Efficacy ofβ2-adrenergic receptor agonist combined with corticosteroid in the treatment of children with cough variant asthma

BACKGROUND Cough variant asthma(CVA)is one of the most common respiratory diseases in children,which has a serious impact on the quality of life and daily activities of children.For severe CVA,immunomodulatory drugs are needed.AIM To evaluate the efficacy of salmeterol combined with budesonide in the treatment of pediatric CVA.METHODS 130 children with CVA from January 2020 to December 2022 were prospectively selected and randomly divided into an observation group(salmeterol combined with budesonide)and a control group(budesonide combined with a placebo).Compare the clinical efficacy of two groups before and after intervention.The evaluation parameters include cough frequency score,nocturnal cough arousal,and lung function indicators.Serum inflammatory markers,immune function markers and airway anatomical indicators were also measured.RESULTS After the intervention,the total effective rate of the observation group was significantly higher than that of the control group,and the cough frequency score and the night cough wake rate of the observation group were lower than that of the control group,with a statistically significant difference.In addition,the changes of lung function indicators,serum markers and immune function markers in the observation group were better than those in the control group.CONCLUSION The clinical efficacy of salmeterol combined with Budesonide in the treatment of CVA is better than that of Budesonide alone.

Experimental study on the regulation effect of Qiaoqin Qingfei agent on cough variant asthma based on airway neurogenic inflammation

Objective:To investigate the mechanism of regulation of airway neurogenic inflammation by Qiaoqin Qingfei agent in rats with cough variant asthma(CVA).Methods:48 SD rats were randomly divided into blank group,model group,montelukast sodium group(1.05 mg/kg)and high,medium and low dose groups(26,13,6.5 g/kg),with 8 rats in each group.The rat CVA model was established by the method of ovalbumin(OVA)combined with aluminum hydroxide(Al(OH)3)sensitization and repeated stimulation.From the second day of sensitization,the rat CVA model was given by gavage for 28 days.The pathological changes of lung tissue were observed under microscope by HE staining.The content changes of nerve growth factor(NGF)and substance P(SP)in alveolar lavage fluid(BALF)were determined by double-antibody sandwich ABC-ELISA,and the protein expression levels of NGF and SP in lung tissue were detected by immunohistochemistry.Results:Pathological findings showed significant inflammatory manifestations in the model group,and the inflammatory infiltration in the high-dose,medium-dose and low-dose groups of Qiaoqin Qingfei agent and montelukast sodium groups were alleviated to varying degrees.Compared with blank group,the protein expression levels of NGF and SP in lung tissue of model group were significantly increased(P<0.01).Compared with model group,the protein expression levels of NGF and SP in lung tissue and the contents of NGF and SP in alveolar lavage fluid in high-dose,medium-dose and low-dose groups and montelukast sodium group were significantly decreased(P<0.05).Conclusion:Qiaoqin Qingfei agent may reduce airway inflammation and relieve cough variant asthma by regulating the protein expression levels of NGF and SP in airway neurogenic inflammation.

Effect of glycyrrhetinic acid on Th1/Th2 balance in cough variant asthma mice

Objective:To evaluate the therapeutic effect of Glycyrrhetinic Acid on cough variant asthma(CVA)mice and to investigate the possible mechanism in reducing lung inflammation.Methods:48 young female Balb/c mice were divided into Control,CVA,Prednisone Acetate,Glycyrrhetinic Acid high-dose,Glycyrrhetinic Acid middle-dose and Glycyrrhetinic Acid lowdose groups randomly,with 8 mice in each group.The CVA mice model was established by ovalbumin(OVA)sensitization and OVA challenge,the animal asthma behavior was observed after drug administration,and the index of the lung of mice were recorded.The level of OVAsIgE in the bronchoalveolar lavage fluid(BALF)was tested by ELISA.The pathological changes of the lung tissue were observed by Hematoxylin and Eosin(H&E)staining.The protein expressions of T-bet,IFN-γ,Gata3,IL-4 and IL-13 in the lung tissue were determined by Western blot.Results:Compared with the CVA group,the index of lung of mice,the OVA-sIgE level in BALF and expression levels of Th2-related factor in the lung tissue of mice in Prednisone Acetate and Glycyrrhetinic Acid groups were significantly decreased(P<0.05 or P<0.01),the infiltration of inflammatory cells in the lung tissue was reduced,while expressions of Th1-related factor in the lung tissue was significantly increased(P<0.05 or P<0.01).Conclusion:Glycyrrhetinic acid has therapeutic effect on CVA mice,the underlying mechanism of Glycyrrhetinic acid alleviating lung impairment and airway inflammation may be associated with mediating the Th1/Th2 imbalance in the lung tissue.

