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Sousa-Pinto B, Vieira RJ, Brozek J, Cardoso-Fernandes A, Lourenço-Silva N, Ferreira-da-Silva R, Ferreira A, Gil-Mata S, Bedbrook A, Klimek L, Fonseca JA, Zuberbier T, Schünemann HJ, Bousquet J. Intranasal antihistamines and corticosteroids in allergic rhinitis: A systematic review and meta-analysis. J Allergy Clin Immunol 2024:S0091-6749(24)00419-6. [PMID: 38685482 DOI: 10.1016/j.jaci.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND There is insufficient systematized evidence on the effectiveness of individual intranasal medications in allergic rhinitis (AR). OBJECTIVES We sought to perform a systematic review to compare the efficacy of individual intranasal corticosteroids and antihistamines against placebo in improving the nasal and ocular symptoms and the rhinoconjunctivitis-related quality of life of patients with perennial or seasonal AR. METHODS The investigators searched 4 electronic bibliographic databases and 3 clinical trials databases for randomized controlled trials (1) assessing adult patients with seasonal or perennial AR and (2) comparing the use of intranasal corticosteroids or antihistamines versus placebo. Assessed outcomes included the Total Nasal Symptom Score, the Total Ocular Symptom Score, and the Rhinoconjunctivitis Quality-of-Life Questionnaire. The investigators performed random-effects meta-analyses of mean differences for each medication and outcome. The investigators assessed evidence certainty using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach. RESULTS This review included 151 primary studies, most of which assessed patients with seasonal AR and displayed unclear or high risk of bias. Both in perennial and seasonal AR, most assessed treatments were more effective than placebo. In seasonal AR, azelastine-fluticasone, fluticasone furoate, and fluticasone propionate were the medications with the highest probability of resulting in moderate or large improvements in the Total Nasal Symptom Score and Rhinoconjunctivitis Quality-of-Life Questionnaire. Azelastine-fluticasone displayed the highest probability of resulting in moderate or large improvements of Total Ocular Symptom Score. Overall, evidence certainty was considered "high" in 6 of 46 analyses, "moderate" in 23 of 46 analyses, and "low"/"very low" in 17 of 46 analyses. CONCLUSIONS Most intranasal medications are effective in improving rhinitis symptoms and quality of life. However, there are relevant differences in the associated evidence certainty.
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Affiliation(s)
- Bernardo Sousa-Pinto
- CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal; MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rafael José Vieira
- CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal; MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jan Brozek
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - António Cardoso-Fernandes
- CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal; MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nuno Lourenço-Silva
- CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal; MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Renato Ferreira-da-Silva
- CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal; MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - André Ferreira
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Sara Gil-Mata
- CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal; MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - João A Fonseca
- CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal; MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Torsten Zuberbier
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology, and Allergology, Berlin, Germany
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jean Bousquet
- ARIA, Montpellier, France; Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Immunology, and Allergology, Berlin, Germany.
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Benfante A, Tomasello A, Caponetto C, Battaglia S, Scichilone N. Are nighttime respiratory symptoms assessed by asthma control test affected by comorbidities? J Asthma 2024:1-6. [PMID: 38446620 DOI: 10.1080/02770903.2024.2327036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/03/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Nocturnal symptoms are common in the asthmatic population, reflecting an exaggerated airway narrowing overnight due to several factors; it is questioned to what extent the awakenings documented in the clinical assessment of asthma control are due to the disease itself or to comorbidities. To answer this question, we aimed to evaluate to what proportion rhinitis, gastroesophageal reflux and the likelihood of being affected by OSAS were related to poor asthma control, by means of ACT evaluation. METHODS Asthmatics attending the outpatient clinic were enrolled and administered the following questionnaires: ACT, Total 5 Symptom Score, GERD Impact Scale, Pittsburgh Sleep Quality Index and the Sleep Disorders Questionnaire. RESULTS One-hundred consecutive patients (M/F: 42/58, mean age 52 ± 15 years) were recruited. According to the ACT findings, 14 asthmatics resulted as fully controlled (FC, ACT equal to 25), 55 partially controlled (PC, 25 < ACT >19) and 31 as uncontrolled (UC, ACT <19). GERD was not associated with the ACT score neither did rhinitic symptomatology. On the other hand, the PSQI scores appeared to significantly increase with the lack of symptom control: FC, 2.0 (1-4); PC, 3.5 (2-5); UC, 6.6 (4-8) (p = 0.002). The SA-SDQ questionnaire results significantly increased with the loss of asthma control: FC, 11.0 (9-12); PC, 12.5 (10-14); UC, 15.1 (14-16) (p = 0.005). CONCLUSIONS These results confirm and extend previous findings showing that there is a higher likelihood that underlying unknown sleep disturbances worsen asthma control, suggesting that a more comprehensive assessment is necessary to clarify the cause of nocturnal symptoms in asthma.
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Affiliation(s)
- Alida Benfante
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - Alessandra Tomasello
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - Chiara Caponetto
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - Salvatore Battaglia
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - Nicola Scichilone
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
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Malizia V, Ferrante G, Cilluffo G, Gagliardo R, Landi M, Montalbano L, Fasola S, Profita M, Licari A, Marseglia GL, La Grutta S. Endotyping Seasonal Allergic Rhinitis in Children: A Cluster Analysis. Front Med (Lausanne) 2022; 8:806911. [PMID: 35155483 PMCID: PMC8825866 DOI: 10.3389/fmed.2021.806911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Seasonal Allergic Rhinitis (SAR) is a heterogeneous inflammatory disease. We hypothesized that a cluster analysis based on the evaluation of cytokines in nasal lavage (NL) could characterize distinctive SAR endotypes in children. Methods This cross-sectional study enrolled 88 children with SAR. Detailed medical history was obtained by well-trained physicians. Quality of life and sleep quality were assessed through standardized questionnaires [Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and Pittsburgh Sleep Quality Index (PSQI) respectively]. Children were grouped through K-means clustering using Interleukin (IL)-5, IL-17, IL-23, and Interferon (INF)-γ in NL. Results Out of the 88 patients enrolled, 80 were included in the cluster analysis, which revealed three SAR endotypes. Cluster 1 showed lower levels of IL-5 and IL-17 and intermediate levels of IL-23 and IFN-γ; Cluster 2 had higher levels of IL-5 and intermediate levels of IL-17, IL-23, and IFN-γ; Cluster 3 showed higher levels of IL-17, IL-23, and IFN-γ and intermediate levels of IL-5. Cluster 1 showed intermediate values of nasal pH and nasal nitric oxide (nNO), and a lower percentage of neutrophils at nasal cytology than Clusters 2 and 3. Cluster 2 had a lower level of nasal pH, a higher nNO, higher scores in the ocular domain of PRQLQ, and worse sleep quality than Clusters 1 and 3. Cluster 3 showed a higher percentage of neutrophils at nasal cytology than Clusters 1 and 2. Conclusions Our study identified three endotypes based on the evaluation of cytokines in NL, highlighting that childhood SAR is characterized by heterogeneous inflammatory cytokines.
