Objective  To explore the clinical efficacy and the best course of treatment of cough variant asthma (CVA) in children.

Methods  The clinical data of children with CVA who were treated in Children 's Hospital Affiliated to Shandong University from October 2019 to June 2022 were retrospectively analyzed. According to different treatment regimens, they were divided into two groups: inhaled corticosteroids combined with long-acting β2 receptor agonist (ICS+LABA) or ICS combined with leukotriene receptor antagonist (ICS+LTRA). The disease control and cough symptom recurrence rate were compared between the two groups.

Results  A total of 187 patients were included, with 50 in ICS+LABA group and 137 in ICS+LTRA group. There was no significant difference in CVA control rate (92.0% vs. 89.8%) and cough recurrence rate (4.0% vs. 11.7%) between the two regimens (P>0.05). Compared with ICS+LABA, ICS+LTRA regimen had the most significant effect at the 16th week of treatment.

Conclusion  The efficacy of ICS+LABA and ICS+LTRA in the treatment of CVA in children is equivalent. It can be selected according to the age of the children and the wishes of the patients. In order to achieve better clinical control,  a minimum of 16 weeks of medication is recommended.

1.中华医学会呼吸病学分会哮喘学组. 咳嗽的诊断与治疗指南(2021)[J]. 中华结核和呼吸杂志, 2022, 45(1): 13-46. [The Chinese Medical Association, Respiratory Branch, Asthma Group. Chinese national guideline on diagnosis and management of cough(2021)[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2022, 45(1): 13-46.] DOI: 10.3760/cma.j.cn112147-20211101-00759.

2.Gao J, Wu HG, Wu F. Small airways dysfunction and bronchial hyper-responsiveness in cough variant asthma[J]. Int J Gen Med, 2020, 13: 1427-1434. DOI: 10.2147/ijgm.S286144.

3.Gao J, Wu F, Wu S, et al. Inflammatory subtypes in classic asthma and cough variant asthma[J]. J Inflamm Res, 2020, 13: 1167-1173. DOI: 10.2147/jir.S269795.

4.Lai K, Zhan W, Wu F, et al. Clinical and inflammatory characteristics of the Chinese apac cough variant asthma cohort[J]. Front Med (Lausanne), 2021, 8: 807385. DOI: 10.3389/fmed.2021.807385.

5.中国儿童慢性咳嗽病因构成比研究协作组. 中国儿童慢性咳嗽病因构成比多中心研究[J]. 中华儿科杂志, 2012, 50(2): 83-92. [Clinical Research Coordination Group of The Causes Constituents Ratio of Chronic Cough in Chinese Children. Prospective multicenter clinical study on the causes constituents ratio of chronic cough in Chinese children[J]. Chinese Journal of Pediatrics, 2012, 50(2): 83-92.] DOI: 10.3760/cma.j.issn.0578-1310.2012.02.002.

6.Yu X, Kong L, Jiang W, et al. Etiologies associated with chronic cough and its clinical characteristics in school-age children[J]. J Thorac Dis, 2019, 11(7): 3093-3102. DOI: 10.21037/jtd.2019.07.36.

7.Chen X, Peng WS, Wang L. Etiology analysis of nonspecific chronic cough in children of 5 years and younger[J]. Medicine (Baltimore), 2019, 98(3): e13910. DOI: 10.1097/md.0000000000013910.

8.Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines[J]. Chest, 2006, 129(1 Suppl): 260s-283s. DOI: 10.1378/chest.129.1_suppl.260S.

9.中华医学会儿科学分会临床药理学组, 国家儿童健康与疾病临床医学研究中心, 中华医学会儿科学分会呼吸学组, 等. 中国儿童咳嗽诊断与治疗临床实践指南(2021版)[J]. 中华儿科杂志, 2021, 59(9): 720-729. [The Subspecialty Group of Pharmacology, the Society of Pediatrics, Chinese Medical Association, National Clinical Research Center for Child Health and Disorders, the Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association, et al. Clinical practice guidelines for the diagnosis and management of children with cough in China (version 2021)[J]. Chinese Journal of Pediatrics, 2021, 59(9): 720-729.] DOI: 10.3760/cma.j.cn112140-20210513-00423.

