Abstract
BackgroundDifferent conditions make the proximal airways susceptible to tussigenic stimuli in the chronic cough (CC) syndrome. Leukotrienes can be implicated in the inflammatory mechanism at play in it. Montelukast is a selective cysteinyl-leukotriene receptor antagonist with proven effectiveness in patients with asthma. The aim of our real-life pilot study was to use montelukast to relieve cough symptoms in patients with CC allegedly due to the two frequent causes other than asthma – upper airway cough syndrome and gastroesophageal reflux (GER).Methods14 consecutive patients with CC were evaluated before and after 2 weeks of treatment with montelukast 10 mg daily. Cough was assessed by validated cough questionnaire. Questionnaires regarding the presence of gastroesophageal reflux were also completed. Cough reflex sensitivity to incremental doubling concentrations of citric acid and capsaicin was measured. Lung function, airway hyperresponsiveness and exhaled breath temperature (EBT), a non-invasive marker of lower airway inflammation, were evaluated to exclude asthma as an underlying cause. Thorough upper-airway examination was also conducted. Cell counts, eosinophil cationic protein (ECP), lactoferrin, myeloperoxidase (MPO) were determined in blood to assess systemic inflammation.ResultsDiscomfort due to cough was significantly reduced after treatment (P < 0.001). Cough threshold for capsaicin increased significantly (P = 0.001) but not for citric acid. The values of lactoferrin and ECP were significantly reduced, but those of MPO rose. EBT and pulmonary function were not significantly affected by the treatment.ConclusionPatients with CC due to upper airway cough syndrome or gastroesophageal reflux (GER) but not asthma reported significant relief of their symptoms after two weeks of treatment with montelukast. ECP, lactoferrin, MPO altered significantly, highlighting their role in the pathological mechanisms in CC. Clinical trial ID at Clinicaltrials.gov is NCT01754220.
Highlights
Different conditions make the proximal airways susceptible to tussigenic stimuli in the chronic cough (CC) syndrome
The afferent part of the cough reflex consists of mainly two types of receptors: predominant rapidly adapting receptors (RARs) that respond primarily to mechanical and acidic stimuli and non-myelinated C-fibers that characteristically respond to chemical and inflammatory stimuli such as histamine, prostaglandins, substance P and capsaicin [3,4]
The effectiveness of montelukast and other cysteinyl - leukotriene receptor antagonist (CysLTRA) has not been investigated in patients with other most frequent CC triggers
Summary
Different conditions make the proximal airways susceptible to tussigenic stimuli in the chronic cough (CC) syndrome. The afferent part of the cough reflex consists of mainly two types of receptors: predominant rapidly adapting receptors (RARs) that respond primarily to mechanical and acidic stimuli (stretch, hypotonic and hypertonic saline, and citric acid) and non-myelinated C-fibers that characteristically respond to chemical and inflammatory stimuli such as histamine, prostaglandins, substance P and capsaicin [3,4]. Capsaicin is known to induce cough in a reproducible and dose-dependent way and acts mainly via transient receptor potential vanilloid receptors [6]. Both types of receptors seem to be at play in subjects with CC, their relative involvement shaping the individual pattern of the condition
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