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Affiliation(s)
- Velia Malizia
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Giuliana Ferrante
- Paediatric Unit, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Giovanna Cilluffo
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Rosalia Gagliardo
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Massimo Landi
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy.,Pediatric National Healthcare System, Turin, Italy
| | - Laura Montalbano
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Salvatore Fasola
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Mirella Profita
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania La Grutta
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
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Ercan N, Demirel F, Yeşillik S, Bolat A, Kartal Ö. Efficacy of sodium hyaluronate in relieving nasal symptoms of children with intermittent allergic rhinitis: a randomized controlled trial. Eur Arch Otorhinolaryngol 2021; 279:2925-2934. [PMID: 34529156 DOI: 10.1007/s00405-021-07073-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Nasal irrigation is recommended as add-on therapy in patients with intermittent allergic rhinitis (AR). We aimed to evaluate the clinical efficacy of adding hyaluronic acid (HA) or normal saline solution (NSS) to nasal corticosteroid (NC) therapy as add-on therapy in improving quality of life and reducing nasal symptom scores of children with intermittent AR compared to NC therapy. METHOD In this 28-day long, open-label, randomized controlled trial, one puff of NC was administered once a day through both nostrils of 76 children with SAR (6-12 years old), whose Total Nasal Symptom Score (TNSS) was ≥ 4. Twenty-six patients received NC only (Group 1); 24 patients received NSS (Group 2), and 26 patients received HA (Group 3) twice a day by means of nasal douche device. Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and TNSS were measured as subjective parameters, and nasal eosinophil count (NEC) in nasal cytology, nasal airflow (NAF), and resistance were measured as objective parameters. RESULTS No significant difference was found in post-treatment between groups in terms of TNSS, PRQLQ, and NEC values. Mean values of post-treatment left NAF of the groups were significantly different (p = 0.030), and the mean value of Group 3 was the highest (mean ± SD = 247.62 ± 155.8 ccm/sn). In comparing pre- and post-treatment intragroup mean total NAR (TNAR) values, a statistically significant decrease was recorded only in group three (p = 0.025). CONCLUSION The addition of HA to NC as an adjunct therapy in children with intermittent AR has limited beneficial effects in our study and deserves further investigation. TRIAL REGISTRY The clinical trial registration number ID:NCT04752956.
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Affiliation(s)
- Nazli Ercan
- Department of Child Health and Diseases, Division of Pediatric Immunology and Allergy, University of Health Sciences Turkey, Gülhane Education and Research Hospital, 06010, Ankara, Turkey.
| | - Fevzi Demirel
- Department of Immunology and Allergy, University of Health Sciences Turkey, Gülhane Education and Research Hospital, 06010, Ankara, Turkey
| | - Sait Yeşillik
- Department of Immunology and Allergy, University of Health Sciences Turkey, Gülhane Education and Research Hospital, 06010, Ankara, Turkey
| | - Ahmet Bolat
- Department of Child Health and Diseases, University of Health Sciences Turkey, Gülhane Education and Research Hospital, 06010, Ankara, Turkey
| | - Özgür Kartal
- Department of Immunology and Allergy, University of Health Sciences Turkey, Gülhane Education and Research Hospital, 06010, Ankara, Turkey
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Thien F, Davies JM, Hew M, Douglass JA, O'Hehir RE. Thunderstorm asthma: an overview of mechanisms and management strategies. Expert Rev Clin Immunol 2020; 16:1005-1017. [PMID: 32960102 DOI: 10.1080/1744666x.2021.1826310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Epidemic thunderstorm asthma (ETSA) is due to a complex interaction of environmental and individual susceptibility factors, with outbreaks reported globally over the last four decades. Australia has been particularly susceptible with nearly half of episodes reported internationally, culminating in the catastrophic Melbourne 2016 event. AREAS COVERED Reported ETSA episodes are reviewed for common environmental and meteorological risk factors. Allergen aerobiology interaction with thunderstorm activity and rapid weather condition changes is examined. Assessment of the clinical and immunological data highlights risk factors for ETSA presentation, hospital admission, and intensive care admission. Risk factors associated with ETSA deaths are evaluated. Public health strategies, as well as pharmacological and immunological management approaches to reduce individual susceptibility and prevent ETSA are discussed. EXPERT OPINION Improved understanding of the specific meteorological factors predisposing to the greatest risk of ETSA to improve forecasting is required. Better monitoring of aeroallergen levels in areas of greatest geographic risk, with further research into allergen aerobiology underpinning mechanisms of allergen exposure is needed. The role of climate change in increasing the risk of ETSA outbreaks requires further research. Public awareness and education are required to reduce exposure, and to improve uptake of pharmacological and immunological risk reduction and preventive strategies.
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Affiliation(s)
- Francis Thien
- Eastern Health Clinical School, Box Hill Hospital , Melbourne, Australia.,Monash University , Melbourne, Australia
| | - Janet M Davies
- Queensland University of Technology , Brisbane, Australia.,Metro North Hospital and Health Service , Brisbane, Australia
| | - Mark Hew
- Monash University , Melbourne, Australia.,Allergy, Asthma & Clinical Immunology, Alfred Health , Melbourne, Australia
| | - Jo A Douglass
- Royal Melbourne Hospital , Parkville, Australia.,Department of Medicine, University of Melbourne , Melbourne, Australia
| | - Robyn E O'Hehir
- Monash University , Melbourne, Australia.,Allergy, Asthma & Clinical Immunology, Alfred Health , Melbourne, Australia
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Bardin PG, Rangaswamy J, Yo SW. Managing comorbid conditions in severe asthma. Med J Aust 2019; 209:S11-S17. [PMID: 30453867 DOI: 10.5694/mja18.00196] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 11/20/2018] [Indexed: 12/26/2022]
Abstract
Asthma care has increasingly focused on personalised management for severe asthma, and recognition of the role and importance of comorbid conditions has increased. Severe asthma can be crippling; associated comorbid conditions often play a key role in the significant disease morbidity and frequently contribute to a severe and difficult-to-treat asthma phenotype. Comorbid conditions can be broadly grouped as being either airway-related or airway-unrelated. Airway-related comorbid conditions with the greatest impact are allergic rhinitis, chronic rhinosinusitis, vocal cord dysfunction, lung fungal sensitisation and underlying structural lung disease. The most important airway-unrelated comorbid conditions are obesity, obstructive sleep apnoea, gastro-oesophageal reflux disease and anxiety and depression. A diagnostic and management algorithm for comorbid conditions in severe asthma is outlined. It concentrates initially on the group with common comorbid conditions that can be managed in primary care. If asthma remains troublesome, emphasis can shift to identifying uncommon and more complex factors. The algorithm allows for personalised diagnostic and management pathways to be implemented. Personalised diagnosis and management of comorbid conditions are essential to achieving effective and improved outcomes for patients with severe asthma.
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Affiliation(s)
- Philip G Bardin
- Monash Lung and Sleep, Monash Hospital and University, Melbourne, VIC
| | | | - Shaun W Yo
- Monash Lung and Sleep, Monash Hospital and University, Melbourne, VIC
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The levels of CD4+CD25+ regulatory T cells in patients with allergic rhinitis. Allergol Select 2018; 2:144-150. [PMID: 31826046 PMCID: PMC6881876 DOI: 10.5414/alx01782e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background: The involvement of CD4+CD25+ regulatory T cells (CD4+CD25+ TRegs) in allergic diseases was reported previously. However, it remains unclear whether CD4+CD25+ TRegs are involved in allergic rhinitis (AR). Methods: Fresh whole blood from 20 patients with AR and 16 healthy donors was used to investigate the frequency of CD4+CD25+ and CD4+CD25hi Treg cells using flow cytometry. In addition, serum total IgE (IU/mL) levels were determined using enzyme-linked immunosorbent assays. Results: Patients with AR had fewer CD4+CD25+ Treg cells (2.80 ± 1.36% vs. 3.94 ± 0.97%, P < 0.01) and CD4+CD25hi TRegs (1.53 ± 0·62% vs. 2.00 ± 0.52%, P < 0.05) than control subjects. The number of CD4+CD25+ and CD4+CD25hi TRegs was correlated negatively with total immunoglobulin E levels (r = –0.79, P < 0.01 and r = –0.61, P < 0.01, respectively). Conclusion: Deficient regulatory T cells might play a role in the development of AR.
