Repeatability of peak nasal inspiratory flow measurements and utility for assessing the severity of rhinitis

Avaliação do respirador oral: uso do espelho de Glatzel e do peak nasal inspiratory flow

OBJETIVO: Comparar o uso do espelho de Glatzel e do peak nasal inspiratory flow na avaliação de indivíduos respiradores orais, bem como analisar a correlação dos dois instrumentos. MÉTODOS: Foram avaliadas 64 crianças, sendo 32 respiradoras orais e 32 respiradoras nasais, na faixa etária de 4 a 12 anos. Os respiradores orais, diagnosticados de acordo com equipe multiprofissional, foram subdivididos de acordo com a causa da obstrução. Foram utilizados o espelho de Glatzel e o peak nasal inspiratory flow nos dois grupos para avaliação da permeabilidade e fluxo aéreo nasal. Os dados foram submetidos à análise estatística. RESULTADOS: O espelho de Glatzel diferenciou o modo respiratório considerando-se os estratos gênero, faixa etária, peso, altura e índice de massa corporal da amostra. Entretanto, não foi capaz de dar indícios sobre a causa da respiração oral. Com o uso do peak nasal inspiratory flow, não foi possível diferenciar o modo respiratório e tampouco a causa da respiração oral. Na amostra pesquisada, não houve correlação entre os instrumentos utilizados. CONCLUSÃO: O espelho de Glatzel mostrou ser capaz de identificar indivíduos com e sem obstrução nasal, embora não tenha sido possível diferenciar os subgrupos de respiradores orais entre si com o uso do instrumento. Já o peak nasal inspiratory flow mostrou-se capaz de diferenciar apenas respiradores nasais de respiradores orais cirúrgicos. Foi encontrada baixa correlação entre os dois instrumentos.

Reversible nasal airway obstruction: does change in nasal peak inspiratory flow following decongestion predict response to topical steroids in chronic rhinosinusitis patients?

BACKGROUND

Predicting which chronic rhinosinusitis patients have nasal obstruction due to reversible mucosal inflammation could prevent unnecessary surgery.

AIM

To investigate whether the change in nasal peak inspiratory flow following maximal decongestion (i.e. mucosal reversibility) at first visit predicts the response to topical steroids in chronic rhinosinusitis patients, as measured by the 22-item Sinonasal Outcome Test.

METHODS

Prospective study of 128 consecutive new adult patients presenting with nasal obstruction due to chronic rhinosinusitis (January 2008 to July 2010). The 22-item Sinonasal Outcome Test questionnaire was administered and the nasal peak inspiratory flow assessed. Following maximal nasal decongestion, the nasal peak inspiratory flow was again tested and the difference calculated. Topical steroids were administered for at least six weeks. The 22-item Sinonasal Outcome Test was then repeated and the difference calculated.

RESULTS

Data were analysed using means and correlation studies (Spearman's rank correlation). There was no correlation between the pre- versus post-decongestion nasal peak inspiratory flow difference and the pre- versus post-steroid 22-item Sinonasal Outcome Test difference, in chronic rhinosinusitis patients with or without nasal polyps.

CONCLUSION

The difference between pre- and post-decongestion nasal peak inspiratory flow does not predict chronic rhinosinusitis patients' response to topical steroids.

Contribution of neurogenic and allergic ways to the pathophysiology of nonallergic rhinitis

BACKGROUND

A neuroallergic interaction was reported in the pathogenesis of allergic rhinitis (AR), but the pathophysiology of nonallergic rhinitis (NAR) is poorly understood. We aimed to explore the contribution of neuroallergic mechanisms to the pathogenesis of NAR.

METHODS

Subjects were divided into three groups - NAR patients (n = 25), AR patients (n = 16) and the control group (n = 10) - and were assessed using the nasal provocation test (NPT) with house dust mite. Total symptom scores, nasal inspiratory peak flow and nasal lavage were performed before and after NPT. Nasal brushing and scraping was done after NPT.