Meta-analysis of the efficacy and safety of Ding-Chuan Tang in the treatment of pediatric cough variant asthma

Objective:To systematically evaluate the clinical efficacy and safety of Ding-Chuan Tang in the treatment of pediatric cough variant asthma(CVA).Methods:Randomized controlled trials on the treatment of pediatric CVA with Ding-Chuan Tang were searched by computer through the China Journal Full Text Database(CNKI),WanFang Digital Journal Full Text Database(WanFang Data),Vipe Chinese Science and Technology Journal Database(VIP),Pubmed Database,Ovid Database,Embase Database,etc.The search time was from database establishment to April 1,2021.Based on the inclusion and exclusion criteria,the Executive editor:Nuo-Xi Pi.Received:10 September 2021;Accepted:13 January 2022;Available online:19 January 2022.©2022 By Author(s).Published by TMR Publishing Group Limited.This is an open access article under the CC-BY license.(http://creativecommons.Org/licenses/BY/4.0/)two researchers independently screened the literature,extracted information,and assessed the methodological quality evaluation of the literature,and Meta-analysis was performed by RevMan 5.4 software.Results:The final number of RCTs was included 17,including cases of affected 1308 children.According to the results of the Meta-analysis:the test group was significantly better than the control group in terms of clinical efficiency,percentage of first second force expiratory volume(FEV1%),percentage of peak expiratory flow rate(PEF%),time to treatment onset,time to the disappearance of symptoms,Chinese medicine symptom score,and recurrence rate;the difference in the incidence of adverse reactions between the two groups was not statistically significant.Conclusion:The clinical treatment of pediatric CVA with Ding-Chuan Tang is effective and does not increase the incidence of adverse reactions.However,the methodological and reporting quality of existing small-sample randomized controlled trials(RCTs)is low,so evidence of efficacy must be confirmed by rigorously designed large-sample clinical trials.

Clinical Analysis of Dispelling Wind,Eliminating Lung and Relieving Cough Combined with Western Medicine in the Treatment of Cough Variant Asthma in Children

Objective:This study mainly explores the clinical effect of dispelling wind,eliminating lung and relieving cough combined with western medicine in the treatment of cough variant asthma.Methods:80 children with cough variant asthma accepted by our hospital from January 2018 to December 2020 were randomly selected for the study and divided into two groups.One group was the reference group(40 cases)treated with procaterol hydrochloride tablets and montelukast sodium,and the other group was the research group(40 cases)・The method of eliminating wind,eliminating lung and relieving cough was combined with procaterol hydrochloride tablets and montelukast sodium to observe and compare the curative effects of the two groups.Results:There was no significant difference in TCM symptom score and eosinophil(EOS)count between the two groups before treatment(P>0.05);After treatment,the TCM symptom scores of coughs,pharyngeal itching,expectoration,nasal congestion and nasal itching in the research group were lower than those in the reference group,and the EOS count was lower than that in the reference group(P<0.05);The effective rate of research group was higher than that of reference group(P<0.05).Conclusions:For children with cough variant asthma,Qufeng Sufei cough relieving method combined with procaterol hydrochloride and montelukast sodium can improve children's symptoms and reduce eosinophil count.

Effects of Huaiqihuang Granule on immunoglobulin, T lymphocyte subsets and cytokines in children with cough variant asthma

Objective:To observe the effect of Huaiqihuang granule on immunoglobulin, T lymphocyte subsets and cytokines in children with cough variant asthma (CVA). Methods:80 cases of children with CVA were enrolled in our hospital from June 2015 to June 2016, and were randomly divided into study group and control group. Two groups were both given salbutamol aerosol powder. On this basis, the control group was given Montelukast Sodium Chewable Tablets, while the study group was treated with Huaiqihuang granules. The interleukin 4 (IL-4), interferon-γ(IFN-γ), IgA, IgG and IgE levels and CD4+, CD8+T lymphocyte ratio analyze in children after 3 months of treatment. Results:There were no significant differences between the two groups before treatment (P>0.05). Both IgA and IgG were significantly higher in the two groups after treatment, while IgE was significantly lower (P<0.05). Compared with the control group, the IgA and IgG in the study group were significantly higher than those in the control group (P<0.05), while IgE was significantly lower (P<0.05). After treatment, compared with the control group, the proportion of CD4+ and CD4+/CD8+ in the study group were significantly lower than that of the control group, and the CD8+ratio increased more significantly (P<0.05). After treatment, IL-4 decreased significantly, while IFN-γand IFN-γ/IL-4 were significantly increased (P<0.05), IL-4 level of the study group decreased significantly compared with the control group, and IFN-γincreased significantly compared with the control group, and the level of IFN-γ/IL-4 after treatment was significantly higher than that of the control group (P<0.05). Conclusions: Huaiqihuang granule can improve humoral immunity and cellular immunity of children with CVA, and can adjust the immune cells balance of Th1/Th2, and improve the immune function and prognosis of children with CVA.

