鼻炎患者气道炎症和高反应性特征比较

目的比较变应性与非变应性鼻炎患者全身及上下气道炎症、气道高反应性的特征及差异,探求上下气道炎症及高反应性之间的内在联系。方法按是否具有鼻炎临床症状及变应原皮肤点刺试验结果将受试者分为三组：变应性鼻炎组184例、非变应性鼻炎组129例、健康正常组162例,均进行外周血嗜酸粒细胞（EOS）计数、鼻灌洗液炎症细胞分类、诱导痰炎症细胞分类、呼出气一氧化氮、肺通气功能检查和乙酰甲胆碱支气管激发试验。比较三组全身及上下气道炎症、气道高反应性的特征及差异。结果①非变应性鼻炎和变应性鼻炎组患者血EOS计数、鼻EOS计数、痰EOS比例阳性率与正常组的差异均具有统计学意义（P〈0.01）,变应性鼻炎组呼出气一氧化氮、支气管激发试验阳性率与正常组的差异具有统计学意义（P〈0.01）;②增加下气道EOS炎症发生的危险因素分别是：变应原皮肤点刺试验阳性（OR=4.096）、血EOS计数升高（OR=9.715）、气道高反应性（OR=3.107）和鼻灌洗液EOS计数升高（OR=16.398）;③增加气道高反应性的危险因素分别是：变应原皮肤点刺试验阳性（OR=4.276）和诱导痰EOS比例升高（OR=4.890）。结论部分无下呼吸道症状的变应性鼻炎患者存在下气道炎症及高反应性;部分无下呼吸道症状的非变应性鼻炎患者存在下气道炎症;上气道炎症是导致下气道炎症的主要高危因素;特应性体质和气道炎症是气道高反应性的独立危险因素。因此,上气道炎症导致下气道炎症,甚至发展为下气道高反应性可能是部分非变应性鼻炎患者向变应性鼻炎甚至哮喘发生、发展的重要过程和机制。     

干扰素-γ诱导的单核因子、单核细胞趋化蛋白-1和转化生长因子-β1在变应性鼻炎的表达及其意义

目的探讨干扰素-γ诱导的单核因子(monokine induced by IFN-γ,Mig)、单核细胞趋化蛋白-1(monocyte chemoattractant protein-1,MCP-1)、转化生长因子-β1(transforming growth factorβ1,TGF-β1)在变应性鼻炎发病中的作用及变应性鼻炎患者Th1/Th2/Th3亚群的功能状态。方法抽取变应性鼻炎患者和健康对照者外周血,用ELISA法检测血清Mig、MCP-1及TGF-β1的含量。结果健康对照组血清Mig为(90.99±21.92)pg/ml,高于变应性鼻炎组的(-4.91±28.01)pg/ml及变应性鼻炎合并哮喘组的(-8.33±8.34)pg/ml(P=0.000)。变应性鼻炎患者血清MCP-1浓度为(81.16±1.40)pg/ml,明显高于健康对照组的(51.56±2.91)pg/ml(P=0.000);变应性鼻炎合并支气管哮喘患者血清MCP-1浓度为(103.31±11.32)pg/ml,较单纯变应性鼻炎患者高(P=0.003);MCP-1与速发相反应的相关典型症状,如鼻塞(r=0.380,P=0.001)、喷嚏(r=0.314,P=0.006)、流涕(r=0.417,P=0.000)、体征(r=0.455,P=0.000)呈正相关。变应性鼻炎及变应性鼻炎合并哮喘患者血清TGF-β1分别为(51.66±5.42)和(54.43±5.10)ng/ml,高于健康对照组的(44.17±7.33)ng/ml(P=0.000),TGF-β1与鼻塞(r=0.882,P=0.000)、流涕(r=0.288,P=0.013)、体征(r=0.559,P=0.000)呈正相关。健康对照组、变应性鼻炎组、变应性鼻炎合并哮喘组血清MCP-1及TGF-β1表达不存在因年龄、性别引起的统计学差异。结论变应性鼻炎和支气管哮喘存在Th2亚群强势,变应性鼻炎患者体内出现保护性(或调节性)Th3功能增强,不同年龄、性别不影响血清MCP-1及TGF-β1表达。     