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8
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Tay TR, Hew M. Comorbid "treatable traits" in difficult asthma: Current evidence and clinical evaluation. Allergy 2018; 73:1369-1382. [PMID: 29178130 DOI: 10.1111/all.13370] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 01/07/2023]
Abstract
The care of patients with difficult-to-control asthma ("difficult asthma") is challenging and costly. Despite high-intensity asthma treatment, these patients experience poor asthma control and face the greatest risk of asthma morbidity and mortality. Poor asthma control is often driven by severe asthma biology, which has appropriately been the focus of intense research and phenotype-driven therapies. However, it is increasingly apparent that extra-pulmonary comorbidities also contribute substantially to poor asthma control and a heightened disease burden. These comorbidities have been proposed as "treatable traits" in chronic airways disease, adding impetus to their evaluation and management in difficult asthma. In this review, eight major asthma-related comorbidities are discussed: rhinitis, chronic rhinosinusitis, gastroesophageal reflux, obstructive sleep apnoea, vocal cord dysfunction, obesity, dysfunctional breathing and anxiety/depression. We describe the prevalence, impact and treatment effects of these comorbidities in the difficult asthma population, emphasizing gaps in the current literature. We examine the associations between individual comorbidities and highlight the potential for comorbidity clusters to exert combined effects on asthma outcomes. We conclude by outlining a pragmatic clinical approach to assess comorbidities in difficult asthma.
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Affiliation(s)
- T. R. Tay
- Allergy, Asthma and Clinical Immunology; The Alfred Hospital; Melbourne Vic. Australia
- Department of Respiratory and Critical Care Medicine; Changi General Hospital; Singapore
| | - M. Hew
- Allergy, Asthma and Clinical Immunology; The Alfred Hospital; Melbourne Vic. Australia
- School of Public Health & Preventive Medicine; Monash University; Melbourne Vic. Australia
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Ai J, Xie Z, Qing X, Li W, Liu H, Wang T, Tan G. Clinical Effect of Endoscopic Vidian Neurectomy on Bronchial Asthma Outcomes in Patients with Coexisting Refractory Allergic Rhinitis and Asthma. Am J Rhinol Allergy 2018; 32:139-146. [PMID: 29649887 DOI: 10.1177/1945892418764964] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The prevalence of both allergic rhinitis and bronchial asthma is high throughout the world; their mutual influence on each other has been documented in many studies. However, studies regarding surgical intervention are limited. Objective To evaluate the clinical significance of endoscopic vidian neurectomy on bronchial asthma outcomes in patients with coexisting refractory allergic rhinitis and asthma. Methods A total of 109 patients with moderate to severe persistent intractable allergic rhinitis and mild/moderate asthma were allocated to the bilateral endoscopic vidian neurectomy group (group 1) or conservative medication group (group 2) according to the patients' self-selection. The Rhinoconjunctivitis Quality of Life Questionnaire, Visual Analog Scale, Asthma Quality of Life Questionnaire, Total Asthma Symptom Score, and medication scores were evaluated at six months, one year, and three years after undergoing the initial treatments. Multivariate analysis was performed to determine which triggers of asthma attacks were associated with improved asthma outcomes in patients. Results Ninety-five patients were followed up for at least three years. Postoperative scores of Rhinoconjunctivitis Quality of Life Questionnaire and Visual Analog Scale were significantly lower than preoperative scores during follow-up in group 1 and were significantly lower than those of group 2. Postoperative scores of Asthma Quality of Life Questionnaire at the three follow-up time points were higher than the preoperative scores in group 1. The Total Asthma Symptom Score was not significantly decreased in group 1. The medication scores for allergic rhinitis and asthma were gradually reduced after surgery. At the end of the follow-up, the improvement rates for allergic rhinitis and asthma were 90.6% and 45.3%, respectively. Asthma outcomes were significantly improved by controlling rhinitis symptoms in patients whose asthma attacks were induced by "rhinitis onset" or "weather change." Conclusion Controlling allergic rhinitis symptoms by bilateral endoscopic vidian neurectomy can significantly improve asthma outcomes in patients whose asthma attacks are induced by rhinitis onset and/or cold air.
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Affiliation(s)
- Jingang Ai
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zuozhong Xie
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Qing
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Wei Li
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Honghui Liu
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China.,2 Allergy Clinic, Third Xiangya Hospital, Central South University, Changsha, China
| | - Tiansheng Wang
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China.,2 Allergy Clinic, Third Xiangya Hospital, Central South University, Changsha, China
| | - Guolin Tan
- 1 Department of Otolaryngology Head and Neck Surgery, Third Xiangya Hospital, Central South University, Changsha, China
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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11
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Malizia V, Fasola S, Ferrante G, Cilluffo G, Montalbano L, Landi M, Marchese D, Passalacqua G, La Grutta S. Efficacy of Buffered Hypertonic Saline Nasal Irrigation for Nasal Symptoms in Children with Seasonal Allergic Rhinitis: A Randomized Controlled Trial. Int Arch Allergy Immunol 2017; 174:97-103. [PMID: 29059673 DOI: 10.1159/000481093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/29/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Saline nasal irrigation is labelled as an add-on treatment in patients with allergic rhinitis (AR). The primary aim of this study was to compare the efficacy of 21-day use of buffered hypertonic saline (BHS) versus normal saline solution (NSS) on reducing nasal symptoms in children with seasonal AR (SAR). Comparing their efficacy on nasal cytology counts (NCC), quality of life, and sleep quality was the secondary aim. METHODS In this 21-day, open-label, randomized controlled study, 36 SAR children (aged 6-13 years) with a Total 5 Symptom Score (T5SS) ≥5 received twice-daily BHS or NSS delivered through a nasal douche. Efficacy measures were least square mean changes (LSmc) in T5SS, NCC, Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), and Pittsburgh Sleep Quality Index (PSQI) scores. RESULTS BHS improved the T5SS total score to a greater extent than NSS (LSmc -6.45 vs. -5.45, p < 0.001). Concerning NCC, BHS significantly reduced the scores of neutrophils (LSmc -0.76, p = 0.004) and eosinophils (LSmc -0.46, p = 0.018), while NSS did not. Similarly, only BHS yielded a significant improvement in the PRQLQ score (LSmc -0.57, p = 0.009), whereas the improvement in PSQI score was comparable between the BHS (LSmc -0.77, p = 0.025) and NSS (LSmc -1.39, p < 0.001) groups. Overall, BHS was well tolerated. CONCLUSIONS In children with SAR, BHS is effective in improving nasal symptoms and NCC, with an associated beneficial effect on quality of life.
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Affiliation(s)
- Velia Malizia
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, University of Palermo, Palermo, Italy
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12
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Ferrando M, Bagnasco D, Roustan V, Canonica GW, Braido F, Baiardini I. Sleep complaints and sleep breathing disorders in upper and lower obstructive lung diseases. J Thorac Dis 2016; 8:E716-25. [PMID: 27621908 DOI: 10.21037/jtd.2016.07.82] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Upper and lower obstructive lung diseases can induce sleep complaints and can be part of the pathogenesis of sleep breathing disorders. In fact, the physiological changes of the pattern of respiration during sleep, added to the airways disease can lead to symptomatic worsening of rhinitis, asthma and chronic obstructive pulmonary diseases (COPD); moreover, their functional and anatomical features can lead to sleep breathing disorders such as obstructive sleep apnea syndrome (OSAS). This review highlights the above-mentioned relationships and the effect of disease management on its comorbidities and the patient's quality of life. Rhinitis, asthma and COPD represent causes of sleep complaints that may be reduced with optimal management of these obstructive airways diseases. Continuous positive airway pressure (CPAP) treatment of sleep apnea needs to be tailored after optimization of the therapy of concomitant diseases, but it can often ameliorate comorbid disease.