10.Global initiative for asthma. global strategy for asthma management and prevention[EB/OL]. (2022) [2023-02-12]. www.ginasthma.org.

11.中华医学会呼吸病学分会哮喘学组. 支气管哮喘防治指南(2020年版)[J]. 中华结核和呼吸杂志, 2020, 43(12): 1023-1048. [Asthma Group of Chinese Throacic Society. Guidelines for bronchial asthma prevent and management (2020 edition)[J]. Chinese Journal of Tuberculosis and Respiratory, 2020. 43(12): 1023-1048.] DOI: 10.3760/cma.j.cn112147-20200618-00721.

12.中华医学会儿科学分会呼吸学组, 《中华儿科杂志》编辑委员会. 儿童支气管哮喘诊断与防治指南(2016年版)[J]. 中华儿科杂志,2016,54(3): 167-181. [Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association, Editorial Board, Chinese Journal of Pediatrics. Guidelines for diagnosis and treatment of bronchial asthma in children (2016 edition)[J]. Chinese Journal of Pediatrics, 2016. 54(3): 167-181.] DOI: 10.3760/cma.j.issn.0578-1310.2016.03.003.

13.中华医学会儿科学分会呼吸学组肺功能协作组, 《中华实用儿科临床杂志》编辑委员会. 儿童肺功能系列指南(二): 肺容积和通气功能[J]. 中华实用儿科临床杂志, 2016, 31(10): 744-750. [The Respiratory Group and Pulmonary Function Collaborative Group of The Pediatric Branch of The Chinese Medical Association, The Editorial Committee of The Chinese Journal of Practical Pediatrics. A series of guidelines for children's lung function (II): lung volume and ventilation function[J]. Chinese Journal of Applied Clinical Pediatrics, 2016, 31(10): 744-750.] DOI: 10.3760/cma.j.issn.2095-428X.2016.10.006.

14.中华医学会儿科学分会呼吸学组肺功能协作组, 《中华实用儿科临床杂志》编辑委员会. 儿童肺功能系列指南(三): 脉冲振荡[J]. 中华实用儿科临床杂志, 2016, 31(11): 821-825. [Editorial Committee of The Chinese Journal of Practical Pediatrics, Collaborative Group on Pulmonary Function, Respiratory Science, Chinese Medical Pediatric Society Guidelines for Pediatric. Lung function series (III): pulse oscillation[J]. Chinese Journal of Applied Clinical Pediatrics, 2016. 31(11): 821-825.] DOI: 10.3760/cma.j.issn.2095-428X.2016.11.006.

15.American Thoracic Society, European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005[J]. Am J Respir Crit Care Med, 2005, 171(8): 912-930. DOI: 10.1164/rccm.200406-710ST.

16.Dweik RA, Boggs PB, Erzurum SC, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications[J]. Am J Respir Crit Care Med, 2011, 184(5): 602-615. DOI: 10.1164/rccm.9120-11ST.

17.Khatri SB, Iaccarino JM, Barochia A, et al. Use of fractional exhaled nitric oxide to guide the treatment of asthma: an official American thoracic society clinical practice guideline[J]. Am J Respir Crit Care Med, 2021, 204(10): e97-e109. DOI: 10.1164/rccm.202109-2093ST.

18.Côté A, Russell RJ, Boulet LP, et al. Managing chronic cough due to asthma and naeb in adults and adolescents: chest guideline and expert panel report[J]. Chest, 2020, 158(1): 68-96. DOI: 10.1016/j.chest.2019.12.021.

19.Lai K, Shen H, Zhou X, et al. Clinical practice guidelines for diagnosis and management of cough-chinese thoracic society (CTS) asthma consortium[J]. J Thorac Dis, 2018, 10(11): 6314-6351. DOI: 10.21037/jtd.2018.09.153.