支气管哮喘合并变应性鼻炎上下气道共治的临床观察

目的探讨上、下气道共治方法治疗支气管哮喘合并变应性鼻炎的临床效果及其安全性。方法 90例支气管哮喘合并常年变应性鼻炎的患者,按照数字随机表法分为A组(n=30)、B组(n=30)和C组(n=30),A组患者应用沙美特罗替卡松粉吸入剂,B组患者应用布地奈德鼻喷雾剂,C组应用沙美特罗替卡松粉联合布地奈德喷雾剂;对比临床治疗效果。结果治疗12周后,C组的哮喘症状记分、第1秒用力呼气容积、外周嗜酸粒细胞百分比(EOS%)、痰EOS%改善明显优于A组和B组,差异均有统计学意义(P<0.05);三组均未出现严重不良反应。结论沙美特罗替卡松粉吸入剂联合布地奈德喷雾剂治疗支气管哮喘合并变应性鼻炎疗效显著、安全,能够全面地控制上、下气道炎症,具有临床推广价值。     

变应性鼻炎和慢性鼻窦炎对哮喘患者肺通气功能的影响

目的探讨变应性鼻炎和慢性鼻窦炎对哮喘患者肺通气功能的影响。方法将110例哮喘患者分为三组:单纯哮喘组(n=37)、哮喘合并变应性鼻炎组(n=40)和哮喘合并变应性鼻炎、慢性鼻窦炎组(n=33),比较三组的FEV1%、PEF%、FEF25%、FEF50%、FEF75%。结果哮喘合并变应性鼻炎组的FEV1%、PEF%、FEF25%低于单纯哮喘组(P<0.05);哮喘合并变应性鼻炎、慢性鼻窦炎组的FEV1%、PEF%、FEF25%、FEF50%、FEF75%低于单纯哮喘组(P<0.05)。结论与单纯哮喘患者比较,哮喘合并变应性鼻炎或慢性鼻窦炎患者的肺通气功能降低。     

鼻部和咽部非变应性炎症对下气道高反应的影响

目的 探讨慢性鼻窦炎、慢性扁桃体炎等上气道黏膜非变应性炎症对下气道支气管黏膜反应的影响及相关关系。方法 选择2014年8月至2015年8月在新疆医科大学第一附属医院耳鼻喉科就诊的慢性鼻窦炎以及慢性扁桃体炎患者,随机选取109例分为两组,慢性鼻窦炎58例、慢性扁桃体炎51例,并选取50例排除上下气道黏膜非变应性炎性症状以及体征的人群作为阴性对照组,在排除药物影响以及肺功能正常前提下均接受支气管激发试验、鼻内镜、变应原皮肤点刺试验检测,将检测结果结合患者症状进行比较分析。结果 支气管激发试验测试结果显示鼻部组(65.5%)相较于咽部组(43.1%)以及对照组(40.0%)的下气道黏膜反应性阳性率增高,而咽部慢性炎症患者的下气道反应阳性率较对照组高,差异有统计学意义(P0.05),其中鼻部组并发变应性鼻炎比例明显高于其他两组(28/58 vs.8/51和3/50)。结论 上气道黏膜慢性炎症与下气道黏膜反应性增高具有相关关系,其中鼻部慢性炎症对下气道反应的影响作用较咽部慢性炎症更明显,鼻部组阳性率受变应性鼻炎因素影响明显。     

支气管舒张试验阴性的哮喘患者呼出气一氧化氮与气道反应性的关系研究

目的 分析支气管舒张试验阴性的哮喘患者呼出气一氧化氮(FeNO)与气道反应性的关系。方法选取2019年3月至2022年3月延安市人民医院和延安市中医医院收治的150例支气管舒张试验阴性的疑似哮喘患者。收集患者的一般资料，测定患者FeNO及肺功能指标[包括第1秒用力呼气容积(FEV₁)占预计值百分比、用力肺活量(FVC)占预计值百分比、FEV₁/FVC比值]。所有患者进行支气管激发试验，记录FEV₁下降20%时吸入乙酰胆碱的累积剂量(PD20-FEV₁)，以PD20-FEV₁<12.8μmol为支气管激发试验阳性，提示气道高反应性，结合临床可诊断为哮喘。根据支气管激发试验结果将患者分为阳性组(n=65)和阴性组(n=85)。支气管舒张试验阴性的哮喘患者FeNO与PD20-FEV₁的相关性分析采用Pearson相关分析。结果 阳性组FeNO、气流受限者占比高于阴性组，FEV₁占预计值百分比和FEV₁/FVC比值...     