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Affiliation(s)
- Matteo Ferrando
- Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Diego Bagnasco
- Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | | | - Giorgio Walter Canonica
- Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Fulvio Braido
- Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Ilaria Baiardini
- Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
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13
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Meteran H, Backer V. Mometasone furoate nasal spray for the treatment of asthma. Expert Opin Investig Drugs 2016; 25:999-1004. [PMID: 27218300 DOI: 10.1080/13543784.2016.1192124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Asthma is a common respiratory disease characterized by airway inflammation, bronchoconstriction and airway hyperresponsiveness and symptoms such as coughing, wheezing, shortness of breath and chest tightness. Allergic rhinitis is a common comorbidity in asthma and glucocorticoids are the key stone in the treatment of both diseases. Mometasone furoate is a potent synthetic steroid with a very high receptor affinity and a low bioavailability and shown to be superior compared to other inhaled corticosteroids. It is not clear whether the use of mometasone furoate nasal spray (MFNS) is associated with an improvement in asthma control. AREAS COVERED This current paper reviews the current knowledge on the effect of mometasone furoate nasal spray in the treatment of asthma and includes clinical trials in which both subjective and objective outcomes are assessed. EXPERT OPINION To date, only few clinical studies have investigated the effect of nasal steroids in the treatment of asthma. The studies investigating the effect of MFNS report contradicting results, although the most well-designed study to answer this question finds no improvement in asthma control. Thus, it seems unlikely that asthma guidelines will be influenced by the current knowledge on the effect of MFNS in the treatment of asthma.
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Affiliation(s)
- Howraman Meteran
- a Respiratory Research Unit , Bispebjerg University Hospital , Copenhagen , Denmark
| | - Vibeke Backer
- a Respiratory Research Unit , Bispebjerg University Hospital , Copenhagen , Denmark
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14
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Yang MT, Chen CC, Lee WT, Liang JS, Fu WM, Yang YH. Attention-Deficit/Hyperactivity Disorder–related Symptoms Improved with Allergic Rhinitis Treatment in Children. Am J Rhinol Allergy 2016; 30:209-14. [DOI: 10.2500/ajra.2016.30.4301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Increased prevalence of attention-deficit/hyperactivity disorder (ADHD) in children with allergic rhinitis (AR) has been reported. Our previous study showed that children with untreated AR had higher ADHD scores than did the controls. Objective This prospective follow-up study aimed to investigate whether elevated ADHD scores in children with AR could be decreased by AR treatment. Methods Sixty-eight children with AR (age range, 6-14 years) and who were drug naive were enrolled and evaluated by AR symptom score, ADHD symptom scores, and computerized continuous performance test, before and after AR therapy, which included nonpharmacologic intervention, oral antihistamines, and topical steroids. Thirty-one age-matched controls and 13 children with pure ADHD were also enrolled for comparison. The relationship between the AR and ADHD score change was analyzed by a partial correlation test, and univariate and multivariate linear regression models were applied to investigate possible predictors for the improvement of ADHD scores by AR treatment. Results AR symptom scores in children with AR decreased significantly after treatment (p < 0.001), and their ADHD scores also decreased significantly (p < 0.001). An improved AR symptom score was positively correlated with improved detectability (rp = 0.617, p = 0.001) and commission error (rp = 0.511, p = 0.011). Significant predictors for the improvement of ADHD scores included age, AR drugs, AR subtypes, and multiple atopic diseases (ps < 0.05). Conclusion Higher ADHD scores in children with AR compared with healthy controls decreased significantly with AR treatment. For children with AR and borderline ADHD symptoms, who do not meet full ADHD diagnostic criteria, we recommend initially treating their AR and monitoring improvement of ADHD symptoms.
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Affiliation(s)
- Ming-Tao Yang
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan, Taiwan
| | - Chia-Chun Chen
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jao-Shwann Liang
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wen-Mei Fu
- Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
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Klimek L, Mullol J, Hellings P, Gevaert P, Mösges R, Fokkens W. Recent pharmacological developments in the treatment of perennial and persistent allergic rhinitis. Expert Opin Pharmacother 2016; 17:657-69. [PMID: 26800187 DOI: 10.1517/14656566.2016.1145661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Allergic rhinitis (AR) has a major negative impact on patients' quality of life (QoL) and carries a high socio economic burden. This is particularly the case for patients who experience symptoms for extended periods of time (i.e. those with perennial (PAR) or persistent AR (PER), depending on the classification system used). This review covers available pharmacological advances and recent developments in the treatment of PAR or PER. AREAS COVERED Pharmacological AR treatment is used to reduce symptom burden and help restore patients' normal daily routine. Traditionally, non-sedating antihistamines and intranasal corticosteroids (INS) were the two drug classes recommended for use first line. These, along with antileukotrienes, decongestants, mast cell stabilizers and anticholinergics, constituted the bulk of the AR treatment arsenal. MP-AzeFlu (Dymista®, Meda, Solna, Sweden) is the most recent addition to that arsenal. It is a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) delivered in a single spray and has surpassed available therapies in terms of symptom control and treatment response. Other relatively new treatments for PAR or PER include H3 antihistamines, toll-like receptor (TLR) agonists, cellulose powders and micro-emulsions, novel biomolecular formulations and omalizumab. Each of these new additions is reviewed here. EXPERT OPINION A new AR drug class has recently been introduced (i.e. RO1AD58). Currently MP-AzeFlu is the only treatment option within this drug class. It can be estimated that combination treatments like MP-AzeFlu will become the mainstay of PAR and PER therapy since use will result in better compliance, improved efficacy over INS and a faster response together with good levels of tolerability. The challenge is to find other equally, or more effective, combination treatments, as has been the therapeutic standard in bronchial asthma for decades. The potential of biologics, as well as TLR-agonists and other new treatment options needs to be further evaluated.
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Affiliation(s)
- Ludger Klimek
- a Center for Rhinology and Allergology , Wiesbaden , Germany
| | - Joaquim Mullol
- b Clinical and Experimental Respiratory Immunoallergy, IDIBAPS; Rhinology and Smell Clinic, ENT Department , Hospital Clínic , Barcelona , Spain
| | - Peter Hellings
- c Laboratory of Clinical Immunology , University Hospitals Leuven , Leuven , Belgium
| | - Philippe Gevaert
- d Upper Airways Research Laboratory, Department of Otorhinolaryngology , Ghent University Hospital , Ghent , Belgium
| | - Ralph Mösges
- e Institute of Medical Statistics , Informatics and Epidemiology (IMSIE) , Cologne , Germany
| | - Wytske Fokkens
- f Department of Otorhinolaryngology , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands
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Yatera K, Yamasaki K, Noguchi S, Nishida C, Oda K, Akata K, Kido T, Ishimoto H, Mukae H. Prevalence of sinusitis and efficacy of intranasal corticosteroid treatment on asthmatic symptoms in asthmatic patients with rhinosinusitis: a pilot study. Int Forum Allergy Rhinol 2015; 6:398-406. [PMID: 26625349 DOI: 10.1002/alr.21672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/14/2015] [Accepted: 10/02/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prevalence of sinusitis on sinus computed tomography (CT) in asthmatic patients and efficacy of intranasal corticosteroid treatment on asthmatic symptoms in asthmatic patients with rhinosinusitis on sinus CT is unclear. METHODS Sinus CT of asthmatic patients were evaluated using the Lund-Mackay system (LMS). Intranasal corticosteroid treatment (mometasone furoate) was newly added to symptomatic asthmatic patients with rhinosinusitis treated without intranasal corticosteroids, and the findings of the Asthma Control Test (ACT), Asthma Control Questionnaire in 5 items (ACQ5), spirometry, and sinus CT were evaluated before and 3 months after additional intranasal corticosteroid treatment. RESULTS In a total of 160 asthmatic patients, rhinosinusitis and maxillary, ethmoidal, sphenoidal, and frontal sinusitis were observed in 75.0%, 70.0%, 53.1%, 33.1%, and 28.8%, respectively. Nasal symptoms and rhinophonia were observed in 81.9% and 72.5%, respectively, and patients with nasal symptoms and those with rhinophonia both showed significantly higher LMS scores in each sinus. Chronic rhinosinusitis (CRS) was observed in 66.9%, and these patients had significantly more severe asthma than the patients without CRS. In patients with CRS, patients with rhinophonia showed significantly higher LMS scores than those without rhinophonia. ACT, ACQ5, and the value of the forced expiratory volume in 1 second (FEV1) all significantly improved 3 months after the additive intranasal corticosteroid treatment in 24 patients, despite the fact that their LMS scores remained unchanged. CONCLUSION Additive intranasal corticosteroid treatment may be an effective treatment option for symptomatic asthmatic patients with rhinosinusitis.