The influence of vitamin D3 on airway inflammation and osteopontin expression in cough variant asthma rats

Objective:To observe the effect of vitaminD3 on airway inflammation and osteopontin(OPN)expression on cough variant asthma(CVA)models.Methods:SD rats were randomly divided into blank group,model group and treatment group,each group with 10 rats.The CVA model was induced by intraperitoneal injection combined with aerosolized ovalbumin(OVA),the treatment group was given 100 mg/ml of vitaminD330 minutes before challenge by administered orally.Airway hyperreaction were measured by airway resistance after inhalation of acetylcholine(Ach).Wright-Gimsa staining was used to observe the inflammatory cells in bronchoalveolar lavage fluid(BALF).HE and PAS were used to observe the morphological changes of lung tissue.OPN expression was detected by immunohistochemistry.Results:1)Airway hyperreaction:airway resistance after inhalation Ach in model group and treatment group were significantly higher than that in blank group(P<0.01),airway resistance in treatment group were lower than that in model group(P<0.01);2)Classification of inflammatory cells:The percentage of macrophages,lymphocytes,neutrophils,and eosinophils in the BALF of the model group and the treatment group were increased compared with the blank group(P<0.01),furthermore,the number of treatment group were lower than the model group(P<0.05);3)Morphological changes of lung tissue:a large amount of inflammatory cells and goblet cell proliferation were observed in the lung tissue of the model group,and these changes were slight in treatment group compared with model group;OPN expression in lung tissue:The expression of OPN in model and treatment group were increased compared with blank group(P<0.05),and the treatment group was lower than that of model group(P<0.05).The OPN content was positively correlated with the percentage of inflammatory cells in BALF(P<0.05).Conclusions:Vitamin D3 can reduce airway hyperreaction and airway inflammation in CVA rats.The mechanism may be related to the intervention of OPN expression in lung tissue.

Effect of inhalant combined with Dingchuan Zhike decoction therapy on the airway remodeling, inflammation and PARC/CCL-18 pathways in patients with cough variant asthma

Objective:To study the effect of inhalant combined with Dingchuan Zhike decoction therapy on the airway remodeling, inflammation and PARC/CCL-18 pathways in patients with cough variant asthma.Methods: A total of 60 patients with cough variant asthma who were treated in our hospital between January 2014 and May 2016 were collected and divided into the control group (n=30) who received conventional inhalant treatment and the observation group (n=30) who received inhalant combined with Dingchuan Zhike decoction treatment according to single-blind randomized controlled method, and the treatment lasted for 6 months. Before treatment and after 6 months of treatment, high-resolution CT was used to determine the airway remodeling index levels, RIA method was used to detect the peripheral blood airway remodeling index contents, and enzyme-linked immunosorbent assay (ELISA) was used to detect the contents of inflammatory mediators in induced sputum and the PARC/CCL-18 in serum.Results: Before treatment, the differences in the airway remodeling degree as well as the contents of inflammatory mediators and PARC/CCL-18 were not statistically significant between the two groups. After 6 months of treatment, CT airway remodeling indexes LA and TA levels of observation group were higher than those of control group while WA level was lower than that of control group, and peripheral blood airway remodeling indexes CTGF, YKL-39, MMP-9 and TIMP-1 contents were lower tha=n those of control group;inflammatory mediators IL-5, IL-6 and IL-8 contents in induced sputum of observation group were lower than those of control group, and serum PARC/CCL-18 content was lower than that of control group.Conclusion:Inhalant combined with Dingchuan Zhike decoction can inhibit the airway remodeling and reduce the airway inflammation in patients with cough variant asthma.