变应性鼻炎和慢性鼻窦炎对哮喘患者肺通气功能的影响

目的 探讨变应性鼻炎和慢性鼻窦炎对哮喘患者肺通气功能的影响.方法 将110例哮喘患者分为三组:单纯哮喘组(n=37)、哮喘合并变应性鼻炎组(n=40)和哮喘合并变应性鼻炎、慢性鼻窦炎组(n=33),比较三组的FEV1％、PEF％、FEF25％、FEF50％、FEF75％.结果 哮喘合并变应性鼻炎组的FEV1％、PEF％、FEF25％低于单纯哮喘组(P＜0.05);哮喘合并变应性鼻炎、慢性鼻窦炎组的FEV1％、PEF％、FEF25％、FEF50％、FEF75％低于单纯哮喘组(P＜0.05).结论 与单纯哮喘患者比较,哮喘合并变应性鼻炎或慢性鼻窦炎患者的肺通气功能降低.     

哮喘患者血清中巨噬细胞炎症蛋白-1的表达及其临床意义

目的:探讨哮喘患者血清中巨噬细胞炎症蛋白-1(MIP-1)的表达以及与病情的关系。方法:选取哮喘患者114例,其中,哮喘急性发作期患者76例(急性发作期组),慢性持续性患者38例(慢性组),同时选取健康志愿者100例作为对照组,检测3组血清及诱导痰中MIP-1、血清IL-13水平以及第1秒用力呼气容积(FEV_1)占预计值百分比。结果:急性发作期组血清及痰液MIP-1和血清IL-13分别为(1981.5±98.8)pg/L、(52.3±7.8)ng/L和(32.5±5.6)pg/m L,明显高于慢性组和对照组(均P0.05),而FEV_1占预计值为(53.8±16.6)%,明显低于慢性组和对照组(均P0.05);慢性组血清及痰液MIP-1和血清IL-13分别为(1422.5±101.2)pg/L、(24.3±6.1)ng/L和(17.4±7.2)pg/m L,明显高于对照组(均P0.05),而FEV_1占预计值为(71.2±15.5)%,明显低于对照组(P0.05);重度急性发作期患者血清及痰液MIP-1和血清IL-13分别为(2340.8±114.8)pg/L、(62.8±8.0)ng/L和(40.8±8.2)pg/m L,明显高于轻度和中度急性发作期患者(均P0.05),而FEV_1占预计值为(45.2±11.4)%,明显低于轻度和中度急性发作期患者(均P0.05);急性发作期组患者血清和痰液MIP-1水平与患者病情、血清IL-13呈正相关(均P0.05),与FEV_1占预计值呈负相关(P0.05),血清MIP-1与痰液MIP-1呈正相关(P0.05);急性发作期患者治疗后血清及痰液MIP-1和血清IL-13明显低于治疗前(均P0.05),而FEV_1占预计值明显高于治疗前(P0.05)。结论:哮喘患者血清及诱导痰中MIP-1水平升高,尤其急性发作期患者显著升高,其表达水平与患者病情、血清IL-13水平及肺功能有一定关系。     

吸烟对哮喘患者FeNO和肺功能的影响

目的探讨吸烟对哮喘患者FeNO和肺功能的影响。方法选取2017年1月至2018年5月于承德医学院附属医院确诊的哮喘患者217例,其中吸烟患者81例(吸烟组),不吸烟患者74例(不吸烟组),已戒烟患者62例(已戒烟组),比较3组间FeNO值、第1秒用力呼气容积占预计值百分比(FEV_1%)、第1秒用力呼气容积/用力肺活量(FEV_1/FVC)、最大呼气流量(MEF)25-75/预计值、和哮喘控制测试(ACT)评分,探讨FeNO与肺功能各指标、ACT评分、吸烟指数、嗜酸性粒细胞百分比(EO%)的相关性。结果吸烟患者FEV_1/FVC较不吸烟组低,差异有统计学意义(P0.05)。吸烟患者MEF25-75/预计值较不吸烟及已戒烟患者低,差异有统计学意义(P0.05)。吸烟组FeNO值较不吸烟组、已戒烟组低,差异有统计学意义(P0.05)。哮喘患者FeNO水平与血EO%呈正相关(r=0.482,P=0.041),与FEV_1/FVC、MEF25～75/预计值、吸烟指数呈负相关性(r=-0.237、-0.384、-0.526,P=0.022、0.003、0.038),差异有统计学意义(P0.05)。结论吸烟可以降低哮喘患者小气道功能指标与FeNO值,使用单一的FeNO方法评估吸烟患者的气道炎症,有可能会低估其气道炎症水平。FeNO水平更能反映哮喘患者嗜酸性气道炎症,能在一定程度上反映小气道功能障碍,尤其在不吸烟的哮喘患者评估价值更高,且FeNO值越高,小气道阻力越高。     

