支气管哮喘患者合并变应性鼻炎的临床调查

目的调查支气管哮喘患者中变应性鼻炎的发生率,并对其临床诊治现状作初步分析。方法连续调查98例确诊的哮喘患者,详细了解其临床表现及诊治现状,并对所得数据进行统计学分析。结果 98例哮喘患者中63例（64.3%）并发变应性鼻炎,其中54例（85.7%）被误认为系反复感冒者。哮喘合并变应性鼻炎组（63例）和单纯哮喘组（35例）在年龄、病程等方面差异无显著性（P〉0.05）。仅在9例变应性鼻炎患者中有6例间断使用过鼻喷皮质类固醇激素治疗。结论较多的哮喘患者合并变应性鼻炎,及反复误诊提示应关注哮喘合并变应性鼻炎的诊治。当前对哮喘合并变应性鼻炎的诊治关注不足。     

Simultaneous treatment of asthma and allergic rhinitis

Asthma and allergic rhinitis (AR) form a well-recognized comorbidity. This study aims at assessing the efficacy of nasally inhaled beclomethasone dipropionate (BDP) in their simultaneous treatment. A randomized controlled trial was conducted with 78 allergic rhinitis and asthma patients aged 5-17 years. Seventy-five individuals completed the study. During 8 weeks, 38 subjects received BDP-CFC aerosol (>or= 500 mcg/day) exclusively via nasal inhalation through a facemask attached to a plastic valved spacer. The control group (37 patients) received 200 mcg/day of aqueous intranasal beclomethasone plus oral inhalation of BDP-CFC (>or= 500 mcg/day) through a mouthpiece connected to the same spacer. Primary outcomes analyzed in order to assess the response to treatment were clinical scoring for allergic rhinitis and measurements of nasal inspiratory peak flow (NIPF). AR clinical scoring and NIPF did not differ in the two groups at admission or at nearly all follow-up visits. Nasal inhalation of beclomethasone dipropionate provides AR symptom relief while maintaining control of asthma by delivering it to the lungs. Therefore, this therapeutic strategy might be considered for patients suffering from this comorbidity, especially in low-resource countries, since it is less expensive than the conventional treatment.     

Skin prick test reactivity to common aeroallergens in asthmatic patients with and without rhinitis

OBJECTIVE: The aim of this study was to investigate the prevalence of skin prick test (SPT) reactivity to common aeroallergens among Malaysian asthmatic patients with and without rhinitis. METHODOLOGY: An SPT using eight aeroallergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, cat fur, cockroach, Acacia sp., Bermuda grass, Aspergillus fumigatus and Aspergillus niger) was performed on 206 asthmatic patients. RESULTS: One hundred and forty patients (68%) were reactive to at least one of the aeroallergens. Among the SPT-positive patients, a positive prick test reaction to the house dust mites, D. pteronyssinus (93.6%), and D. farinae (81.4%) was most common, followed by cat fur (20.0%), cockroach (7.9%), Bermuda grass (7.9%), Acacia sp. (7.9%), A. fumigatus (0.7%) and A. niger (0.7%). A history of rhinitis was elicited in 111 (53.9%) patients and 95 (85.3%) of these patients were SPT-positive compared with only 45 (47.4%) of 95 patients with asthma symptoms alone (P < 0.001). The presence of rhinitis and a young age of onset of asthma were independent factors for positive SPT reaction to at least one of the aeroallergens. CONCLUSIONS: The prevalence of SPT reactivity to common aeroallergens is high among Malaysian asthmatics, particularly in those with an early age of onset and in those with coexisting rhinitis.     