The effectiveness and safety of HuangQiXiXin decoction for cough variant asthma:protocol for a systematic review

Objective:A comprehensive and updated systematic review is needed to evaluate the effectiveness and safety of HuangQiXiXin decoction(HQXXD)for cough variant asthma(CVA).The aim of this systematic review protocol is to comprehensively assess the effectiveness and safety of HQXXD for CVA.Methods:An overall search for studies in main English and Chinese electronic databases from their inception to January 2021 will be performed.Randomized controlled trials regarding HQXXD for CVA will be included.We will use RevMan 5.3 software to perform statistical analysis and meta-analysis.Results:The findings of this systematic review will be disseminated through peer-reviewed publications.Conclusion:The systematic review will provide more evidence regarding the effectiveness and safety of HQXXD for CVA.

DRUGS FOR RELIEVING COUGH AND ASTHMA——Selected from A Practical English——Chinese Library of Traditional Chinese Medicine

Drugs of this category have the effectsof nourishing the lung to relieve cough andlowering the adverse flow of q(?) to relieveasthma.They are indicated for syndrome ofcough and dyspnea which is very complicat-ed and may be manifested as cough withoutsputum,cough with watery thin sputum orwith yellow thick sputum,cough withdyspnea due to affection by exopathogens,or cough with dyspnea due to consumptivediseases.Appropriate drugs should be chos-en with regard to the different syndromes,

Clinical Study on Treatment of Cough Variant Asthma by Chinese Medicine

To observe the clinical efficacy and the change of airway responsiveness to Chinese medicine （CM） in treating cough variant asthma （CVA）. Methods： Ninety-four patients who had confirmed the diagnosis of CVA were selected and randomly assigned to the treatment group and the control group by the blocked randomization method. The ratio of the two groups was 2：1. The treatment group had 63 patients that were treated by CM, lost in 10 cases, 53 patients had finished the trial. The control group had 31 patients that were treated by montelukast tablets and theophylline, lost in 5 cases, 26 patients had finished the trial, two weeks as one therapeutic course. The syndrome efficacy, cough efficacy, symptom score and the airway responsiveness between two groups were observed. Results： The comparison of the syndrome efficacy： the total effective rate of the treatment group was 90.57% and the control group was 76.92%, and the two groups were significantly different （P〈0.05）. The comparison of the cough efficacy： the total effective rate of the treatment group was 98.11% and the control group was 80.77%, and the two groups were also significantly different （P〈0.05）. Syndrome scoring and cough scoring were all significantly lowered, but the airway responsiveness was not significantly lowered. Conclusions： The treatment of CM could ease the cough, improve the syndrome, and shows obvious advantages compared with the control group, which is worthy of extensive clinical application.

Effectiveness and safety of traditional Chinese herbs in children with cough variant asthma: a systematic review and Meta-analysis

OBJECTIVE:To systematically investigate the clinical effectiveness and safety of traditional Chinese herbs(TCHs)as an alternative to conventional medicine(CM)in children with cough variant asthma(CVA).METHODS:Randomized controlled trial(RCT)studies that were published from their inceptions to March 31,2020,were identified from the electronic databases of China National Knowledge Infrastructure,Wangfang,Pub Med,and Cochrane Central Library.The primary outcome of the review was the total effective rate(TER),and the secondary outcomes were immunoglobulin E(Ig E),peak expiratory flow(PEF),adverse drug reactions,and relapse rates of interventions.RESULTS:For the Meta-analysis,13 studies involving 992 children with CVA were included.In terms of TER and Ig E,the experimental interventions of TCH,when compared with the control interventions of CM,on pediatric CVA were found to be significantly effective(P<0.0001),whereas for spirometry,PEF was not significantly improved in the TCH group(P=0.48).The incident rates of adverse drug reaction and relapse were found to be significantly lower in the TCH group than those in the CM group(P=0.02 and P<0.0001,respectively).CONCLUSION:Compared with CM therapy,the effects of TCH therapy on pediatric CVA were significantly beneficial in terms of TER and Ig E,but not for PEF,and the methodological quality of included studies was poor.Therefore,the results should be interpreted with caution.More randomized controlled trials with rigorous experimental methodologies are required for objectivity in the future.

