Effect of leukotriene receptor antagonist on airway mucus hypersecretion in patients with acute exacerbation of bronchiectasis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 NIE Xiaohong , XU Zhiqiang , ZHANG Yi , LAI Xiaorong

Department of Respiratory Medicine, The 416 Hospital of Nuclear Industry, Chengdu, Sichuan 610051, P.R.China;

Corresponding author：

NIE Xiaohong, Email: xhnie1226@sina.com

Keywords：

Leukotriene receptor antagonist; Bronchiectasis; Montelukast; Neutrophil elastase; Mucus hypersecretion; Airway resistance

DOI：

10.7507/1671-6205.201702005

Video：

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Objective To explore the effect of leukotriene receptor antagonist montelukast on physicochemical property of sputum and airway mucus hypersecretion in patients with acute exacerbation of bronchiectasis. Methods Eighty-four inpatients with acute exacerbation of bronchiectasis were randomly divided into a control group and an experiment group, with 42 cases in each group. The control group received conventional therapy and the experiment group took orally montelukast 10 mg before sleep every day based on conventional therapy for two weeks. At admission and 15 days after admission, the amount in 24 hours, dry/wet weight ratio and viscosity of sputum were observed while the levels of neutrophil elastase (NE) and mucin MUC5ac in sputum were determined by ELISA. The pulmonary ventilation function, airway resistance and blood gas analysis were also measured. Results The sputum amount in 24 hours, dry/wet weight ratio and viscosity of sputum, NE and MUC5ac of sputum, pulmonary ventilation function, blood gas analysis and airway resistance were declined or improved remarkably after treatment compared with before treatment in two groups (P<0.05). Meanwhile, the sputum amount in 24 hours [(5.62±1.83) g vs. (7.53±2.32) g], NE [(3.85±0.97) μg/ml vs. (4.54±1.03) μg/ml], MUC5ac [(0.65±0.21) μg/ml vs. (0.82± 0.29) μg/ml] and the airway resistance [(119.16±11.76)% vs. (128.37±12.08)%] were declined remarkably in the experiment group compare with the control group after treatment (all P<0.05). The viscosity of sputum between the two groups after treatment showed no significant difference. Conclusion In patients with acute exacerbation of bronchiectasis, montelukast can reduce amount of sputum and airway resistance, reduce expression of mucin MUC5ac through down-regulation of NE, thus inhibit airway mucus hypersecretion.

Citation： NIE Xiaohong, XU Zhiqiang, ZHANG Yi, LAI Xiaorong. Effect of leukotriene receptor antagonist on airway mucus hypersecretion in patients with acute exacerbation of bronchiectasis. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(4): 375-378. doi: 10.7507/1671-6205.201702005 Copy

1.	慢性气道炎症性疾病气道黏液高分泌管理中国专家共识编写组. 慢性气道炎症性疾病气道黏液高分泌管理中国专家共识. 中华结核和呼吸杂志, 2015, 38(10): 723-729.
2.	成人支气管扩张症诊治专家共识编写组. 成人支气管扩张症诊治专家共识. 中华结核和呼吸杂志, 2012, 35(7): 485-492.
3.	万志辉, 范慧, 胡克, 等. 长期吸入沙美特罗/氟替卡松联合小剂量红霉素口服治疗支气管扩张症的疗效观察. 中国呼吸与危重监护杂志, 2012, 11(4): 371-374.
4.	Haworth CS, Bilton D, Elborn JS. Long-term macrolide maintenance therapy in non-CF bronchiectasis: evidence and questions. Respir Med, 2014, 108(10): 1397-1408.
5.	钟慧, 洪建国. 半胱氨酰白三烯受体拮抗剂孟鲁司特的研究进展. 中华哮喘杂志(电子版), 2011, 5(5): 362-366.
6.	钟贞, 邓玥, 张婷. 慢性气道炎症黏液高分泌的治疗药物研究进展. 重庆医学, 2014,43(13):1644-1646.
7.	Rvan A, Smith A, Moore P, et al. Expression and characterization of a novel recombinant version of the secreted human mucin MUC5AC in airway cell lines. Biochemistry, 2015, 54(4): 1089-1099.
8.	Moulton BC, Barker AF. Pathogenesis of bronchiectasis. Clin Chest Med, 2012, 33(2): 211-217.
9.	Main E, Grillo L, Rand S.Airway clearance strategies in cystic fibrosis and non-cystic fibrosis bronchiectasis. Semin Respir Crit Care Med.2015,36(2): 251-266.
10.	李晓云, 刘双. 支气管扩张病因的研究进展. 心肺血管病杂志, 2014, 33(1): 124-126.
11.	倪圣, 丁建中. 气道黏液高分泌机制研究进展. 长江大学学报(自科版), 2013, 10(9): 97-101.
12.	Gehrig S, Duerr J, Weitnauer M, et al. Lack of neutrophil elastase reduces inflammation, mucus hypersecretion, and emphysema, but notmucus obstruction, in mice with cystic fibrosis-like lung disease. Am J Respir Crit Care Med, 2014, 189(9): 1082-1092.
13.	吴其标, 曹世宏. 中性粒细胞弹性蛋白酶在支气管扩张症发病中的作用及治疗对策. 国外医学内科学分册, 2004, 31(12): 519-521.
14.	陶和平, 涂小金, 李顺文, 等. 黏液高分泌对慢性阻塞性肺疾病转归的预测价值. 中国现代医生, 2015, 53(33): 32-34, 38.
15.	严能兵, 罗鸿. 白三烯的研究进展与临床意义. 国际检验医学杂志, 2014, 35(6): 721-723.
16.	Coffey MJ, Torretti B, Mancuso P. Adipokines and cysteinyl leukotrienes in the pathogenesis of asthma. J Allergy(Cairo), 2015, 2015(94): 1-9.
17.	周敏, 陈辉龙, 程胜, 等. 孟鲁司特对哮喘小鼠肺组织黏蛋白 MUC5ac 表达的影响. 医药导报, 2013, 32 (1): 5-8.
18.	邓俊, 杨艳, 梁宇佳, 等. 孟鲁司特对哮喘大鼠气道炎症的调控作用及其机制. 山东医药, 2016, 56 (24): 34-36.
19.	Tenero L, Piazza M, Sandri M, et al. Effect of montelukast on markers of airway remodeling in children with asthma. Allergy Asthma Proc, 2016, 37(5): 77-83.
20.	陈凡, 焦琳, 吴莎, 等. 孟鲁司特联合抗生素治疗支气管扩张症的临床观察. 临床肺科杂志, 2015, 20(9): 1703-1706.