Randomized placebo‐controlled trial of lactobacillus on asthmatic children with allergic rhinitis

Previous studies have suggested that probiotic administration may have therapeutic and/or preventive effects on atopic dermatitis in infants; however, its role in allergic airway diseases remains controversial. To determine whether daily supplementation with specific Lactobacillus gasseri A5 for 8 weeks can improve the clinical symptoms and immunoregulatory changes in school children suffering from asthma and allergic rhinitis (AR). We conducted a randomized, double‐blind, placebo‐controlled study on school children (age, 6–12 years) with asthma and AR. The eligible study subjects received either L. gasseri A5 (n = 49) or a placebo (n = 56) daily for 2 months. Pulmonary function tests were performed, and the clinical severity of asthma and AR was evaluated by the attending physicians in the study period. Diary cards with records of the day‐ and nighttime peak expiratory flow rates (PEFR), symptoms of asthma, and AR scores of the patients were used for measuring the outcome of the treatment. Immunological parameters such as the total IgE and cytokine production by the peripheral blood mononuclear cells (PBMCs) were determined before and after the probiotic treatments. Our results showed the pulmonary function and PEFR increased significantly, and the clinical symptom scores for asthma and AR decreased in the probiotic‐treated patients as compared to the controls. Further, there was a significant reduction in the TNF‐α, IFN‐γ, IL‐12, and IL‐13 production by the PBMCs following the probiotic treatment. In conclusion, probiotic supplementation may have clinical benefits for school children suffering from allergic airway diseases such as asthma and AR. Pediatr Pulmonol. 2010;45:1111–1120. © 2010 Wiley‐Liss, Inc.     

Prediction of atopy by skin prick tests in patients with asthma and/or persistent rhinitis

BackgroundPatient history gives important clues about the likelihood of atopy. However, the accuracy of assessment of atopy based on detailed allergy history is low. The objective of this survey was to determine the successful prediction rate of atopy by a questionnaire and the effect of various factors on the successful prediction.MethodsA standard questionnaire including detailed allergy history was filled in by two experienced allergists for 169 patients having bronchial asthma and/or persistent rhinitis symptoms. Skin prick test (SPT) results were predicted based on the clinical data obtained by a questionnaire. Final diagnosis was made after SPT. Sensitivity and specificity analysis of SPT results prediction was investigated using two different cut-off values (3 mm and 5 mm) for positive tests, and factors associated with successful atopy prediction were analysed.ResultsSPT was predicted to be positive in 42.6% and was positive in 36.1%. Depending on SPT results with the cut-off value 3 mm, prediction sensitivity was 77%, specificity was 65.3%, positive predictive value was 65%, and negative predictive value was 86%. Successful positive atopy prediction was associated with age; true negative prediction was also associated with age and high education. With the threshold of 5 mm for a positive test, sensitivity, specificity, positive and negative predicted values were 91%, 61%, 14% and 99%, respectively.ConclusionIt seems that the success rate of detailed history is high for negative prediction. However, detailed history alone does not seem to be efficient for atopy prediction.     

Experimental and seasonal exposure to birch pollen in allergic rhinitis and allergic asthma with regard to the inflammatory response

Background and Aims: Seasonal allergy is an interesting model to study the pathophysiological mechanisms involved in allergic inflammation. However, experimental allergen exposure is easier to perform and standardise. The primary aim of this study was to compare the inflammatory responses to high‐dose bronchial challenge and natural exposure during birch pollen season. The second aim was to compare the responses of patients with allergic rhinitis and allergic asthma, respectively to both types of allergen exposure. Methods: Fifteen birch pollen‐allergic patients (seven with asthma and eight with rhinitis) and five healthy individuals were studied during pollen season and after challenge with birch allergen. Symptoms, medication and peak expiratory flow rate (PEFR) were recorded, and blood samples, spirometry and induced sputum were analysed during season and after challenge. Results: Patients with allergic asthma demonstrated a greater bronchial responsiveness to bronchial provocation with birch allergen than patients with rhinitis (P = 0.04) whereas no difference was found regarding nasal challenge. No significant association was found between the level of responsiveness and the inflammatory response after seasonal exposure. Seasonal exposure was related to a more marked systemic inflammatory blood–eosinophil increase than bronchial challenge [(median) (0.25 vs 0.11 × 109/L, P = 0.03)] and after nasal challenge, respectively [(median) (0.25 vs 0.04 × 109/L, P = 0.003)]. A significant correlation in eosinophil cationic protein in induced sputum was found between the experimental and seasonal exposure (rho = 0.62, P = 0.02). Conclusions: Bronchial allergen challenge with inhalation of birch pollen gives a similar inflammatory response in the airway but less systemic inflammation than seasonal exposure in birch pollen allergic patients with asthma and rhinitis. Please cite this paper as: Kämpe M, Janson C, Stålenheim G, Stolt I and Carlson M. Experimental and seasonal exposure to birch pollen in allergic rhinitis and allergic asthma with regard to the inflammatory response. The Clinical Respiratory Journal 2009; DOI:10.1111/j.1752‐699X.2009.00140.x.     