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Affiliation(s)
- Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Kei Yamasaki
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Shingo Noguchi
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Chinatsu Nishida
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Keishi Oda
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Kentarou Akata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Takashi Kido
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
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Mener DJ, Lin SY. Improvement and prevention of asthma with concomitant treatment of allergic rhinitis and allergen-specific therapy. Int Forum Allergy Rhinol 2015; 5 Suppl 1:S45-50. [PMID: 26072703 DOI: 10.1002/alr.21569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/05/2015] [Accepted: 05/11/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Asthma and allergic rhinitis are 2 of the most prevalent chronic medical diseases. Asthma is estimated to affect 8% of adults and 9% of children, with nearly 300 million people affected worldwide. Poorly controlled allergic rhinitis may be associated with worsening asthma symptoms over time. Various treatments have been proposed in the improvement and prevention of asthma in children and adults with allergic symptoms, which have included pharmacotherapy with antihistamines and topical intranasal corticosteroids, as well as allergen-specific immunotherapy. METHODS Articles were selected through PubMed and personal knowledge of the authors based on a comprehensive literature review examining whether treatment of allergic rhinitis improves and/or prevents concomitant symptoms of asthma. The largest and highest-quality studies were included in the literature review. The search selection was not standardized. Articles written in a language other than English were excluded. RESULTS Clinical trials have showed improvement in asthma symptoms with concomitant treatment of allergic rhinitis with antihistamines and topical intranasal corticosteroids, though improvement in objective pulmonary function parameters has not been uniformly demonstrated with antihistamine use alone. There is very strong evidence to suggest that subcutaneous and sublingual immunotherapy may in addition prevent the progression of asthma in high-risk atopic patients by inducing immunological tolerance. CONCLUSION Traditional pharmacotherapy with antihistamines and topical intranasal steroids has been shown to improve allergic rhinitis symptoms with concomitant allergic asthma; however, only allergen-specific immunotherapy offers long-term control in improving asthma symptoms, exacerbations, and likely ultimate prevention in developing asthma.
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Affiliation(s)
- David J Mener
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sandra Y Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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Hyperactivity and impulsivity in children with untreated allergic rhinitis: corroborated by rating scale and continuous performance test. Pediatr Neonatol 2014; 55:168-74. [PMID: 24211085 DOI: 10.1016/j.pedneo.2013.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/01/2013] [Accepted: 09/26/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Allergic rhinitis (AR) is the most common chronic allergic disease in school-age children. An increased prevalence of attention deficit hyperactivity disorder (ADHD) in AR patients has been reported; however, inattention and hyperactivity in AR children have not been investigated using objective and scientific measurements. METHODS We used AR symptom score, ADHD symptom scale, and computerized continuous performance test (CPT) to study the attention and impulsivity in AR children, age-matched controls, and ADHD children (aged 6-15 years). Univariate and multivariate linear regression analyses were applied to identify risk factors for impulsivity and inattention in AR children. RESULTS Twenty-nine controls, 10 ADHD, and 105 AR children were enrolled. There were no differences in age and sex among the three groups. The scores of Hyperactivity/Impulsivity subscales of ADHD symptoms from both parents and teachers were significantly higher in the AR children. The CPT in AR children revealed higher commission errors, shorter reaction times, and more perseveration. Risk factors for inattention and impulsivity in AR children included younger age, male sex, higher AR symptom scores, persistent AR, moderate/severe AR, multiple atopic diseases, family history of atopy, and possible comorbidity with ADHD. CONCLUSION Care for AR children should not only involve treating their allergy, but also monitoring the possible comorbidities of impulsivity and inattention. In children with impulsivity, AR should be considered in addition to ADHD.
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Oka A, Matsunaga K, Kamei T, Sakamoto Y, Hirano T, Hayata A, Akamatsu K, Kikuchi T, Hiramatsu M, Ichikawa T, Nakanishi M, Minakata Y, Yamamoto N. Ongoing allergic rhinitis impairs asthma control by enhancing the lower airway inflammation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 2:172-8. [PMID: 24607045 DOI: 10.1016/j.jaip.2013.09.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/03/2013] [Accepted: 09/04/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship between allergic rhinitis and asthma is well accepted; however, little is known about the mechanism that underlies the interactions between the upper and lower airways. OBJECTIVE To investigate the symptomatic and inflammatory linkages between allergic rhinitis and asthma in patients with atopy. METHODS We enrolled 520 patients with asthma who were taking inhaled corticosteroids, and examined them by using the Asthma Control Questionnaire, spirometry, exhaled nitric oxide fraction (FENO), visual analog scale for nasal symptoms, allergic rhinitis questionnaire, and serum specific IgE (study 1). The symptomatic and inflammatory marker responses to nasal corticosteroids in patients with incompletely controlled asthma (Asthma Control Questionnaire > 0.75) and moderate-to-severe persistent allergic rhinitis were also observed (study 2). RESULTS A total of 348 patients (66.9%) had atopy and allergic rhinitis. There was a striking difference in the proportion of patients with incomplete asthma control, depending on the presence as well as the activity of rhinitis (no rhinitis, 11.0%; mild intermittent, 20.4%; moderate-to-severe intermittent, 44.6%; mild persistent, 53.1%; moderate-to-severe persistent, 65.7%). The FENO levels were increased with the activity of rhinitis, and the nasal visual analog scale was positively correlated with the FENO levels (r = 0.31; P < .0001). The additive treatment with nasal corticosteroids improved the nasal visual analog scale, Asthma Control Questionnaire, and FENO levels, and the changes in these variables were correlated with each other in all parameters (all P < .001). CONCLUSION This observational study of patients with atopy indicates that the ongoing allergic rhinitis is related to worsening of asthma by enhancing the lower airway inflammation.