20.娄南南, 郭晶, 马香, 等. 咳嗽变异性哮喘病理机制及治疗的研究进展[J]. 结核与肺部疾病杂志, 2022, 3(6): 521-525. [Lou NN, Guo J, Ma X, et al. Research progress in pathological mechanism and treatment of cough variant asthma[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(6): 521-525.] DOI: 10.19983/j.issn.2096-8493.20220135.

21.陈颖, 黄俊文, 杨淑銮, 等. 咳嗽变异性哮喘与嗜酸粒细胞性支气管炎表型与疗程研究进展[J]. 实用医学杂志, 2022, 38(15): 1851-1855. [Chen Y, Huang JW, Yang SL, et al. Study of the phenotype and course of treatment of cough variant asthma and eosinophil bronchitis[J]. The Journal of Practical Medicine, 2022, 38(15): 1851-1855.] DOI: 10.3969/j.issn.1006-5725.2022.15.001.

22.吴奎, 王彦, 陈章,等. 糖皮质激素吸入对咳嗽变异性哮喘患者呼出气NO水平的影响[J]. 重庆医学, 2015, 44(8): 1041-1043. [Wu K, Wang Y, Chen Z, et al. Effects of inhaled corticoids on the fractional exhaled NO levels in cough variant asthma patients[J]. Chongqing Medicine, 2015, 44(8): 1041-1043.] DOI: 10.3969/j.issn.1671-8348.2015.08.010.

23.Wang XP, Yang LD, Zhou JF. Montelukast and budesonide combination for children with chronic cough-variant asthma[J]. Medicine (Baltimore), 2018, 97(30): e11557. DOI: 10.1097/md.0000000000011557.

24.Lin J, Wang Z, Qiu C, et al. A multicenter, prospective, observational study on montelukast monotherapy or montelukast-based combinations treating cough variant asthma[J]. J Thorac Dis, 2020, 12(11): 6573-6585. DOI: 10.21037/jtd-20-1989.

25.唐晓林, 赵紫平. 布地奈德福莫特罗粉吸入剂治疗咳嗽变异性哮喘的临床疗效及其安全性[J]. 临床合理用药杂志, 2020, 13(33): 57-59. [Tang XL, Zhao ZP. Clinical efficacy and safety of budesonide formoterol powder inhalation in the treatment of cough variant asthma[J]. Chinese Journal of Clinical Rational Drug Use, 2020, 13(33): 57-59.] DOI: 10.15887/j.cnki.13-1389/r.2020.33.020.

26.高厚桂. 沙美特罗替卡松气雾剂辅助治疗咳嗽变异性哮喘患者的临床效果[J]. 现代医用影像学, 2020, 29(6): 1174-1177. [Gao HG . Clinical effect of salmeterol and fluticasone aerosol on cough variant asthma[J]. Modern Medical Imageology, 2020, 29(6): 1174-1177.] https://doc.taixueshu.com/journal/20200351xdyyyxx.html.

27.Sun W, Liu HY. Montelukast and budesonide for childhood cough variant asthma[J]. J Coll Physicians Surg Pak, 2019, 29(4): 345-348. DOI: 10.29271/jcpsp.2019.04.345.

28.Chen L, Huang M, Xie N. The effect of montelukast sodium plus budesonide on the clinical efficacy, inflammation, and pulmonary function in children with cough variant asthma[J]. Am J Transl Res, 2021, 13(6): 6807-6816. https://pubmed.ncbi.nlm.nih.gov/34306431/.

29.Liu M, Liu K, Zhu N, et al. Inflammatory mediators in induced sputum and airway hyperresponsiveness in cough variant asthma during long-term inhaled corticosteroid treatment[J]. Mediators Inflamm, 2012, 2012: 403868. DOI: 10.1155/2012/403868.

30.Yi F, Jiang Z, Li H, et al. Small airway dysfunction in cough variant asthma: prevalence, clinical, and pathophysiological features[J]. Front Physiol, 2021, 12: 761622. DOI: 10.3389/fphys.2021.761622.