| BackgroundThe bronchial asthma is an airway chronical inflammatory disease referred to cells (eosinophile granulocyte, mast cell, T cell, neutrophile granulocyte, airway cellula epithelialis and so on) and celelular component. This chronical inflammation induce increase of airway hyperresponsiveness. Commonly, it represented the reversible limition of airflow, which was extensive and changeful, aroused the symptoms of paroxysmal pant, short of breath cough. The symptom of asthma often outbreaks and was aggravated at night or in the early morning, which of most patients can be relieved with or without treatment. Patients with asthma have been increasing year by year, that make the socio-economic loss is growing . Asthma has become one of the major health problem in industrialized countries. Therefore, the effective control of asthma has become the key to the treatment of asthma. Glucocorticoids can eliminate airway inflammation effectively, and reduce the contraction symptoms of bronchial spasm significantly, inhibit the anaphylactogens, reduce reaction of bronchial asthma. Glucocorticosteroid is the first choice medicine at present. because its lower drug side effects and complications by oral and intravenous. But its oral administration and the vein medication side effects are so large, and the complication are so much, that Glucocorticoid's clinical application has been limited. Inhaled glucocorticoids direct role in bronchial lesions, with fewer dose, fewer side effects and the advantages of ease of use, so that most of asthma can be controlled. The 1992 enacted the global consensus on diagnosis and treatment of asthma has recommended the ICS therapy as the first choice therapy which treated for asthma.Compared with systemic corticosteroid therapy,small to medium-dose inhaled corticosteroid dose is more safer. about 10 percent of ICS enters the gas channel,and the rest was swallowed.The long-term use may cause hoarseness and pharynx candidiasis. Systemic side effects have adrenal suppression, decreased bone mineral density in children with growth slowing and metabolic changes. Some patients inhaling the recommended doses of ICS can cause varying degrees of systemic adverse reactions, and in some cases patients inhaling surpasses doses of ICS can not effectively control asthma symptoms. Moreover, some patients especially children and the elderly, who have poor compliance to anapnotherapy and cannot use inhalers correctly.that make the the long-term treatment of ICS limited.Therefore, we need to find one medicine with ICS,β2-acceptor energiner in the treatment of asthma,with which more patients with asthma achieves the asthma's complete control and good control quickly at lower dose ICS. Montelukast, the strong effect highly selective leukotriene receptor antagonist, can block the interaction between Cysteinyl leukotriene receptor and it's acceptor's, therefore block organ's response to leukotriene. Montelukast, a kind of leukotriene receptor antagonist, is not glucocorticoid drug, that has avoid corticosteroid-related side effects. so it is suitable for long-term use.PurposeInvestgate the effect of Montelukast combine with Aerosol inhalation on treating asthma through detecting the T lymphocyte subgroup,NK cell,the IL-4,lung function, and EOS. and reclamate a new way of the treatment of asthma.MethodThe sample who was diagnosed identifily as a midrange asthma impatient with acute exacerbation was selected.The thirty-four samples were divided into 2 groups at random, the control group and the treatment group, there were 17 samples for each. The control group use conventional therapy contain antibiotics, glucocorticoid, doxofylline, etal; the treatment group were given inhaled treatment which contained budesonide 2 mg and 0.9% isotonic Na chloride 3ml, Terbutaline 0.25 and 0.9% isotonic Na chloride 3ml. twice a day. add montelukast 10mg Oral bedtime, once a day. The time of therapy is two weeks. Detect the T lymphocyte subgroup,NK cell,the IL-4,lung function, and EOS. before and after the treatments, to contrast the Results whether or not have statistical difference. After discharge, The control group still use conventional therapy (contain antibiotics, glucocorticoid,doxofylline, etc. ), if the symptom of asthma outbreak; the treatment group were given Symbicort Turbuhaler (budesonide+ formoterol), twice a day. add montelukast 10mg Oral bedtime, once a day. Followed up for 2 months.Result1. Patients with acute bronchial asthma attack was obstructive ventilation dysfunction, both FEV1/FVC% and PEF reduce. After treatment, FEV1/FVC% and PEF increase significantly. the treatment group was obviously higher than that in the control (P<0.05). 2. patients with bronchial asthma exist lymphocyte subsets imbalance,displaying CD4%,CD4/CD8 and NK% rise. after the treatment, CD4%, CD4/CD8 and NK% decrease in varying degrees(P<0.05). the treatment group was obviously decrease than that in the control (P<0.05). However, CD8% did not change significantly (P> 0.05). 3. The IL-4 level of Patients with acute bronchial asthma attack obviously increase,After treatment, The level of IL-4 was decreased in two groups. the treatment group decreased obviously than that in the control (P<0.05). 4. the EOS counts of Patients with acute bronchial asthma increased obviously. After treatment, The level of EOS decreased in two groups (P<0.05). the treatment group decreased obviously than that in the control (P<0.05). 5. After 2 months, the symptom of asthma was improved (P<0.05), the treatment group improved obviously than that in the control (P<0.05).Conclusion1. patients with asthma have immune functional disorder.the main performance of the dysfunction are the T lymphocyte subgroup disorder and NK cell quantity and the active change. 2. the essence of the asthma is the airway chronic inflammation,and EOS is the mainly effector cell. when patient with asthma outbreak, the EOS, in peripheral blood and airway, increased obviously, and drops along with asthma symptom's alleviation. that confirmed EOS influential role in asthma. 3. IL-4 was considered as a leading role factor that cause asthma. IL-4 increased, when asthma patient asthma outbreak.and drops along with asthma symptom's alleviation. 4. the treatment of Montelukast Combinate with Budesonide,LABA plays synergistic action on, on eliminate airway inflammation. the Combination was more effective than conventional therapy. SO, it worth being recommend.
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