RESULTS

NPT was positive in NAR (52%) and AR (100%) patients and negative in all controls. After NPT, total symptom scores increased in both rhinitis groups. Post-NPT values of nasal inspiratory peak flow decreased only in AR patients. NAR patients showed a similar inflammatory cell profile in the nasal smears to AR patients which was different in controls. There were more tryptase- and immunoglobulin E (IgE)-positive cells in the nasal mucosa of AR patients, and more substance-p-positive cells were observed in NAR patients compared with controls. However, IgE- and tryptase-positive cells in NAR patients and substance-p-positive cells in AR patients were detectable in nasal mucosa, but rarely in the controls. Comparing the values before and after NPT, tryptase significantly increased in the nasal lavages of AR and NAR patients, while house dust mite-specific IgE did not change.

CONCLUSIONS

We showed the existence of a common pathophysiological mechanism with different contributions in AR and NAR. We conclude that the difference in dominance of neuroallergic ways may determine the major phenotype of rhinitis.

Changes in nasal air flow and school grades after rapid maxillary expansion in oral breathing children

Objective: To analyse the changes in nasal air flow and school grades after rapid maxillary expansion (RME) in oral breathing children with maxillary constriction. Material and Methods: Forty-four oral breathing children (mean age 10.57 y) underwent orthodontic RME with a Hyrax screw. Forty-four age-matched children (mean age 10.64 y) with nasal physiological breathing and adequate transverse maxillary dimensions served as the control group. The maxillary widths, nasal air flow assessed via peak nasal inspiratory flow (PNIF), and school grades were recorded at baseline, and 6 months and one year following RME. Results: After RME, there were significant increases in all the maxillary widths in the study group. PNIF was reduced in the study group (60.91 ± 13.13 l/min) compared to the control group (94.50 ± 9.89 l/min) (P < 0.000) at the beginning of the study. Six months after RME, a significant improvement of PNIF was observed in the study group (36.43 ± 22.61). School grades were lower in the study group (85.52 ± 5.74) than in the control group (89.77 ± 4.44) (P < 0.05) at the baseline, but it increased six months after RME (2.77 ± 3.90) (P < 0.001) and one year later (5.02 ± 15.23) (P < 0.05). Conclusions: Nasal air flow improved in oral breathing children six months and one year after RME. School grades also improved, but not high enough to be academically significant.

Key words:Maxillary constriction, oral breathing, nasal air flow, rapid maxillary expansion, school grades.

Asthma outcomes: pulmonary physiology

BACKGROUND

Outcomes of pulmonary physiology have a central place in asthma clinical research.

OBJECTIVE

At the request of National Institutes of Health (NIH) institutes and other federal agencies, an expert group was convened to provide recommendations on the use of pulmonary function measures as asthma outcomes that should be assessed in a standardized fashion in future asthma clinical trials and studies to allow for cross-study comparisons.

METHODS

Our subcommittee conducted a comprehensive search of PubMed to identify studies that focused on the validation of various airway response tests used in asthma clinical research. The subcommittee classified the instruments as core (to be required in future studies), supplemental (to be used according to study aims and in a standardized fashion), or emerging (requiring validation and standardization). This work was discussed at an NIH-organized workshop in March 2010 and finalized in September 2011.

RESULTS

A list of pulmonary physiology outcomes that applies to both adults and children older than 6 years was created. These outcomes were then categorized into core, supplemental, and emerging. Spirometric outcomes (FEV(1), forced vital capacity, and FEV(1)/forced vital capacity ratio) are proposed as core outcomes for study population characterization, for observational studies, and for prospective clinical trials. Bronchodilator reversibility and prebronchodilator and postbronchodilator FEV(1) also are core outcomes for study population characterization and observational studies.

CONCLUSIONS

The subcommittee considers pulmonary physiology outcomes of central importance in asthma and proposes spirometric outcomes as core outcomes for all future NIH-initiated asthma clinical research.