Observation on clinical effects of tuina plus montelukast sodium tablets for children with cough variant asthma

Objective： To observe the clinical effects of tuina plus oral administration of montelukast sodium tablets for children with cough variant asthma （CVA）. Methods： A hundred and six children with CVA were randomly divided into a treatment group and a control group, 53 cases in each group. The treatment group was treated with Tuina therapy plus oral administration of montelukast sodium tablets, and the control group was treated only by oral administration of montelukast sodium tablets. Tuina treatment was given three times per week. 5 mg of montelukast sodium tablets was given orally before bedtime every night. The therapeutic effects were assessed after the treatment of four weeks in both groups. Results： The total effective rates were 92.5% in the treatment group and 77.4% in the control group. The difference in the total effective rate between the two groups was statistically significant （P〈0.05）. Conclusion： The therapeutic effect of tuina plus montelukast sodium tablets for children with CVA is better than that of oral administration of montelukast sodium tablets alone.

Effect and safety of stimulating acupoints in children with cough variant asthma：A Meta-analysis

OBJECTIVE:To evaluate the efficacy and safety of stimulating acupoints in subjects with childhood cough variant asthma(CVA).METHODS:A Meta-analysis of randomized controlled trials(RCTs) about the comparison between acupoint sticking therapy and non-acupoint sticking therapy for childhood CVA was conducted.The trials' quality and risk bias were assessed using the Cochrane Handbook tool.Odds ratio(OR) or risk ratio(RR) with 95% confidence intervals(CIs),mean differences(MDs) or standardized mean differences(SMDs) of a random-effects model were calculated.Heterogeneity was assessed by P value and I2 statistics.RESULTS:Thirteen studies were included in our review,indicating that the total effective rate of stimulating-acupoint group is better than that of control group [RR 1.19,95% CI(1.13-1.26),P < 0.00001].The recurrence rate in two years [RR 0.31,95%CI(0.19-0.51),P < 0.000 01] and cough duration[MD =-2.42,95% CI(-3.75,-1.09),P = 0.0004]of childhood CVA in stimulating-acupoint group were significantly lower than those in control group.Besides,stimulating acupoints can reduce the level of Ig E [SMD =-0.75,95% CI(-1.21,-0.30),P = 0.001] and EOS [SMD =-0.36,95% CI(-0.92,0.21),P = 0.22].CONCLUSION:Our findings suggest that stimulating acupoints had positive effects on childhood CVA and was relatively safe treatment.However,more RCTs with more useful indicators are warrant to confirm the current findings.

Therapeutic efficacy and safety rating of Tui-Pushing chest-back manipulation for children with cough variant asthma Therapeutic efficacy and safety rating of Tui-Pushing chest-back manipulation for children with cough variant asthma

Objective:To observe and evaluate the clinical efficacy and safety of using pediatric Tuina(Chinese therapeutic massage),Tui-Pushing chest-back manipulation,in treating children with cough variant asthma(CVA).Methods:Seventy-two kids with CVA were divided into two groups using the random number table method,with 36 cases in each group.The control group received the conventional Tuina treatment,and the observation group received additional Tui-Pushing chest-back manipulation.The clinical efficacy and adverse reactions were observed and recorded for the two groups.Results:After three treatment courses,compared with the control group,the observation group showed advantages in the total effective rate,reducing the number and intensity of cough and improving the nature of cough(P<0.05).However,at the one-month follow-up,there were no significant differences between the two groups in these parameters(P>0.05).Regarding the adverse reaction rate,there was no significant between-group difference(P>0.05).Conclusion:It is effective and safe to use pediatric Tuina,Tui-Pushing chest-back manipulation,plus the conventional treatment protocol to treat CVA in children.

A Brief Analysis on the Characteristics of Chinese Medicine and Treatment for Cough Variant

Cough variant is a common disease of the respiratory system and can lead to a unique type of asthma.The disease has no obvious symptoms such as wheezing nor shortness of breath.Coughing is the main clinical symptom,as it causes airway hyper-responsiveness.Traditional Chinese medicine(TCM)has a unique understanding of this disease,and the effect is obvious after treatment,as it's based on symptom differentiation.This article takes the concept of“mild fluid retention”from“The Synopsis of the Golden Chamber”as an entry point,briefly describes the relationship between cough variant and mild fluid retention,as well as the diagnosis and treatment of Chinese medicine.