经鼻吸入布地奈德治疗过敏性鼻炎-哮喘综合征

目的最近世界变态反应组织提出了过敏性鼻炎-哮喘综合征（combined allergic rhinitis and asthma syndrome,CARAS）这一新的诊断术语。同时指出上、下呼吸道疾病需要进行联合诊断和联合治疗。采用了鼻-口两用雾化器（spacer）,分别经口或经鼻吸入糖皮质激素治疗CARAS患者,以评价经鼻吸入糖皮质激素在防治CARAS的价值。方法采用鼻-口两用雾化器（商品名：吸保）吸入布地奈德气雾剂治疗86例CARAS患者,随机将患者分为经口吸入组和经鼻吸入组,同时观察了两组治疗前后的鼻部症状记分、胸部症状记分、肺功能和气道反应性。结果鼻吸组与口吸组均可显著改善胸部症状、肺通气功能,降低气道高反应性。治疗前后差异有统计学意义（P〈0．01）,两组间比较差异无统计学意义,但在改善鼻部症状记分方面鼻吸组明显优于口吸组（P〈0．01）。结论与口腔吸入比较,经鼻吸入给予布地奈德气雾剂是一种既可控制过敏性鼻炎,又可防治哮喘的治疗方法,应在伴有过敏性鼻炎的哮喘和CARAS患者的防治中推荐使用。     

经鼻吸入布地奈德治疗过敏性鼻炎-哮喘综合征

目的 最近世界变态反应组织(WAO)提出了过敏性鼻炎-哮喘综合征(combined allergic rhinitis and asthma syndrome,CARAS)这一新的诊断术语.同时指出上、下呼吸道疾病需要进行联合诊断和联合治疗.采用了鼻-口两用雾化器(spacer),分别经口或经鼻吸入糖皮质激素治疗CARAS患者,以评价经鼻吸入糖皮质激素在防治CARAS的价值.方法 采用鼻-口两用雾化器(商品名:吸保)吸入布地奈德气雾剂治疗86例CARAS患者,随机将患者分为经口吸入组和经鼻吸入组,同时观察了两组治疗前后的鼻部症状记分、胸部症状记分、肺功能和气道反应性.结果 鼻吸组与口吸组均可显著改善胸部症状、肺通气功能,降低气道高反应性.治疗前后差异有统计学意义(P＜0.01),两组间比较差异无统计学意义(P＞0.05),但在改善鼻部症状记分方面鼻吸组明显优于口吸组(P＜0.01).结论 与口腔吸入比较,经鼻吸入给予布地奈德气雾剂是一种既可控制过敏性鼻炎,又可防治哮喘的治疗方法,应在伴有过敏性鼻炎的哮喘和CARAS患者的防治中推荐使用.     