The burden of allergic rhinitis and asthma

Asthma and allergic rhinitis are common health problems that cause major illness and disability worldwide. The prevalence of allergic rhinitis is estimated to range from 10% to 20% in the USA and Europe. Multiple factors contribute to the wide range of reported prevalence rates. These include type of prevalence rate reported (current or cumulative), study selection criteria, age of participants, differences in survey methods, varied geographic locations and socioeconomic status, any of which are significant enough to confound direct comparison between studies. There is no standard set of diagnostic criteria for allergic rhinitis. In most studies, the criteria for diagnosis are based on the subject's reporting, solely by questionnaire and rarely confirmed by skin testing. In addition, most studies focus on hay fever, leaving perennial allergic rhinitis underestimated. Sinus imaging is generally not performed and, therefore, rhinosinusitis not differentiated. Some investigators report 'current' prevalence while others report 'cumulative' or 'lifetime' prevalence. Epidemiologic studies have consistently shown that asthma and rhinitis often coexist in the same patients. The prevalence of asthma is <2% in subjects without rhinitis while it varies from 10% to 40% in patients with rhinitis. Furthermore, the majority of patients with asthma experience rhinitis, which is a factor in the risk for asthma. Despite recognition that allergic rhinitis and asthma are global health problems, there are insufficient epidemiologic data and more data are needed with regard to their etiologic risk factors and natural history. This aim of this review is to enable the reader to discuss prevalence, risk factors and prognosis of allergic rhinitis and asthma.

Powered-assisted partial turbinectomy versus mometasone furoate nasal spray for relief of nasal blockage in chronic or idiopathic rhinosinusitis

CONCLUSION

Power-assisted turbinectomy is a safe and reliable alternative for patients with nasal blockage if nasal corticosteroid spray therapy is not suitable.

OBJECTIVE

Powered-assisted partial turbinectomy was compared to the use of a corticosteroid nasal spray for relief of nasal obstruction in chronic or idiopathic rhinosinusitis.

METHODS

Patients were randomized to either power-assisted partial turbinectomy or daily use of mometasone furoate nasal spray for 6 months. Evaluation by peak nasal inspiratory flow (PNIF) and grading of symptoms by use of visual analog scale was done after 3 and 6 months. Grading of symptoms was also done by use of a questionnaire approximately 30 months after the last visit.

RESULTS

PNIF scores improved for all patients, although significantly only for patients on mometasone spray. Patients' self-reported symptoms decreased more for operated patients. Side effects were few and mild in both groups.

Diagnostic accuracy evaluation of nasal sound spectral analysis compared with peak nasal inspiratory flow in nasal septal deviation

BACKGROUND

Noninvasive evaluation of nasal airflow has remained a constant challenge for clinicians. A recently developed method for measurement of nasal obstruction has been evaluated. This study was designed to compare results of nasal sound spectral analysis (NSSA) with results of peak nasal inspiratory flow (PNIF) and visual analog scale (VAS) of nasal obstruction. Main outcome measure was diagnostic accuracy evaluation of NSSA compared with PNIF in nasal septal deviation.

METHODS

Analysis of original nasal sounds was performed using the ameliorated NSSA system with a software program and evaluation of nasal inspiratory sound and its intensity into spectral and frequency scale was performed using fast Fourier transform. NSSA and PNIF were performed on 43 patients with nasal septal deviations and 40 healthy subjects. We characterized the following frequency spectrum using a series of variables: low frequency (0-1 kHz), medium frequency (1-2 kHz), and high frequency (2-4 kHz).

RESULTS

A significant difference was observed between PNIF values and nasal inspiratory sound intensity of the deviated patients and the control group (p < 0.001). A correlation was observed in patients between NSSA results at a frequency range of 2-4 kHz and PNIF results. A cutoff between normal and pathological of 15.2 ± 2.0 dB (2-4 kHz) for NSSA and 118.0 ± 15.5 L/min for PNIF was calculated. No significant differences in terms of sensitivity of NSSA and PNIF (86.04% versus 79.07%) and specificity (82.50% versus 77.50%) were computed.

CONCLUSION

NSSA and PNIF provide valuable information to aid in support of clinical decision making.

North African reference equation for peak nasal inspiratory flow

AIM

To assess, in healthy North African subjects, the applicability and reliability of a previously published reference equation and normal values for peak nasal inspiratory flow, and to calculate a peak nasal inspiratory flow reference equation in this population.