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Affiliation(s)
- Asako Oka
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kazuto Matsunaga
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
| | | | | | - Tsunahiko Hirano
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Hayata
- Division of Respiratory Medicine, Naga Hospital, Kinokawa, Japan
| | - Keiichiro Akamatsu
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kikuchi
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masataka Hiramatsu
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tomohiro Ichikawa
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masanori Nakanishi
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshiaki Minakata
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Nobuyuki Yamamoto
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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Lohia S, Schlosser RJ, Soler ZM. Impact of intranasal corticosteroids on asthma outcomes in allergic rhinitis: a meta-analysis. Allergy 2013; 68:569-79. [PMID: 23590215 DOI: 10.1111/all.12124] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2012] [Indexed: 11/27/2022]
Abstract
Given the relationship between allergic rhinitis (AR) and asthma, it can be hypothesized that reducing inflammation in the upper airway with intranasal corticosteroid (INCS) medications may improve asthma outcomes. The goal of this study was to perform a systematic review with meta-analysis of the efficacy of INCS medications on asthma outcomes in patients with AR and asthma. Asthma-specific outcomes from randomized, controlled studies evaluating INCS medications in patients with AR were evaluated, including studies that compared INCS sprays to placebo, INCS sprays plus orally inhaled corticosteroids to orally inhaled corticosteroids alone, and nasally inhaled corticosteroids to placebo. Sufficient data for meta-analysis were retrieved for 18 trials with a total of 2162 patients. Asthma outcomes included pulmonary function, bronchial reactivity, asthma symptom scores, asthma-specific quality of life, and rescue medication use. The subgroup of studies comparing INCS spray to placebo had significant improvements in FEV1 (SMD = 0.31; 95% CI, 0.04-0.58), bronchial challenge (SMD = 0.46; 95% CI, 0.12-0.79), asthma symptom scores (SMD = -0.42; 95% CI, -0.53 to -0.30), and rescue medication use (SMD = -0.29; 95% CI, -0.58 to -0.01). Nasal inhalation of corticosteroids significantly improved morning and evening peak expiratory flow. There were no significant changes in asthma outcomes with the addition of INCS spray to orally inhaled corticosteroids. Thus, the results of this meta-analysis demonstrated that intranasal corticosteroid medications significantly improve some asthma-specific outcome measures in patients suffering from both AR and asthma. This effect was most pronounced with INCS sprays when patients were not on orally inhaled corticosteroids, or when corticosteroid medications were inhaled through the nose into the lungs. Overall, intranasal corticosteroid medications improve some asthma-specific outcome measures in patients with both AR and asthma. Further research is needed to clarify the role of INCS sprays as asthma-specific therapy, as well as the role of the nasal inhalation technique as a monotherapy in patients suffering from both asthma and AR.
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Affiliation(s)
- S. Lohia
- Division of Rhinology and Sinus Surgery; Department of Otolaryngology - Head and Neck Surgery; Medical University of South Carolina; Charleston; SC; USA
| | - R. J. Schlosser
- Division of Rhinology and Sinus Surgery; Department of Otolaryngology - Head and Neck Surgery; Medical University of South Carolina; Charleston; SC; USA
| | - Z. M. Soler
- Division of Rhinology and Sinus Surgery; Department of Otolaryngology - Head and Neck Surgery; Medical University of South Carolina; Charleston; SC; USA
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Arshad SH, Dharmage SC, Ferreira F, Fixman ED, Gadermaier G, Hauser M, Sampson AP, Teran LM, Wallner M, Wardlaw AJ. Developments in the field of allergy in 2011 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2013. [PMID: 23181787 DOI: 10.1111/cea.12037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As in previous years, we felt it would be of value to our readership to summarize the new information provided by the authors who have published in Clinical and Experimental Allergy in 2011 and set this in the context of recent advances in our understanding of the pathogenesis and management of allergic disease in all its many manifestations. In 2011, about 210 articles were published in Clinical and Experimental Allergy including editorials, reviews, opinion articles, guidelines, letters, book reviews and of course at the heart of the journal, papers containing original data. As before, this review is divided into sections based on the way the journal is structured, although this year we have grouped together all the papers dealing with mechanisms of allergic disease, whether they involve patients (clinical mechanisms), pure in vitro studies (basic mechanisms) or animal models (experimental models), as we felt this was a more coherent way to deal with the subject. In the field of asthma and rhinitis, the relationship between airway inflammation and airway dysfunction was of perennial interest to investigators, as were phenotypes and biomarkers. Aspirin hypersensitivity appeared in studies in several papers and there was new interest in asthma in the elderly. The mechanisms involved in allergic disease describe advances in our understanding of T cell responses, the relationship between inflammation and disease, mast cell and basophil activation, steroid resistance and novel therapies. In the section dealing with epidemiology, studies seeking to identify risk factors for allergic disease including vitamin D are prominent, as once again are studies investigating gene-environment interactions. The clinical allergy section focuses on drug allergy, food allergy and immunotherapy. The area of oral immunotherapy for food allergy is well covered and we were grateful to Stephen Durham for guest editing an outstanding special issue on immunotherapy in the centenary year of Leonard Noon's pioneering work. Lastly, in the field of allergens, the interest in component-resolved diagnosis continues to grow and there are also articles describing important novel cultivars and the effect of food processing on the allergenic properties of foods. Another terrific year, full of important and high-quality work,which the journal has been proud to bring to the allergy community.
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Affiliation(s)
- S H Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
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Chauhan BF, Chartrand C, Ducharme FM. Intermittent versus daily inhaled corticosteroids for persistent asthma in children and adults. Cochrane Database Syst Rev 2013:CD009611. [PMID: 23450606 DOI: 10.1002/14651858.cd009611.pub3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Daily inhaled corticosteroids (ICS) are the recommended mainstay of treatment in children and adults with persistent asthma. However, often, ICS are used intermittently by patients or recommended by physicians to be used only at the onset of exacerbations. OBJECTIVES The aim of this review was to compare the efficacy and safety of intermittent versus daily ICS in the management of children and adults with persistent asthma and preschool-aged children suspected of persistent asthma. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register of trials (CAGR) and the ClinicalTrials.gov web site up to October 2012. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared intermittent ICS versus daily ICS in children and adults with persistent asthma. No co-interventions were permitted other than rescue relievers and oral corticosteroids used during exacerbations. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, methodological quality and extracted data. The primary efficacy outcome was the number of patients with one or more exacerbations requiring oral corticosteroids and the primary safety outcome was the number of patients with serious adverse health events. Secondary outcomes included exacerbations, lung function tests, asthma control, adverse effects, withdrawal rates and inflammatory markers. Equivalence was assumed if the risk ratio (RR) estimate and its 95% confidence interval (CI) were between 0.9 and 1.1. Quality of the evidence was assessed using GRADE. MAIN RESULTS Six trials (including one trial testing two relevant protocols) met the inclusion criteria for a total of seven group comparisons. The four paediatric trials (two involving preschool children and two school-aged children) and two adult parallel-group trials, lasting 12 to 52 weeks, were of high methodological quality. A total of 1211 patients with confirmed, or suspected, persistent asthma contributed to the meta-analyses. There was no statistically significant group difference in the risk of patients experiencing one or more exacerbations requiring oral corticosteroids (1204 patients; RR 1.07; 95% CI 0.87 to 1.32; the large confidence interval translates into a risk of exacerbations in the intermittent ICS group varying between 17% and 25%, assuming a 19% risk with daily ICS). Age, severity of airway obstruction, step-up protocol used during exacerbations and trial duration did not significantly influence the primary efficacy outcome. No group difference was observed in the risk of patients with serious adverse health events (1055 patients; RR 0.82; 95% CI 0.33 to 2.03). Compared to the daily ICS group, the intermittent ICS group displayed a smaller improvement in change from baseline peak expiratory flow rate (PEFR) by 2.56% (95% CI -4.49% to -0.63%), fewer symptom-free days (standardised mean difference (SMD) -0.15 (95% CI -0.28 to -0.03), fewer asthma control days -9% (95% CI -14% to -4%), more use of rescue β2-agonists by 0.12 puffs/day (95% CI 0 to 0.23) and a greater increase from baseline in exhaled nitric oxide of 16.80 parts per billion (95% CI 11.95 to 21.64). There was no significant group difference in forced expiratory volume in one second (FEV1), quality of life, airway hyper-reactivity, adverse effects, hospitalisations, emergency department visits or withdrawals. In paediatric trials, intermittent ICS (budesonide and beclomethasone) were associated with greater growth by 0.41 cm change from baseline (532 children; 95% CI 0.13 to 0.69) compared to daily treatment. AUTHORS' CONCLUSIONS In children and adults with persistent asthma and in preschool children suspected of persistent asthma, there was low quality evidence that intermittent and daily ICS strategies were similarly effective in the use of rescue oral corticosteroids and the rate of severe adverse health events. The strength of the evidence means that we cannot currently assume equivalence between the two options.. Daily ICS was superior to intermittent ICS in several indicators of lung function, airway inflammation, asthma control and reliever use. Both treatments appeared safe, but a modest growth suppression was associated with daily, compared to intermittent, inhaled budesonide and beclomethasone. Clinicians should carefully weigh the potential benefits and harm of each treatment option, taking into account the unknown long-term (> one year) impact of intermittent therapy on lung growth and lung function decline.