256例过敏性鼻炎-哮喘综合征问卷调查分析

目的 了解过敏性鼻炎-哮喘综合征(combined allergic rhinitis and asthma syndrome,CARAS)的诊断及治疗现状,总结CARAS诊疗过程中存在的问题,提高临床医师对CARAS的认识和诊治水平.方法 2011年10月至2012年6月,重庆医科大学附属第一医院收集支气管哮喘(bronchial asthma,BA)患者155例,过敏性鼻炎(allergic rhinitis,AR)患者101例,共256例.通过笔答问卷的方式,了解BA和AR患者中合并上呼吸道和下呼吸道症状的比率、两种疾病目前的诊断和治疗情况.结果 BA患者中合并AR症状的比率为72.3％ (112/155),确诊为AR的仅占33.5％(52/155).AR患者中合并BA症状的比率为35.6％ (36/101),确诊为BA的仅占10.9％ (11/101).联合诊断BA和AR的人数仅占调查总人数的25.0％ (63/256),同时合并上、下呼吸道症状的患者进行规范联合治疗患者仅占13.5％ (20/148).导致患者未规律联合治疗最主要的原因是医师未告知患者联合治疗的重要性.结论 大部分BA患者都合并有AR,AR患者中也有相当一部分可能合并BA,但绝大部分CARAS患者均未得到准确诊断和规范的联合治疗,治疗现状不容乐观.临床医师应建立“同一气道,同一疾病”的观念,并掌握正确的协同诊治方法,同时加强对CARAS患者的健康教育和随访管理,提高患者的依从性,才能提高治疗效果.     

Occurrence and impact of sinusitis in patients with asthma and/or allergic rhinitis

Objective: The occurrence of radiological sinusitis in patients with asthma without any obvious nasal symptoms could possibly increase the severity of asthma. We investigated the occurrence and impact of sinusitis on computed tomography of the paranasal sinuses (CT-PNS) in patients with asthma and/or allergic rhinitis. Effect of sinusitis on the quality of life (QoL) was also assessed. Methods: All subjects underwent spirometry with reversibility, CT-PNS, intradermal test against common aeroallergens and responded to Symptom Severity Score and Rhinosinusitis Disability Index (RSDI). Of the 216 consecutive patients, 27 had asthma without nasal symptoms (Group 1), 58 had asthma with allergic rhinitis (Group 2) and 131 had allergic rhinitis (Group 3). Thirty normal healthy controls without atopy were also included (Group 4). Results: 20/27 (74%) patients in Group 1 had sinusitis on CT-PNS. 48/58 (82%) patients in Group 2 and 88/131 (67%) patients in Group 3 had chronic rhinosinusitis (CRS) as confirmed on CT-PNS. 6/30 (20%) healthy controls in Group 4 had mucosal thickening. Asthmatics with radiological sinusitis in Group 1 and with CRS in Group 2 had significantly lower FEV1, FEV1/FVC ratio, were more symptomatic and had a greater impairment of QoL. The mean sinus severity score was significantly higher in Group 2. In Group 3, sinusitis occurred significantly higher in “blockers” than “sneezers-runners” (41/79 versus 47/52, p = 0.045). Conclusions: Occurrence of radiological sinusitis on CT-PNS in asthmatics without nasal symptoms and CRS in allergic rhinitis with or without asthma increases the severity of the disease and affects the QoL.     

The relation between physician-diagnosed sinusitis,asthma, and skin test reactivity to allergens in 8-year-old children

The purpose of this study was to assess the prevalence of sinusitis in a nonselected sample of children, and the relation of sinusitis to allergic rhinitis (AR), atopy, asthma, and cough in the same population sample. Of 1246 children enrolled at birth in the Tucson Children's Respiratory Study, 835 were studied at a mean age ± SD of 8.6 ± 0.7 years. Questionnaires asking about MD-Sinusitis, MD-AR, MD-Asthma, and cough were completed by parents. Skin tests for seven common aeroallergens in the Tucson area had been performed in 630 of the participating children at the mean age ± SD of 6.3 ± 0.9 years. Prevalence of MD-Sinusitis was 13.1%; 78% of subjects with MD-Sinusitis also had MD-AR. Detailed analysis of the relation between MD-Sinusitis and individual environmental allergens tested for showed that only a response to Bermuda grass pollen was significantly associated with MD-Sinusitis after controlling for MD-AR [adjusted odds ratio 2.3 (95% Cl 1.2–4.3)]. Having MD-Sinusitis was also significantly associated with MD-Asthma and cough [odds ratios 3.0 (95% Cl 1.8–5.2)] and 2.5 (95% Cl 1.6–3.8), [respectively]. However, logistic regression demonstrated that, after controlling for MD-AR and skin test reactivity, MD-Sinusitis was no longer significantly associated with MD-Asthma or cough. We conclude that MD-Sinusitis is a common condition in childhood. The main independent risk factors in our community for MD-Sinusitis were grass pollen and current MD-AR. MD-Sinusitis was not associated with MD-Asthma or with cough after controlling for skin test reactivity and for MD-AR. Pediatr Pulmonol. 1996; 22:141–146. © 1996 Wiley-Liss, Inc.     