1. 慢性气道炎症性疾病气道黏液高分泌管理中国专家共识编写组. 慢性气道炎症性疾病气道黏液高分泌管理中国专家共识. 中华结核和呼吸杂志, 2015, 38(10): 723-729.
2. 成人支气管扩张症诊治专家共识编写组. 成人支气管扩张症诊治专家共识. 中华结核和呼吸杂志, 2012, 35(7): 485-492.
3. 万志辉, 范慧, 胡克, 等. 长期吸入沙美特罗/氟替卡松联合小剂量红霉素口服治疗支气管扩张症的疗效观察. 中国呼吸与危重监护杂志, 2012, 11(4): 371-374.
4. Haworth CS, Bilton D, Elborn JS. Long-term macrolide maintenance therapy in non-CF bronchiectasis: evidence and questions. Respir Med, 2014, 108(10): 1397-1408.
5. 钟慧, 洪建国. 半胱氨酰白三烯受体拮抗剂孟鲁司特的研究进展. 中华哮喘杂志(电子版), 2011, 5(5): 362-366.
6. 钟贞, 邓玥, 张婷. 慢性气道炎症黏液高分泌的治疗药物研究进展. 重庆医学, 2014,43(13):1644-1646.
7. Rvan A, Smith A, Moore P, et al. Expression and characterization of a novel recombinant version of the secreted human mucin MUC5AC in airway cell lines. Biochemistry, 2015, 54(4): 1089-1099.
8. Moulton BC, Barker AF. Pathogenesis of bronchiectasis. Clin Chest Med, 2012, 33(2): 211-217.
9. Main E, Grillo L, Rand S.Airway clearance strategies in cystic fibrosis and non-cystic fibrosis bronchiectasis. Semin Respir Crit Care Med.2015,36(2): 251-266.
10. 李晓云, 刘双. 支气管扩张病因的研究进展. 心肺血管病杂志, 2014, 33(1): 124-126.
11. 倪圣, 丁建中. 气道黏液高分泌机制研究进展. 长江大学学报(自科版), 2013, 10(9): 97-101.
12. Gehrig S, Duerr J, Weitnauer M, et al. Lack of neutrophil elastase reduces inflammation, mucus hypersecretion, and emphysema, but notmucus obstruction, in mice with cystic fibrosis-like lung disease. Am J Respir Crit Care Med, 2014, 189(9): 1082-1092.
13. 吴其标, 曹世宏. 中性粒细胞弹性蛋白酶在支气管扩张症发病中的作用及治疗对策. 国外医学内科学分册, 2004, 31(12): 519-521.
14. 陶和平, 涂小金, 李顺文, 等. 黏液高分泌对慢性阻塞性肺疾病转归的预测价值. 中国现代医生, 2015, 53(33): 32-34, 38.
15. 严能兵, 罗鸿. 白三烯的研究进展与临床意义. 国际检验医学杂志, 2014, 35(6): 721-723.
16. Coffey MJ, Torretti B, Mancuso P. Adipokines and cysteinyl leukotrienes in the pathogenesis of asthma. J Allergy(Cairo), 2015, 2015(94): 1-9.
17. 周敏, 陈辉龙, 程胜, 等. 孟鲁司特对哮喘小鼠肺组织黏蛋白 MUC5ac 表达的影响. 医药导报, 2013, 32 (1): 5-8.
18. 邓俊, 杨艳, 梁宇佳, 等. 孟鲁司特对哮喘大鼠气道炎症的调控作用及其机制. 山东医药, 2016, 56 (24): 34-36.
19. Tenero L, Piazza M, Sandri M, et al. Effect of montelukast on markers of airway remodeling in children with asthma. Allergy Asthma Proc, 2016, 37(5): 77-83.
20. 陈凡, 焦琳, 吴莎, 等. 孟鲁司特联合抗生素治疗支气管扩张症的临床观察. 临床肺科杂志, 2015, 20(9): 1703-1706.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of leukotriene receptor antagonist on airway mucus hypersecretion in patients with acute exacerbation of bronchiectasis

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