咳喘息に対するmontelukastの効果と気道内の炎症細胞動態について

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Cough variant asthma (CVA) is characterized by a cough without apparent wheezing for more than 8 weeks. β_2-agonists are effective in CVA, which is believed to be a subtype of asthma. We examined the clinical effects of the once daily administration of montelukast (10mg/day), a leukotriene receptor antagonist (LTRA), on CVA in 31 patients (23 females and 8 males; median age, 42.0 years) and the profile of inflammatory cells in the airways before treatment. Coughing improved after the two-week treatment of montelukast in 18 patients, but did not improve in the remaining 13, whose symptoms disappeared after the inhalation of fluticasone propionate at a dose of 400 μg/day. The time interval from the onset of cough symptom to the initiation of treatment was shorter in the cases in which montelukast was effective. We obtained bronchial biopsies and used double staining with anti-CD63 antibody and anti-human tryptase antibody to examine the expression of CD63, a marker of degranulation, by mast cells. The ratio of the number of CD63-positive cells to that of tryptasepositive mast cells was found to be significantly higher in cases in which montelukast was effective than in those in which montelukast was ineffective. A similar difference was observed in the number of eosinophils in airways. Based on these results, we suggest that leukotriene may be closely involved in the pathophysiology of a subgroup of patients with CVA; that activated mast cells and eosinophils are responsible for airway inflammation in LTRA-responsive CVA; and that, in terms of LTRA effectiveness, distinct pathogenic mechanisms may exist in CVA during its clinical course.
愛知医科大学の論文
2005-12-15

咳喘息に対するmontelukastの効果と気道内の炎症細胞動態について

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