The correlation between FeNO and nNO in allergic rhinitis and bronchial asthma

This study aimed to evaluate the correlation between fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) in allergic rhinitis (AR) and patients with or without bronchial asthma (BA).A total of 90 patients who were diagnosed with persistent AR (AR group, n = 30), BA (BA group, n = 30), or allergic rhinitis with bronchial asthma (AR-BA) (AR-BA group, n = 30), were enrolled in this study, along with 30 healthy adult volunteers (control group, n = 30). The participants were further divided into 2 groups based on the results of a skin-prick test (SPT): a highly atopic group (SPT = 3+ and above) and a moderately atopic group (SPT = 2+ and below). All participants underwent FeNO and nNO measurement, an absolute blood eosinophil count, total serum immunoglobulin measurement, and horizontal baseline lung capacity determination.The results showed that the FeNO levels in the 3 observation groups were significantly higher than those in the control group (P < .01), and in the BA group they were significantly higher than in the AR-BA group (P < .01). The levels of nNO in both the AR group and the AR-BA group were higher than those in the control group and the BA group (P < .01), but there was no significant difference between the AR group and the AR-BA group (P > .05). The levels of nNO in the BA group were also significantly different from those in the control group (P < .01).FeNO and nNO are positively correlated with the degree of AR in patients with BA; therefore, nNO levels can be used as an inflammatory marker of AR in patients with BA. FeNO can also be used as an inflammatory marker of AR in patients complicated with BA as a warning indicator of asthma.     

变应性鼻炎与支气管哮喘患者的肺功能改变

目的 通过对变应性鼻炎(A组)与支气管哮喘患者(B组)及健康对照组(C组)进行肺功能检测,寻找两种疾病肺功能改变的意义.方法 采用美国Sensor-Medics6200体描箱对A、B、C组患者检测肺功能有关指标.结果 A、B两组V25％ 、V50％明显降低,与C组比较,差异显著(P＜0.01)；A组V50％与B组比较,有意义地增高(P＜0.05)；B组RV明显增高,与A、C组比较,差异显著(P＜0.01)；A、B两组Raw与C组比较,有意义地增高(P ＜0.05)；FVE1％:B组低于C组(P＜0.05),而A组与C组及A组与B组对照均无明显差异(P＞0.05)；DLCO％:B组高于A及C两组(P＜0.05).结论 两组患者对肺功能影响相似,主要是小气道阻塞,只是哮喘组影响强.     

过敏性鼻炎-哮喘综合征的临床经济学研究

目的 明确过敏性鼻炎-哮喘综合征(combined allergic rhinitis and asthma syndrome,CARAS)这一新的医学诊断术语.从临床经济学角度出发,对经鼻吸入糖皮质激素对CARAS联合治疗与传统的采用鼻喷雾剂和口喷雾剂分别治疗的成本/效果比(C/E)进行研究比较.方法 哮喘门诊中随机选择CARAS患者74例,随机分为两组.其中一组为联合治疗组,采用经鼻吸入糖皮质激素喷雾剂进行治疗;另一组为传统治疗组,采用鼻喷雾剂和口喷雾剂分别进行治疗,疗程3个月.分别计算两组治疗的总费用(C),治疗后鼻部症状改善总评分(E1)、胸部症状改善总评分(E2)和PEFR增加值(E3),分别计算联合治疗组和传统治疗组的C/E1,C/E2和C/E3.结果 C/E1,联合组为8.194,传统组为17.499;C/E2,联合组为9.001,传统组为15.432;C/E3,联合组为8.489,传统组为15.867.结论 联合治疗组和传统治疗组在临床疗效基本相同的情况下,联合治疗组3个指标的C/E都远远低于传统治疗组的C/E,联合治疗这一新的治疗方式更具有临床经济学意义.     