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Affiliation(s)
- Bhupendrasinh F Chauhan
- Clinical Research Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Canada.
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Profita M, Riccobono L, Bonanno A, Chanez P, Gagliardo R, Montalbano AM, Albano GD, Liotta G, Gjomarkaj M, La Grutta S. Effect of nebulized beclomethasone on airway inflammation and clinical status of children with allergic asthma and rhinitis: a randomized, double-blind, placebo-controlled study. Int Arch Allergy Immunol 2012; 161:53-64. [PMID: 23257680 DOI: 10.1159/000343137] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 08/31/2012] [Indexed: 11/19/2022] Open
Abstract
We aimed to evaluate the therapeutic effect of nebulized beclomethasone dipropionate (nBDP) on both allergic asthma and rhinitis. In a randomized, double-blind, placebo-controlled study, 40 children (mean age 10.7 ± 2.1 years) with allergic asthma and rhinitis received either nBDP (daily dose of 800 µg, administered twice daily) or placebo for 4 weeks (with a face mask), after a 2-week run-in period of clinical assessment. Nasal and oral fractional exhaled nitric oxide (FeNO) measurements together with pulmonary function tests, nasal and oral exhaled breath condensate (EBC) collection for pH and interleukin-5 (IL-5) measurements as well as nasal and bronchial symptom scores were obtained at baseline and after 4-week treatment. A significant improvement in oral FeNO, oral and nasal EBC IL-5 and nasal EBC pH was observed in the nBDP group when comparing the values with baseline, together with an improvement in symptom score of the visual analogue scale, nasal obstruction, sneezing, rhinorrhea, breathing difficulty, cough, wheezing and sleep disturbance (nBDP end treatment vs. baseline, Wilcoxon signed-rank test). nBDP was more effective than placebo (ANCOVA test) in improving [difference Δ = response after treatment at the last visit (active or placebo) - value at baseline] nasal pH, oral IL-5, oral FeNO, forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity, peek expiratory flow, visual analogue scale, breathing difficulty, cough, wheezing and sleep disturbance scores. No differences were observed between the nBDP and the placebo group for symptom score of rhinitis. nBDP is a useful treatment for airway inflammation and clinical status in children with concomitant allergic asthma and rhinitis.
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Affiliation(s)
- Mirella Profita
- Unit Ex vivo/in vitro Models to Study Immunopathology and Pharmacology of Airway Diseases, Institute of Biomedicine and Molecular Immunology, Italian National Research Council, Palermo, Italy.
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Chauhan BF, Chartrand C, Ducharme FM. Intermittent versus daily inhaled corticosteroids for persistent asthma in children and adults. Cochrane Database Syst Rev 2012; 12:CD009611. [PMID: 23235678 DOI: 10.1002/14651858.cd009611.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Daily inhaled corticosteroids (ICS) are the recommended mainstay of treatment in children and adults with persistent asthma. Yet often, ICS are used intermittently by patients or recommended by physicians to be used only at the onset of exacerbations. OBJECTIVES The aim of this review was to compare the efficacy and safety of intermittent versus daily ICS in the management of children and adults with persistent asthma and preschool-aged children suspected of persistent asthma. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register of trials (CAGR) and the ClinicalTrials.gov website up to December 2011. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared intermittent ICS versus daily ICS in children and adults with persistent asthma. No co-interventions were permitted other than rescue relievers and oral corticosteroids used during exacerbations. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, methodological quality and extracted data. The primary efficacy outcome was the number of patients with one or more exacerbations requiring oral corticosteroids and the primary safety outcome was the number of patients with serious adverse health events. Secondary outcomes included exacerbations, lung function tests, asthma control, adverse effects, withdrawal rates and inflammatory markers. Equivalence was assumed if the risk ratio (RR) estimate and its 95% confidence interval (CI) were between 0.9 and 1.1. MAIN RESULTS Six trials (including one trial testing two relevant protocols) met the inclusion criteria for a total of seven group comparisons. The four paediatric trials (two involving preschool children and two school-aged children) and two adult parallel-group trials, lasting 12 to 52 weeks, were of high methodological quality. A total of 1211 patients with confirmed, or suspected, persistent asthma contributed to the meta-analyses. There was no statistically significant group difference in the risk of patients experiencing one or more exacerbations requiring oral corticosteroids (1204 patients; RR 1.07; 95% CI 0.87 to 1.32). The patients' age, severity of airway obstruction, step-up protocol used during exacerbations and trial duration did not significantly influence the primary efficacy outcome. No group difference was observed in the risk of patients with serious adverse health events (1055 patients; RR 0.82; 95% CI 0.33 to 2.03). Compared to the daily ICS group, the intermittent ICS group displayed a smaller improvement in change from baseline peak expiratory flow rate (PEFR) by 2.56% (95% CI -4.49% to -0.63%), fewer symptom-free days (standardised mean difference (SMD) -0.15 (95% CI -0.28 to -0.03), fewer asthma control days -9% (95% CI -14% to -4%), more use of rescue β(2)-agonists by 0.12 puffs/day (95% CI 0 to 0.23) and a greater increase from baseline in exhaled nitric oxide of 16.80 parts per billion (95% CI 11.95 to 21.64). There was no significant group difference in forced expiratory volume in one second (FEV(1)), quality of life, airway hyper-reactivity, adverse effects, hospitalisations, emergency department visits or withdrawals. In paediatric trials, intermittent ICS (budesonide and beclomethasone) were associated with greater growth by 0.41 cm change from baseline (532 children; 95% CI 0.13 to 0.69) compared to daily treatment. AUTHORS' CONCLUSIONS In children and adults with persistent asthma and in preschool children suspected of persistent asthma, intermittent and daily ICS strategies did not significantly differ in the use of rescue oral corticosteroids and the rate of severe adverse health events, neither did they reach equivalence. Daily ICS was superior to intermittent ICS in several indicators of lung function, airway inflammation, asthma control and reliever use. Both treatments appeared safe, but a modest growth suppression was associated with daily, compared to intermittent, inhaled budesonide and beclomethasone. The clinician should carefully weigh the potential benefits and harm of each treatment option, taking into account the unknown long-term (> one year) impact of intermittent therapy on lung growth and lung function decline.
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Affiliation(s)
- Bhupendrasinh F Chauhan
- Clinical Research Unit on Childhood Asthma, Research Centre, CHU Sainte-Justine, Montreal, Canada.