SUBJECTS AND METHODS

Anthropometric data were recorded in 212 volunteers (100 females and 112 males) aged 13-27 years. Peak nasal inspiratory flow was measured several times. Univariate and multiple linear regression analyses were used to determine the reference equation.

RESULTS

The previously published reference equation and normal values did not reliably predict peak nasal inspiratory flow in the study population. In our subjects, the reference equation (r2 = 30 per cent) for peak nasal inspiratory flow (l/min) was 1.4256 × height (m) + 33.0215 × gender (where 0 = female, 1 = male) + 1.4117 × age (years) - 136.6778. The lower limit of normal was calculated by subtracting from the peak nasal inspiratory flow reference value (84 l/min).

CONCLUSION

This is the first published study to calculate a reference equation for peak nasal inspiratory flow in North African subjects. This equation enables objective evaluation of nasal airway patency in patients of North African origin.

Objective measures in aesthetic and functional nasal surgery: perspectives on nasal form and function

The outcomes of aesthetic and functional nasal surgery are difficult to assess objectively because of the intricate balance between nasal form and function. Despite historical emphasis on patient-reported subjective measures, objective measures are gaining importance in both research and the current outcomes-driven health care environment. Objective measures currently available have several shortcomings that limit their routine clinical use. In particular, the low correlation between objective and subjective measures poses a major challenge. However, advances in computer, imaging, and bioengineering technology are now setting the stage for the development of innovative objective assessment tools for nasal surgery that can potentially address some of the current limitations. Assessment of nasal form after aesthetic surgery is evolving from two-dimensional analysis to more sophisticated three-dimensional analysis. Similarly, assessment of nasal function is evolving with the introduction of computational fluid dynamics techniques, which allow for a detailed description of the biophysics of nasal airflow. In this article, we present an overview of objective measures in both aesthetic and functional nasal surgery and discuss future trends and applications that have the potential to change the way we assess nasal form and function.

Effect of intense swimming training on rhinitis in high-level competitive swimmers

BACKGROUND

Rhinitis is commonly reported by swimmers. Seasonal allergic rhinitis may impair athletes' performance and quality of life (QOL). No data are currently available on the changes of nasal symptoms during and after a swimming season. We aimed to determine in competitive swimmers: (1) the prevalence of rhinitis and its impact on their QOL during an intense training programme, (2) the changes in nasal symptoms and QOL after a resting period and (3) the relationship between rhinitis and airway hyperresponsiveness (AHR).

METHODS

Thirty-nine swimmers and 30 healthy controls answered the Rhinitis Quality of Life Questionnaire (RQLQ) and scored nasal symptoms on a seven-point Likert scale during the week preceding their visit. Subjects had allergy skin prick tests and a methacholine challenge. Peak nasal inspiratory flows were also measured. The athletes performed these tests during an intense training period (V1), outside the pollen season and after at least 2 weeks without swimming (V2).

RESULTS

At V1, rhinitis symptoms were reported by 74% of swimmers and 40% of controls (P<0.01). Eighty-four percent of swimmers and 72% of controls were atopic (NS). RQLQ score was higher in swimmers compared with controls at V1 (27.3+/-28.5 vs. 9.5+/-12.7, respectively, P<0.005). The presence of AHR during training did not correlate with the presence of rhinitis symptoms. At V2, the nasal symptoms and RQLQ scores were similar in swimmers and controls.

CONCLUSION

Intense swimming training is associated with an increase in nasal symptoms and impairment in QOL in most competitive swimmers. Such an increase is not related to seasonal allergen exposure in atopic athletes and probably results from chlorine derivative exposure.

Nasal congestion index: A measure for nasal obstruction

OBJECTIVES

The relationship between congestion of the nasal mucosa and subjective nasal obstruction remains poorly defined. Applying the novel Nasal Congestion Index (NCI), we compared subjective nasal obstruction with objective measures for reversible congestion of the nasal mucosa.

STUDY DESIGN

A total of 2,523 consecutive patients were included in this cross-sectional study. Eligible subjects were adults referred to the ENT department, Sørlandet Hospital, Kristiansand, Norway, for evaluation of chronic nasal or sleep-related complaints.