完全控制的支气管哮喘患者肺功能和气道高反应性测定

目的检测完全控制的支气管哮喘患者肺功能和气道反应,探讨其临床意义。方法选择71例完全控制的支气管哮喘患者,测定肺功能和气道反应性。选择30名急性发作期支气管哮喘患者和15名健康老年人作为对照。结果71例完全控制的支气管哮喘患者中,49例(84.5%)支气管激发试验阳性,9例(15.5%)支气管激发试验阴性。完全控制哮喘组和哮喘组患者FEV1占预计值%和FEV1/FVC分比较差异有统计学意义(P0.01);完全控制哮喘组和健康对照组受试对象FEV1占预计值%和FEV1/FVC比较差异无统计学意义(P0.05)。结论完全控制的支气管哮喘患者多数存在气道高反应性,测定患者气道反应性有助于指导哮喘治疗。     

Exhaled Nitric Oxide in Children with Allergic Rhinitis and/or Asthma: A Relationship with Bronchial Hyperreactivity

Background. Nowadays, the measure of the fractional concentration of exhaled nitric oxide (FeNO) enables to assess airway inflammation during an office visit and there is international consensus on this testing methodology. The aim of this study was to evaluate whether FeNO measurement is predictable for bronchial hyperreactivity (BHR) in children with allergic rhinitis, asthma, or both. Methods. Two hundred and eighty children with allergic rhinitis, allergic asthma, or both were evaluated. Bronchial function (FEV₁ and FEF_25–75), BHR (assessed by methacholine challenge), FeNO, and sensitizations were assessed. Results. Bronchial function, BHR, and FeNO were significantly different in the three groups (p < .001). A strong inverse correlation between FeNO and BHR was found in patients with asthma and with asthma and rhinitis (r?=??0.63 and r?=??0.61, respectively). A cutoff of 32 ppb of FeNO was a predictive factor for BHR. Conclusions. This study highlights the relevance of FeNO as possible marker for BHR in allergic children and underlines the close link between upper and lower airways.     

过敏性鼻炎与支气管哮喘患者的Fe NO比较研究

目的探讨呼出气一氧化氮(Fe NO)在支气管哮喘(BA)和过敏性鼻炎(AR)患者中的应用,比较Fe NO和外周血嗜酸粒细胞分类(EOS%)在健康对照组(A组)、AR(B组)、BA/AR(C组)及BA(D组)之间的不同,寻找两种疾病Fe NO、EOS%改变的意义,以及两种疾病之间的关系。方法采用按国际技术标准设计的尚沃纳库仑一氧化氮分析仪对A、B、C、D组患者检测Fe NO,同时测定各组患者血常规。结果三组病例ROC曲线下面积均大于0.5;AR、BA/AR、BA三组Fe NO、EOS%水平均高于对照组(P0.05),三组组间无明显差异(P0.05);Fe NO与EOS%间存在显著相关性(r=0.505,P0.0 5)。结论Fe NO诊断支气管哮喘和过敏性鼻炎有临床意义。Fe NO可以反映患者气道嗜酸性炎症水平。过敏性鼻炎与支气管哮喘这两种疾病存在密切的关系。     

Relationship between upper airway diseases,exhaled nitric oxide,and bronchial hyperresponsiveness to methacholine