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Cheng X, Lou W, Wang C, Zhang W, Han D, Zhang L. FOXP3-marked IL-17a-producing regulatory T cells are increased in patients with allergic rhinitis. Acta Otolaryngol 2012; 132:1311-7. [PMID: 22992221 DOI: 10.3109/00016489.2012.709320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The deficient regulatory T cells may play a role in the development of allergic rhinitis. OBJECTIVE A subpopulation of regulatory T cell that produce IL-17a were proved to show an apparent duality of regulatory T cell and effector T helper-17 cells. We studied this subpopulation in patients with allergic rhinitis. METHODS Fresh whole blood from 20 patients with allergic rhinitis and 19 healthy donors was used to investigate the frequencies of CD4(+)IFN-γ(+) T cells (effector T helper-1), CD4(+)IL-4(+) T cells (effector T helper-2) and CD4(+)IL-17a(+) T cells (effector T helper-17) by flow cytometry after stimulation for 4-6 h. Simultaneously, CD4(+) T lymphocytes were isolated from peripheral blood mononuclear cells and then the frequencies of regulatory T cells and IL-17a-producing regulatory T cells in the allergic rhinitis group were compared with healthy controls after T-cell antigen receptor stimulation for 48 h. The suppressive capacity of CD4(+)CD25(high)CD127(low) regulatory T cells that were stimulated by Dermatophagoides pteronyssinus in both groups was isolated and assessed. RESULTS The frequencies of effector T helper-17 and effector T helper-2 cells were higher in the allergic group compared with healthy controls. Regulatory T cells were similar in both groups, but IL-17a-producing regulatory T cells were increased in the allergic group. In addition, the capacity of regulatory T cells to suppress effector T helper-17 cytokine production was significantly decreased in the allergic group.
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Affiliation(s)
- Xiang Cheng
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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Braido F, Baiardini I, Stagi E, Scichilone N, Rossi O, Lombardi C, Ridolo E, Gani F, Balestracci S, Girbino G, Senna GE, Bordo A, Church MK, Canonica GW. RhinAsthma patient perspective: a short daily asthma and rhinitis QoL assessment. Allergy 2012; 67:1443-50. [PMID: 22978345 DOI: 10.1111/all.12014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 01/30/2023]
Abstract
BACKGROUND The present study aimed to develop a short validated patient-completed questionnaire, the RhinAsthma Patient Perspective (RAPP), to assess the health-related quality of life (HRQoL) in patients with asthma and comorbid allergic rhinitis in clinical practice. METHODS A provisional RAPP questionnaire was formed from candidate items identified through retrospective analysis of 333 RHINASTHMA questionnaires. This was then tested on 150 asthma patients with allergic rhinitis. RESULTS Psychometric analyses identified eight items fitting a unidimensional model to form RAPP. Internal consistency (Cronbach's alpha coefficient > 0.8) and agreement with RHINASTHMA (r = -0.31, P = 0.0001) were excellent. Criterion, discriminant, and convergent validity were good. Reliability in 47 stable patients was very good (intra-class and concordance correlation coefficients were 0.90 and 0.89, respectively). Responsiveness in 103 patients with health improvement or deterioration was significantly associated with changes in Global Rating Scale (r = -0.4965, P < 0.01), Rhinitis Visual Analogue Scale (r = 0.5722, P < 0.01) and asthma control test (r = -0.6483, P < 0.01). Minimal clinical difference in the analyzed population was 2. CONCLUSION RhinAsthma Patient Perspective is a simple eight-question questionnaire with good measurement properties and sensitivity to health changes, which will provide a valid, reliable and standardized HRQoL measurement in patients with asthma and comorbid allergic rhinitis in clinical practice.
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Affiliation(s)
- F. Braido
- Allergy and Respiratory Diseases Clinic; University of Genoa; IRCCS-AOU San Martino; Genova; Italy
| | - I. Baiardini
- Allergy and Respiratory Diseases Clinic; University of Genoa; IRCCS-AOU San Martino; Genova; Italy
| | - E. Stagi
- Epidemiology, Biostatistics and Clinical trials; National Cancer Research Institute; Genoa; Italy
| | - N. Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica; University of Palermo; ‘Villa Sofia-Cervello’ Hospital; Palermo; Italy
| | - O. Rossi
- Operative Immunoallergy Unit; A.O.U. Careggi; Florence; Italy
| | - C. Lombardi
- Pneumoallergology Unit; S. Orsola FBF Hospital; Brescia; Italy
| | - E. Ridolo
- Clinical Sciences; University of Parma; Parma; Italy
| | - F. Gani
- Allergy Unit; Respiratory Diseases Division; A.O.U. San Luigi; Torino; Italy
| | - S. Balestracci
- Allergy and Respiratory Diseases Clinic; University of Genoa; IRCCS-AOU San Martino; Genova; Italy
| | - G. Girbino
- Respiratory Department; University Hospital; Messina; Italy
| | - G. E. Senna
- Allergy Service; Verona Major Hospital; Verona; Italy
| | - A. Bordo
- Allergy and Respiratory Diseases Clinic; University of Genoa; IRCCS-AOU San Martino; Genova; Italy
| | - M. K. Church
- Department of Dermatology and Allergy; Allergy Centre Charité; Charité-Universitätsmedizin Berlin; Berlin; Germany
| | - G. W. Canonica
- Allergy and Respiratory Diseases Clinic; University of Genoa; IRCCS-AOU San Martino; Genova; Italy
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Scadding G, Walker S. Poor asthma control?--then look up the nose. The importance of co-morbid rhinitis in patients with asthma. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:222-8. [PMID: 22643359 DOI: 10.4104/pcrj.2012.00035] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Many factors can impair asthma control. One which is frequently overlooked is rhinitis. Asthma patients with significant rhinitis are over four times more likely to have poorly controlled asthma than those without. Over 80% of patients with asthma have rhinitis, which may be allergic or inflammatory/non-allergic. Both types of rhinitis share pathophysiological similarities with eosinophilic asthma, cause bronchial hyper-reactivity, and are predisposing factors for the subsequent development of asthma. Nasal allergen challenge in allergic rhinitis results in inflammation in the bronchi as well as the nose, and the reverse is also true. This article reviews briefly the evidence for the link between asthma and rhinitis, advocates looking for rhinitis when patients present with poorly controlled asthma, and provides guidance for the diagnosis and treatment of rhinitis.
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Affiliation(s)
- Glenis Scadding
- The Royal National Throat, Nose and Ear Hospital, London, UK.
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Makihara S, Okano M, Fujiwara T, Kimura M, Higaki T, Haruna T, Noda Y, Kanai K, Kariya S, Nishizaki K. Early interventional treatment with intranasal mometasone furoate in Japanese cedar/cypress pollinosis: a randomized placebo-controlled trial. Allergol Int 2012; 61:295-304. [PMID: 22441634 DOI: 10.2332/allergolint.11-oa-0382] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 11/19/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Little is known about the safety and effectiveness of early interventional treatment (EIT) with intranasal corticosteroids for seasonal allergic rhinitis. We designed a double-blinded, randomized, placebo-controlled 12-week trial of EIT with mometasone furoate nasal spray (MFNS) for Japanese cedar/cypress pollinosis (JCCP). METHODS A total of 50 JCCP patients received MFNS (200μg once daily: n = 25) or placebo (n = 25) starting on February 1, 2010. Treatments continued until the end of April. The primary endpoint was the comparison of the total nasal symptom score (TNSS) between the MFNS and placebo groups. The secondary endpoints included comparisons of QOL, daytime sleepiness, nasal ECP levels, and safety. RESULTS Continuous dispersion of Japanese cedar pollen began on February 22. Although the placebo group showed a significant worsening of symptoms after the start of the continuous dispersion, no worsening occurred in the MFNS group. A significant difference in the TNSS between the two groups was seen starting at 4 weeks after the treatment. Similar results were seen for QOL and sleepiness. Nasal ECP levels in March were significantly lower in the MFNS group. A total of 56% of the MFNS group progressed to a persistent allergic rhinitis state in accordance with the ARIA classification, as opposed to 84% of the placebo group. MFNS was well tolerated, and the plasma cortisol concentrations were similar between the two groups. CONCLUSIONS EIT with MFNS for JCCP is both safe and effective. This treatment can potentially lessen symptoms and help pollinosis patients remain in the intermittent state.
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Affiliation(s)
- Seiichiro Makihara
- Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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