METHODS

Subjects underwent acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) at baseline and after decongestion of the nasal mucosa. Based on these registrations, an NCI was calculated for minimal cross-sectional area (MCA), nasal cavity volume (NCV), and PNIF, and employed for quantification of reversible mucosal congestion. Subjective nasal obstruction was measured by nasal obstruction visual analogue scales (NO-VAS). Statistical analyses were based on ANOVA and multiple linear and logistic regression, adjusting for age, gender, body mass index, asthma, allergy, smoking history, and type of planned intervention.

RESULTS

Crude estimates indicated that the NCIs were significantly higher in subjects with severe complaints of nasal obstruction compared with subjects with lesser symptoms (P < .001). These associations were confirmed by linear and logistic regression analyses. NCI for MCA, NCV, and PNIF showed highly significant associations with subjective nasal obstruction (P < .001).

CONCLUSIONS

We have clearly demonstrated an association between subjective nasal obstruction and reversible congestion of the nasal mucosa by employing the NCI. The measure has proven to be useful for evaluating patients with complaints of nasal obstruction.

Long-term study of fluticasone propionate aqueous nasal spray in acute and maintenance therapy of nasal polyposis

BACKGROUND

Topical steroids are first-line medication to control nasal polyposis (NP), a disease with long-term clinical course.

OBJECTIVE

The aim of this study was to evaluate the efficacy and safety of fluticasone propionate aqueous nasal spray (FPANS) 200 microg twice a day (bd) after 1 month of treatment, and to compare FPANS 200 microg bd and FPANS 200 microg once a day (od) in maintenance and long-term treatment.

METHODS

Double-blind, placebo-controlled, 8-month study with three treatment periods (1-month acute period followed with 1-month maintenance period and 6-month follow-up period) was carried out. Group 1 received FPANS 200 microg bd, during acute, maintenance and follow-up periods, Group 2 received FPANS 200 microg bd during acute period and FPANS 200 microg od during maintenance and follow-up periods, and Group 3 received placebo during acute and maintenance periods and FPANS 200 microg bd during follow-up period. Endpoints were change from baseline in clinic peak nasal inspiratory flow (PNIF), domiciliary evening PNIF, intensity of symptoms and polyposis grade.

RESULTS

After acute period and maintenance periods, FPANS 200 microg bd was significantly more effective than placebo on all endpoints and more effective than FPANS 200 microg od after 1-month maintenance period on clinic PNIF, evening PNIF, obstruction, percentage of days with no sense of smell and percentage of nights with no disturbances. The two doses were similar on other endpoints. After the 6-month follow-up period, there was no difference between the two doses of FPANS at all efficacy endpoints. The safety profile of FPANS did not highlight any new or unanticipated adverse events.

CONCLUSION

The study demonstrated the efficacy of FPANS 200 microg bd in acute treatment and FPANS 200 microg od as a sufficient dose to maintain a long-term efficacy in the treatment for NP.

EAACI position paper on occupational rhinitis

The present document is the result of a consensus reached by a panel of experts from European and non-European countries on Occupational Rhinitis (OR), a disease of emerging relevance which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored on that of occupational asthma, as well as a diagnostic algorithm based on steps allowing for different levels of diagnostic evidence are proposed. The needs for future research are pointed out. Key messages are issued for each item.

Does nasal obstruction mean that the nose is obstructed?

OBJECTIVES/HYPOTHESIS

It is still a matter of controversy to what extent the sense of nasal obstruction is associated with objective measures for nasal space and airflow. Knowledge about this is important in the evaluation of nasal complaints and the planning of its treatment. In this study, we evaluated the relationship between subjective nasal obstruction and the corresponding anatomic and physiological nasal parameters using acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF).

STUDY DESIGN

Two thousand five hundred twenty-three consecutive patients were included in this cross-sectional study. Eligible subjects were adults referred to the Ear, Nose, and Throat Department, Sørlandet Hospital, Kristiansand, Norway, for evaluation of chronic nasal or sleep related complaints.