Objective: The “united airway disease” concept is based on the bidirectional interaction between asthma and rhinitis. The aim of this study was to determine the relationship between upper airway diseases and bronchial hyperresponsiveness (BHR), as well as their association with the fractional concentration of exhaled nitric oxide (FeNO) and atopy in patients with persistent symptoms suggestive of asthma requiring methacholine challenge testing (MCT) to confirm asthma diagnosis. Methods: A cross-sectional prospective study was carried out in adult patients with persistent asthma-like symptoms and negative bronchodilator testing. FeNO and MCT were performed in all patients. Asthma was confirmed based on the presence of suggestive symptoms and MCT results. Associated upper airway diseases included allergic rhinitis, nonallergic rhinitis, chronic rhinosinusitis with nasal polyps (CRSwNP), and aspirin-exacerbated respiratory disease (AERD). Results: The study included 575 patients; asthma was confirmed in 32.3%, and FeNO values ≥ 50 ppb were found in 27% of the patients. Elevated FeNO was significantly associated to AERD. The prevalence of atopy in asthma patients was 86.6%. Atopy was present in 90.4% of patients with asthma and FeNO levels ≥ 50 ppb. A significant association was found between AERD, asthma, and FeNO ≥ 50 ppb. Conclusions: Patients with symptoms suggestive of asthma but negative bronchodilator testing are commonly seen in usual practice. In this population, the association of high FeNO levels and BHR to atopy, as well as to AERD, suggests the presence eosinophilic inflammation in both the upper and lower airways and supports the “one airway” hypothesis.     

Measurements of nasal fractional exhaled nitric oxide with a hand-held device in patients with allergic rhinitis: relation to cedar pollen dispersion and laser surgery

BackgroundThere has been an increasing interest in monitoring the fractional concentrations of exhaled NO (FeNO) levels in allergic rhinitis (AR) patients. In the present study, we examined whether the nasal FeNO measurement might reflect the degree of local allergic inflammation as well as subjective symptoms.MethodsThe FeNO measurement was performed using a handheld electrochemical analyzer (NObreath®) with a nose adaptor. In the cross-sectional study, 56 patients with perennial AR patients, 18 AR patients with bronchial asthma (BA), 12 patients with vasomotor rhinitis, and 30 normal subjects were enrolled. For the follow-up study, 12 seasonal allergic rhinitis (SAR) patients against Japanese cedar and 10 perennial AR patients who underwent laser surgery were examined.ResultsThe AR patients and vasomotor rhinitis patients showed significantly higher oral FeNO levels as compared with the normal subjects. The nasal FeNO levels were significantly higher in the perennial AR patients with or without BA than in the normal subjects and vasomotor rhinitis patients. There were positive correlations between the nasal symptom scores and FeNO levels. The SAR patients showed a significant decrease in the nasal FeNO level after the pollen dispersion season. In addition, the therapeutic effects of laser surgery in the AR patients accompanied a significant reduction in the nasal FeNO levels one month after treatment.ConclusionsThe nasal FeNO measurement by NObreath® is easy to perform and suitable for monitoring AR patients in various treatment modalities. Furthermore, it may have potential usefulness as a tool to improve daily clinical care.     

呼出气一氧化氮对支气管哮喘的诊断价值及其与气道炎症的相关性分析

目的 通过探讨呼出气一氧化氮(FeNO)与肺泡灌洗液中气道炎症细胞、肺功能、血清总IgE及支气管激发试验的相关性,明确FeNO对哮喘的诊断价值,并寻求适用于哮喘患者气道炎症监测、评估与管理的方法.方法 选择符合标准的哮喘患者103例及健康对照组49例,对其分别进行FeNO及支气管激发试验.同时哮喘患者行BALF检查;同时进行肺功能,记录FEV1％pred、FEV1/FVC、最大呼气中期流速(MMFR)、呼气峰流速(PEF);行血常规、血清总IgE检查.结果 将FeNO的影响因素引入多重线性回归分析,发现FeNO主要受年龄、过敏性鼻炎、吸烟指数的影响,与肺泡灌洗液中嗜酸粒细胞百分比(EOS％)呈显著正相关(r =0.278,P=0.007).外周血EOS％增高,FeNO值增加,但外周血EOS％在不同FeNO水平间的差异无统计学意义(F=2.868,P=0.062);血清总IgE随FeNO增加显著,且其在不同FeNO水平间的差异有统计学意义(F=4.407,P=0.015).ROC曲线示PC20的曲线下面积AUC:0.853,95％ CI:0.778～0.928,FeNO曲线下面积AUC:0.712,95％ CI:0.628～0.796.PC20≤8 g/L为阳性判断标准时的灵敏度(0.837vs 0.674)以及特异度(0.776 vs 0.571)均高于以FeNO浓度≥26.5 ppb的阳性阈值.结论 FeNO与肺泡灌洗液EOS及血清总IgE关系密切,在评估哮喘患者嗜酸性气道炎症中具有重要作用;与支气管激发试验相比,FeNO在诊断哮喘上的灵敏度和特异度相对较低,因此在哮喘的诊断上FeNO检测不能完全替代支气管激发试验.     

