Liu Qianqian, Zhang Wenwen, Tian Tian, Liu Yu, Bai He, Hu Qiya, Qi Feng
Department of Anesthesiology and Pain Clinic, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China.
Department of Respiratory, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China.
Front Med (Lausanne). 2023 Feb 23;10:937377. doi: 10.3389/fmed.2023.937377. eCollection 2023.
Cough variant asthma (CVA) is a chronic inflammatory airway disease characterized by airway hyper-responsiveness (AHR), of which cough is the only symptom. The cough is a result of the contraction of the vocal cords, diaphragm, sternocleidomastoid muscle, and other respiratory related muscles caused by the AHR. Long-term chronic coughing can lead to repetitive contraction and chronic strain of the muscles involved in the head and neck, ultimately contributing to the formation of latent myofascial trigger points (MTrPs). In turn, latent MTrPs can also irritate or compress the nerves around them, triggering cough. The date indicated that latent MTrPs can induce autonomic phenomena and are effective in allergic rhinitis. But their roles in asthma are unclear. In this article, the efficacy and safety of latent MTrPs injection therapy in CVA were investigated.
This randomized controlled trial was conducted with 110 patients. Patients were assigned to the intervention or control group in a 1:1.5 ratio. Intervention group ( = 44): single injection therapy with latent MTrPs. Control group ( = 66): budesonide-formoterol plus montelukast for 8 weeks. During the 36-week follow up period, the recurrence rate at week 36, cough visual analog scale (VAS), ACT (asthma control test)-scores, ACQ5 (asthma control questionnaire)-scores, AQLQ (asthma quality of life questionnaire)-scores, proportion of using rescue medication, and adverse events were evaluated.
The recurrence rate at week 36 was lower in the intervention group than in the control group (36 weeks, 5.0 vs. 34.55%, = 0.001). There were significant differences between groups in change from baseline to 36 weeks in VAS [36 weeks, 1.70 (1.49) vs. 3.18 (2.04), < 0.001]; ACT-score [36 weeks, 21.38 (2.65) vs. 18.53 (3.00), < 0.001]; ACQ5-score [36 weeks, 0.85 (0.55) vs. 1.52 (0.62), < 0.001]; AQLQ-score [36w, 174.40 (18.22) vs. 151.69 (24.04), < 0.001]; proportion of using rescue medication (36 weeks, 5.0 vs. 29.1%, = 0.003). Fewer adverse events occurred in the two groups.
Latent myofascial trigger points injection therapy provided long-acting, practical, short treatment duration and safety methods for CVA.
http://www.chictr.org.cn/index.aspx, Chinese Clinical Trial Registry Center, ChiCTR2100044079.
咳嗽变异性哮喘（CVA）是一种以气道高反应性（AHR）为特征的慢性炎症性气道疾病，咳嗽是其唯一症状。咳嗽是由AHR引起的声带、膈肌、胸锁乳突肌和其他呼吸相关肌肉收缩的结果。长期慢性咳嗽可导致头颈部相关肌肉反复收缩和慢性劳损，最终促使潜在肌筋膜触发点（MTrP）形成。反过来，潜在MTrP也可刺激或压迫其周围神经，引发咳嗽。有数据表明，潜在MTrP可诱发自主神经现象，且对过敏性鼻炎有效。但其在哮喘中的作用尚不清楚。本文研究了潜在MTrP注射疗法在CVA中的疗效和安全性。
本随机对照试验纳入110例患者。患者按1:1.5的比例分为干预组或对照组。干预组（n = 44）：采用潜在MTrP单次注射疗法。对照组（n = 66）：使用布地奈德福莫特罗加孟鲁司特治疗8周。在36周的随访期内，评估第36周的复发率、咳嗽视觉模拟量表（VAS）、ACT（哮喘控制测试）评分、ACQ5（哮喘控制问卷）评分、AQLQ（哮喘生活质量问卷）评分、使用急救药物的比例以及不良事件。
干预组第36周的复发率低于对照组（36周时，5.0% 对34.55%，P = 0.001）。从基线到3周6时，两组在VAS变化方面存在显著差异[36周时，1.70（1.49）对3.18（2.04），P < 0.001]；ACT评分[36周时，21.38（2.65）对18.53（3.00），P < 0.001]；ACQ5评分[36周时，0.85（0.55）对1.52（0.62），P < 0.001]；AQLQ评分[36周时，174.40（18.22）对151.69（24.04），P < 0.001]；使用急救药物的比例（36周时，5.对29.1%，P = 0.003）。两组发生的不良事件较少。
潜在肌筋膜触发点注射疗法为CVA提供了长效、实用、治疗时间短且安全的方法。
http://www.chictr.org.cn/index.aspx，中国临床试验注册中心，ChiCTR2100044