METHODS

Subjects underwent AR and nasal flow measurements. Subjective grading of nasal obstruction was obtained by a nasal obstruction visual analogue scale. Associations between nasal obstruction visual analogue scale scores, AR, and PNIF were assessed using multiple linear regression, adjusting for age, gender, body mass index, and asthma, allergy, and smoking history.

RESULTS

The sense of nasal obstruction was associated with nasal cavity volumes in both anterior and middle segments of the nasal cavities, with minimal cross-sectional areas in middle segments and for the nasal cavity as a whole, and with PNIF. Associations with minimal cross-sectional areas in anterior segments did not reach significance.

CONCLUSIONS

The present study demonstrates highly significant associations between the subjective sensation of nasal obstruction and corresponding measures for nasal cavity volume, area, and airflow. We conclude that AR and PNIF are valuable objective instruments for evaluation of subjective nasal obstruction.

Multiallergen nasal challenges in nonallergic rhinitis

BACKGROUND

It has been proposed that some patients with nonallergic rhinitis may have "localized allergy" of the nasal mucosa. Nasal challenges with aeroallergens can help determine whether a patient is clinically allergic via an IgE-mediated pathway.

OBJECTIVE

To determine the prevalence of localized allergy in patients with negative skin prick test results via nasal challenges with an array of allergens.

METHODS

Twenty individuals with perennial rhinitis and negative epicutaneous test results to common perennial aeroallergens underwent nasal challenges to glycerin, Alternaria, cockroach, timothy grass, cat hair, and Dermatophagoides pteronyssinus. Total symptom scores, peak nasal inspiratory flow rates, and nasal eosinophil counts were determined.

RESULTS

Of 20 patients with nonallergic rhinitis, 4 were hyperresponsive to glycerin and were not subsequently challenged. Eleven patients had negative nasal challenges. Five patients developed positive challenges (total symptom score > or = 5) to 7 allergens. These 5 patients returned for nasal provocation testing to their offending allergens, and these repeated challenges were negative. Three control subjects with allergic rhinitis developed positive challenges after nasal allergen challenge.

CONCLUSIONS

Although some individuals with nonallergic rhinitis can have positive nasal allergen challenges, these results were not reproducible in the present patient population.

BSACI guidelines for the management of allergic and non-allergic rhinitis

This guidance for the management of patients with allergic and non-allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy. There are also special sections for children, co-morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research.

[Peak Nasal Inspiratory Flow: learning curve for the measurement method and reproducibility]

OBJECTIVES

A prospective study on the learning curve and reproducibility of PNIF measurement with 18 different operators.

MATERIAL AND METHODS

Five hundred twenty-eight patients in two groups were prospectively enrolled in this study from September 2003 to April 2004. The learning curve of the technique was monitored after five patients had been measured. Reproducibility was evaluated with all patients after two consecutive measurements.

RESULTS

The technique was acquired by all operators after the fifth patient. The mean PNIF measurements in controls and patients were 86.02+/-36.96 l/min and 89.59+/-41.97 l/min, respectively. Reproducibility (PNIF2-PNIF1=5.51+/-24.93 l/min) was obtained for all operators, whatever the number of measurements taken.

CONCLUSIONS

The study confirms the good reproducibility and the easy training in PNIF measurement.

Clinical efficacy and pharmacokinetic profiles of intranasal and oral cetirizine in a repeated allergen challenge model of allergic rhinitis

BACKGROUND

Intranasal and oral antihistamines are effective in treating allergic rhinitis. Studies comparing these routes of administration of an antihistamine regarding efficacy and pharmacokinetic profile are lacking.

OBJECTIVE

To compare topical and oral routes of administration of cetirizine regarding efficacy, plasma exudation, and systemic drug levels in a repeated allergen challenge model of allergic rhinitis.