Forced expiratory flow between 25 and 75% of vital capacity might be a predictive factor for bronchial hyperreactivity in children with allergic rhinitis, asthma, or both

Allergic rhinitis and asthma are closely associated. Bronchial hyperreactivity (BHR) is a pathophysiological characteristic of asthma. Forced expiratory flow between 25 and 75% of vital capacity (FEF(25-75)) has been previously shown to be able to predict BHR in adult patients with allergic rhinitis. Therefore, the aim of this study was (i) to evaluate the presence of BHR in a large group of children with allergic rhinitis, asthma or both and (ii) to confirm whether FEF(25-75) might be related to BHR and may predict BHR also in a pediatric population. Nine hundred fifty children with allergic rhinitis (350), asthma (300), or both (300) were enrolled. Clinical examination, skin-prick test, spirometry, and methacholine challenge were performed in all patients. Severe BHR was quite frequent in allergic children, mainly in asthmatic patients. FEF(25-75) values were significantly related to BHR grade, mainly in children with rhinitis (r = 0.69). Impaired FEF(25-75) values (such as ≤65% of predicted) constituted a relevant predictive factor for severe BHR, mainly in children with rhinitis (odds ratio, 8.9). In conclusion, this pediatric study confirmed that impaired FEF(25-75) values might predict severe BHR in children, mainly in those with allergic rhinitis. Therefore, low FEF(25-75) values could suggest BHR in children.     

Early bronchial airflow impairment in patients with persistent allergic rhinitis and bronchial hyperreactivity

BACKGROUND: Allergic rhinitis and its impact on asthma (ARIA) document underlines the link between upper and lower airways. Patients suffering from allergic rhinitis frequently (up to 80%) show bronchial hyperreactivity (BHR). OBJECTIVES: This study aimed at evaluating a group of subjects suffering from persistent allergic rhinitis, with BHR but with nasal symptoms only, to investigate the type and intensity of nasal symptoms, nasal and bronchial airflow, and BHR grade during the pollen season. METHODS: One hundred and twenty one polysensitized rhinitics were investigated. Total symptom score (TSS) was assessed in all patients. Rhinomanometry, spirometry and methacholine bronchial challenge were performed in all patients. RESULTS: 65 (53.7%) patients had impaired FEF 25-75 values. TSS correlated with nasal airflow (P<0.001) and BHR grade (P<0.001). Nasal airflow correlated with FEF 25-75 values (P<0.05) and BHR (P<0.001). FEF 25-75 values correlated with FEV(1) levels (P<0.003), BHR grade (P<0.001), and nasal obstruction symptom (P<0.05). Severe BHR correlated with FEV(1) (P<0.05) and FEF 25-75 (P<0.03) values, nasal airflow (P<0.05) and nasal symptoms (P<0.001). CONCLUSIONS: This study evidences that early bronchial impairment is frequently detectable in patients with persistent allergic rhinitis and BHR. Moreover, nasal function is strictly related with bronchial calibre and BHR grade. Therefore, careful evaluation of lower airways should be investigated in all rhinitics as suggested by the ARIA document.     

