic cough variant asthma (CVA) in children. This study aimed to investigate the clinical effects of DFD sublingual immunotherapy on mite-allergic CVA in children.MethodsWe retrospectively analyzed the clinical data on 225 children with mite-allergic CVA treated in Wuhan Children′s Hospital from January 2016 to January 2017. The patients were divided into a control (n=123) and an experimental group (n=102) to receive symptomatic treatment and symptomatic treatment combined with DFD sublingual immunotherapy, respectively, both for 10 months. We recorded the relevant indicators, including the symptom scores, lung function parameters, levels of dust mite IgE and inflammatory factors (IL-4, TGF-β and INF-γ), and related risk factors, and compared the data obtained between the two groups of patients before and after treatment.ResultsThere were no statistically significant differences between the two groups of patients in the baseline daily and nocturnal cough symptom scores, lung function parameters, or levels of serum IgE, IL-4, TGF-β and INF-γ (P>0.05). After treatment, the children in the experimental group showed markedly lower daily and nocturnal cough symptom scores than the control (0.87±0.06 and 0.91±0.11 vs 2.54±0.32 and 2.38±0.42, P<0.05), better pulmonary function parameters (FEV1/FVC: \[1.98±0.56\]% / \[79.67±9.05\]% vs \[1.65±0.37\] / \[75.87±11.56\]%, P<0.05), and a higher effectiveness rate (73.53% vs 54.47%, P<0.05). The single- and multi-factor analyses showed that age, disease course and treatment methods were independent risk factors influencing the therapeutic effect on mite-allergic CVA in children (P<0.05).ConclusionSublingual immunotherapy with DFD can effectively improve the clinical symptoms and lung function in children with mite-allergic CVA, which may be associated with the decreased levels of serum IgE, IL-4, TGF-β and INF-γ. Age, disease course and treatment methods are independent risk factors influencing the therapeutic effect.