METHODS

Oral cetirizine dihydrochloride, 10 mg once daily, and topical cetirizine dinitrate in a dose corresponding to 4.4 mg of the dihydrochloride salt twice daily were given to grass pollen-sensitive individuals for 12 days in a double-blind, placebo-controlled, crossover design. Timothy grass pollen allergen challenges were given once daily for 7 days using a nasal spray device. Nasal symptoms and peak inspiratory flow were recorded in the morning, 10 minutes after allergen challenge, and in the evening. The pharmacokinetics of the treatments was monitored in 8 patients. The remaining 28 patients were challenged topically with histamine 12 and 24 hours after the final topical and oral cetirizine doses, respectively. Nasal lavage levels of alpha2-macroglobulin were determined to evaluate histamine-induced mucosal plasma exudation.

RESULTS

During the last 3 days of the repeated allergen challenge model, chronic symptoms were established. Both treatments reduced symptoms 10 minutes after allergen challenge (P < .001 vs placebo). Neither treatment reduced morning and evening symptoms or nasal peak inspiratory flow. Topical, but not oral, cetirizine reduced histamine-induced plasma exudation (P < .01 vs placebo) when systemic drug levels were similar in the 2 treatment regimens.

CONCLUSIONS

Topical and oral cetirizine reduced acute nasal symptoms produced by allergen challenges in patients with established chronic symptoms. There were also antihistaminic effects of topical cetirizine not related to systemic drug levels.

Comparison of anatomic, physiological, and subjective measures of the nasal airway

BACKGROUND

Studies comparing different categories of nasal measures have reported inconsistent results. We sought to compare validated measures of the nasal airway: anatomic (acoustic rhinometry), physiological (nasal peak inspiratory flow), and subjective experience (Nasal Obstruction Symptom Evaluation Scale and a visual analog scale [VAS]).

METHODS

This prospective cross-sectional study of 290 nonrhinologic patients included upright and supine rhinometry (minimum cross sectional area [MCA] and volume) and flow (mean and maximum) measurements, as well as subjective measures. Associations between measures were evaluated with Spearman correlations and multivariate linear regression, adjusting for age, sex, race, body mass index, and smoking history.

RESULTS

Correlations between objective (rhinometry and flow) and subjective categories of nasal measures ranged from -0.16 to 0.03 (mean correlation, -0.07 +/- 0.05), with 0 significant correlations of 16 tested. Correlations between anatomic (rhinometry) and physiological (flow) categories ranged from 0.04 to 0.15 (mean correlation, 0.10 +/- 0.03), with 0 significant correlations of 16 tested. In contrast, within each category (rhinometry, flow, and subjective), all correlations were significant (13 correlations, all p < 0.001) and ranged from 0.62 to 0.99. Of 16 adjusted associations between objective and subjective measures, 14 were not significant (p > 0.05); only upright and supine MCAs were significantly associated with the VAS (both, p < 0.05).

CONCLUSION

Validated anatomic, physiological, and subjective nasal measures may assess different aspects of the nasal airway and provide complementary information. Future studies should be directed at developing a composite measure including components from all three categories of nasal measurement.

Efficacité de Dérinox® chez des patients souffrant d’une rhinite virale évaluée par un PNIF (Peak Nasal Inspiratory Flow)

OBJECTIVES

The aim of this study was to compare the efficacy and tolerance of Dérinox (D) to Rhinofluimucil (R) and placebo (P) in the treatment of common cold, using an objective measure of nasal obstruction, the Peak Nasal Inspiratory Flow (PNIF--Clement Clarke International, Harlow, Angleterre).

PATIENTS AND METHODS

This randomized, double-blind, double-dummy, parallel group study enrolled 354 patients (34 P, 165 D et 155 R) included by 85 general practitioners. The treatment duration was 5 days at usual recommended dosage regimens. PNIF measures were done before drug administration (T0) as well as 15 min and 3 h after each intake. Moreover, nasal obstruction, rhinorrhea and global discomfort were subjectively assessed.

RESULTS

The efficacy of D was superior to that of P and R when comparing PNIF from T0 to T3 h after the first intake. At T15 min, rhinorrhea was significantly improved with both active treatments and global discomfort was significantly improved with D only. Treatment tolerance was satisfactory and comparable between the 3 groups.

CONCLUSION

Efficacy of Dérinox(R) was superior to that of P and R for the improvement of the nasal obstruction (PNIF) between T0 and T3h (main criteria) after the first intake in patients suffering from common cold.