A real - life observational pilot study to evaluate the effects of two-week treatment with montelukast in patients with chronic cough

Roxana K Mincheva, Tanya Z Kralimarkova, Miroslava Rasheva, Zlatko Dimitrov, Denislava Nedeva, Maria Staevska, Vera Papochieva, Penka Perenovska, Karina Bacheva, Vasil D Dimitrov, Todor A Popov, Roxana K Mincheva, Tanya Z Kralimarkova, Miroslava Rasheva, Zlatko Dimitrov, Denislava Nedeva, Maria Staevska, Vera Papochieva, Penka Perenovska, Karina Bacheva, Vasil D Dimitrov, Todor A Popov

Abstract

Background: Different 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).

Methods: 14 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.

Results: Discomfort 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.

Conclusion: Patients 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.

Figures

Figure 1
Figure 1
Leicester cough Questionnaire (LCQ) scores before and after treatment.
Figure 2
Figure 2
Inverse correlation between LCQ and FSSG scores.
Figure 3
Figure 3
Cough indices for citric acid before and after treatment.
Figure 4
Figure 4
Cough indices for capsaicin before and after treatment.

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