Peripheral nitric oxide is increased in rhinitic patients with asthma compared to bronchial hyperresponsiveness

Allergic rhinitis is a predisposing factor for developing clinical asthma. Moreover, allergic rhinitis is often associated with bronchial hyperresponsiveness (BHR). We hypothesise that patients with asthma have more small airway involvement than those with allergic rhinitis and BHR alone. The aim of this study was to assess peripheral and proximal NO concentration in rhinitic subjects, and to correlate the peripheral NO concentration to the peripheral obstruction in response to methacholine. Patients with allergic rhinitis with or without BHR, or clinical asthma were investigated in and out of the allergy season. Healthy subjects served as controls. Fractional exhaled NO was performed, and peripheral NO concentration and proximal flux of NO was calculated. Methacholine test was performed including impulse oscillometry. Rhinitic patients with asthma demonstrate an increase in both proximal and peripheral NO compared to those with rhinitis alone or those with BHR. There is a trend of increased peripheral NO from patients with rhinitis only, rhinitis and BHR, to rhinitis with asthma. The increase in peripheral NO correlated with an increased peripheral obstruction in response to methacholine. Patients with seasonal allergic rhinitis demonstrated a decrease in both proximal and peripheral NO in the off-season. The results support our hypothesis that rhinitic patients with asthma have more peripheral lung inflammation and small airway involvement compared to rhinitic patients with BHR alone.     

Effect of treating allergic rhinitis with corticosteroids in patients with mild-to-moderate persistent asthma

STUDY OBJECTIVES: Rhinitis and asthma are considered to be synchronic or sequential forms of the same allergic syndrome. Treating the inflammation associated with allergic rhinitis influences the control of asthma. However, few studies have investigated the effect of treating perennial rhinitis on persistent asthma and vice versa. We determined the effects of inhaled or topical nasal beclomethasone dipropionate (BDP) administered separately or in combination on the control of asthma and bronchial hyperresponsiveness (BHR) in patients with the rhinitis/asthma association. DESIGN: A double-blind, parallel, three-group study. SETTING: Outpatient clinic of Pulmonary Division/Heart Institute (InCor) and the Division of General Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil. PATIENTS: Seventy-four patients with mild-to-moderate asthma and allergic rhinitis (median age, 25 years). INTERVENTIONS: Patients received nasal or inhaled BDP separately or in combination for 16 weeks after a 2-week placebo run-in period. MEASUREMENTS AND RESULTS: Nasal and pulmonary symptoms, as well as pulmonary function and BHR, were compared among the three groups after 4 weeks and 16 weeks of treatment. Patients in all three groups demonstrated a progressive and significant decrease in nasal and pulmonary symptoms, which started after 4 weeks (p < 0.05) and continued through the end of treatment (p < 0.001). Clinical improvement was similar and parallel in the three groups. Asthma-related morbidity, evaluated by quantifying absence from work, emergency department visits, and nighttime awakenings, also decreased in the three groups (p < 0.05). CONCLUSIONS: Failure to consider treatment of rhinitis as essential to asthma management might impair clinical control of asthma. Furthermore, these data suggest that asthma and rhinitis in some patients can be controlled by the exclusive use of nasal medication.     

支气管哮喘患者呼出气一氧化氮与外周血嗜酸性粒细胞的相关性

目的观察支气管哮喘患者呼出气一氧化氮(Fe NO)的表达水平,分析其与外周血嗜酸性粒细胞(EOS)之间的相关性。方法收集2013年2月-2014年12月期间贵州省人民医院支气管哮喘患者58例,其中支气管哮喘急性发作期40例(急性发作期组),支气管哮喘缓解期18例(缓解期组),健康对照组30例。采用Fe NO分析仪测定Fe NO水平,并检测各组外周血嗜酸粒细胞计数,采用SPSS 11.5统计软件进行统计学处理,组间差异性比较采用单因素方差分析,相关性分析采用Pearson相关性分析。P0.05为差异有统计学意义。结果支气管哮喘急性发作期组Fe NO为101.44±32.87ppb,EOS为5.0±2.62×10~9/L;缓解期组Fe NO为32.83±11.42 ppb,EOS为1.32±0.59×10~9/L;健康对照组Fe NO为8.43±3.02ppb,EOS为0.22±0.09×10~9/L。发作期组及缓解期组Fe NO及EOS水平均高于健康对照组(P0.05)。急性发作期组与缓解期组比较,Fe NO及EOS水平差异有统计学意义(P0.05)。支气管哮喘患者Fe NO水平与EOS呈正相关性(P0.05)。结论 Fe NO能够一定程度上反应气道嗜酸细胞炎症,Fe NO检测可能有助于评估支气管哮喘的控制水平。