过敏性鼻炎-哮喘综合征的临床经济学研究

目的明确过敏性鼻炎一哮喘综合征（combinedallergicrhinitisandasthmasyndrome,CARAs）这一新的医学诊断术语。从临床经济学角度出发,对经鼻吸入糖皮质激素对CARAS联合治疗与传统的采用鼻喷雾剂和口喷雾剂分别治疗的成本／效果比（C／E）进行研究比较。方法哮喘门诊中随机选择CARAS患者74例,随机分为两组。其中一组为联合治疗组,采用经鼻吸入糖皮质激素喷雾剂进行治疗;另一组为传统治疗组,采用鼻喷雾剂和口喷雾剂分别进行治疗,疗程3个月。分别计算两组治疗的总费用（C）,治疗后鼻部症状改善总评分（E1）、胸部症状改善总评分（E2）和PEFR增加值（E3）,分别计算联合治疗组和传统治疗组的C／E1,C／E2和C／E3。结果C／E1,联合组为8．194,传统组为17．499;C／E2,联合组为9．001,传统组为15．432;C／E3,联合组为8．489,传统组为15．867。结论联合治疗组和传统治疗组在临床疗效基本相同的情况下,联合治疗组3个指标的C／E都远远低于传统治疗组的C／E,联合治疗这一颓的治疗方式更具有临床经济学意义。     

The natural course of atopy determined by skin prick tests in patients with bronchial asthma and/or rhinitis

BackgroundThe skin prick test (SPT) is the cheapest, most widely used and practical method for the diagnosis of allergic diseases. The results of repeat test might show variations due to aging.ObjectiveTo perform repeat SPTs to determine possible changes in the atopy rate in general as well as changes in the allergen spectrum of atopic patients occurring over time and to identify the factors that could affect this change.MethodsA total of 222 patients who received a diagnosis of bronchial asthma and/or persistant rhinitis in our Adult Allergy Unit and who attended follow-up visits in the outpatient unit over a 2-year period were enrolled. SPT with 10 visit common aeroallergens were performed at the first and the second test was performed after an interval of at least 2 years.ResultsThe mean age was 36.4 ± 11.4 years and 77.5 % of the patients were women. The mean interval between the two tests was 43.4 ± 20.0 (minimum = 24-maximum = 105) months. Repeat tests showed that the atopy rate decreased from 58.6% to 47.7 %; sensitivity rates to 10 allergens also decreased. These differences were statistically significant (p < 0.05).ConclusionThe atopy rate determined by SPTs tends to decrease over time. The most important factor affecting this decrease is time itself.     

过敏性鼻炎-哮喘综合征的临床经济学研究

目的明确过敏性鼻炎-哮喘综合征（combinedallergicrhinitisandasthmasyndrome，CARAS）这一新的医学诊断术语。从临床经济学角度出发，对经鼻吸入糖皮质激素对CARAS联合治疗与传统的采用鼻喷雾剂和口喷雾剂分别治疗的成本／效果比（C／E）进行研究比较。方法哮喘门诊中随机选择CARAS患者74例，随机分为两组。其中一组为联合治疗组，采用经鼻吸入糖皮质激素喷雾剂进行治疗；另一组为传统治疗组，采用鼻喷雾剂和口喷雾剂分别进行治疗，疗程3个月。分别计算两组治疗的总费用（C），治疗后鼻部症状改善总评分（E1）、胸部症状改善总评分（E2）和PEFR增加值（E3），分别计算联合治疗组和传统治疗组的C／E1，C／E2和C／E3。结果C／E1，联合组为8．194，传统组为17．499；C／E2，联合组为9．001，传统组为15．432；C／E3，联合组为8。489，传统组为15．867。结论联合治疗组和传统治疗组在临床疗效基本相同的情况下，联合治疗组3个指标的C／E都远远低于传统治疗组的C／E，联合治疗这一新的治疗方式更具有临床经济学意义。