Effect and mechanism of application in canicular days plus enteral nutrition for cough variant asthma in kids

Objective： To observe the clinical efficacy of application in canicular days plus enteral nutrition in treating cough variant asthma （CVA） in kids, and to explore its action mechanism. Methods： Following a randomized controlled single-blind parallel-group design, 138 eligible kids with CVA were randomized into an observation group, a canicular-day application group, and an enteral nutrition group, 46 kids in each group. The canicular-day application group was intervened by application in canicular days, the enteral nutrition group was by enteral feeding, and the observation group was by both canicular-day application and enteral feeding. The therapeutic efficacies were evaluated after a treatment course. Results： The recovery rate and total effective rate were respectively 50.0% and 98.0% in the observation group, versus 23.9% and 91.3% in the canicular-day application group, and 13.0% and 78.6% in the enteral nutrition group. The observation group was significantly superior to the other two groups （both P〈0.05）. In comparing the global symptom score, peak expiratory flow （PEF）, forced expiratory volume in one second （FEVl）, CD3^＋, CD4^＋, CD4^＋/CD8^＋, CD8^＋, hemoglobin （Hb）, total protein （TP）, albumin （ALB）, eosinophil cationic protein （ECP）, lipid peroxide （LPO）, leukotriene （LT）, body weight （BW）, triceps skin-fold （TSF）, and arm muscle circumference （AMC）, the observation group was significantly better than the other two groups （both P〈0.05）. Conclusion： Application in canicular days plus enteral nutrition can significantly improve the pulmonary function and symptoms in children＇s CVA, and the effect is possibly produced by regulating cellular immune system, enhancing Hb, TP, ALB, BW, TSF, AMC, and inhibiting the production of ECP, LPO, and LT.

IT IS GASTROESOPHAGEAL REFLUX DISEASE, NOT ASTHMA: A CASE REPORT

THE incidence of gastroesophageal reflux disease （GERD） is high in Western nations. Its extraesophageal manifestations such as asthma, paroxysmal laryngospasm, and excessive throat phlegm,

ACUPUNCTURE TREATMENT OF ASTHMA

Case History Ms. Shi ××, 61 years of age,researchfelloW in Chinese Academy of Sciences,ViS-ited on 27 November 1979. Chief complaint:Cough and asthma fora week. A cold caught ten years before had re-sulted in asthma which led to repeated fol-lowing attacks were more severe during au-tumn and winter.The present attack wascaused by invasion of cold due to suddenchange of weather.The patient sufferedfrom dyspnea。oppressed feeling in the chest.

Manipulation parameter optimization in Liu's back tuina therapy for kids'cough variant asthma in remission stage

Objective:To determine the optimal manipulation parameters in Liu's back tuina therapy for remission-stage cough variant asthma(CVA)in kids.Methods:A 5-factor 3-level L18(37)orthogonal design was adopted.The experimental factors and levels were selected:A,the number of times of Rou-kneading Feishu(BL 13);B,the frequency of Rou-kneading Feishu(BL 13);C,the number of times of Tui-pushing in a'介'-like pattern;D,the frequency of Tui-pushing in a'介'-like pattern;E,the intensity of red color after Ca-scrubbing Feishu(BL 13)with salt.A1,A2 and A3 stood for 10 times,20 times and 30 times,respectively;B1,B2 and B3 stood for 200 times/min,240 times/min and 280 times/min,respectively;C1,C2 and C3 stood for 50 times,75 times and 100 times,respectively;D1,D2 and D3 stood for 150 times/min,175 times/min and 200 times/min,respectively;E1,E2 and E3 stood for pinkish,bright red and dark red,respectively.A total of 108 kids with CVA in remission stage were divided into 18 groups using the random number table method,with 6 cases in each group.Changes in the cough score and fractional exhaled nitric oxide(FENO)level were observed after 15-day treatment.Results:The cough score and FENO level changed significantly in every group after treatment(all P<0.01).By the effect in improving cough score,the factors were listed as D,B,A,C and E in descending order;the most optimal manipulation parameter combination was group 17(A3B2C1D3E1);the second optimal parameter combinations were group 7(A3B1C2D1E3),group 13(A2B1C2D3E1)and group 14(A2B2C3D1E2).Regarding the effect in down-regulating the level of FENO,the factors were listed as C,A,E,B and D in descending order;the most optimal manipulation parameter combination was group 13(A2B1C2D3E1);the second optimal parameter combinations were group 18(A3B3C2D1E2),group 16(A3B1C3D2E3)and group 14(A2B2C3D1E2).Conclusion:Two most effective manipulation parameter combinations were selected out of 18 different parameter combinations in Liu's back tuina therapy for remission-stage CVA in kids.Doctors can choose an appropriate manipulation based on the symptom features of the disease.