Household mold exposure in association with childhood asthma and allergic rhinitis in a northwestern city and a southern city of China

BackgroundThe prevalence of asthma and allergic diseases has increased rapidly in Chinese cities over the past decades. Few studies have examined the potential role of household mold in asthma and allergies in Chinese cities.MethodsA cross-sectional survey in 4,691 school-age children was performed in Lanzhou and Wuhan. The two cities represent distinct climate conditions, as Lanzhou, located in northwestern China, has dry and cold winter and relatively cool summer whereas Wuhan, located in central-southern China, has hot and humid summer and mild winter temperatures. Two schools were randomly selected from a suburb and an urban area of each city, respectively. Data were collected using a modified Chinese version of the American Thoracic Society (ATS) standard respiratory health questionnaire for children, regarding asthma, substance allergy, allergic rhinitis, presence of mold in residence, and household characteristics. Logistic regression models were applied to identify the odds ratios of childhood asthma and allergies with regard to mold.ResultsThe prevalence rates of asthma, substance allergy, allergic rhinitis, and mold, were all higher in Wuhan than in Lanzhou. We observed significant associations of household mold with increased prevalence for both asthma [odds ratio (OR) =2.399, 95% confidence interval (95% CI): 1.309–4.398], substance allergy (OR =1.729, 95% CI: 1.282–2.332) and allergic rhinitis (OR =1.969, 95% CI: 1.491–2.600), with spatial heterogeneity across urban versus suburban schools. The mold effect was modified by age group and breast-feeding status.ConclusionsAcross two climatically distinct cities, household mold exposure was significantly associated with an increased risk for asthma and allergies. Younger children and children from the suburbs were more likely to be affected by mold. Whether breastfeeding enhanced or weakened the mold effects were inconsistent across the cities and across the health outcomes.     

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.     

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。     

支气管哮喘合并过敏性鼻炎的临床治疗观察

目的了解布地奈德鼻喷剂联合舒利迭吸入剂对过敏性鼻炎-哮喘综合症患者的治疗效果。方法60例过敏性鼻炎-哮喘综合症患者,随机分为两组,对照组30例,给予吸入舒利迭50/100μg或50/250μg,1吸/次,2次/日。试验组30例,在吸入舒利迭治疗基础上,同时给予布地奈德鼻喷剂治疗,每个鼻孔各1喷,64μg/喷,2次/日。治疗时间为8周。结果试验组比对照组能显著提高患者的生存质量,对照组不能有效改善患者的鼻炎症状。结论联合治疗过敏性鼻炎和支气管哮喘比单纯治疗支气管哮喘更能有效地提高患者的生存质量。     

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.     

重庆地区过敏性鼻炎-哮喘综合征患者规律服药的现状及其对治疗效果的影响

目的了解重庆地区过敏性鼻炎一哮喘综合征（combinedallergicrhinitisandasthmasyndrome,CARAS）患者规律服药的现状以及观察规律服药对CARAS治疗效果的影响。方法在重庆医科大学附属第一医院呼吸内科及耳鼻喉科门诊收集18～70岁CARAS患者共256例,通过问卷调查的方式了解其中规律服药患者的比例,同时根据疾病确诊情况将256例患者分为3组：仅确诊支气管哮喘（bronchialasthma,BA）者为I组,仅确诊过敏性鼻炎（allergicrhinitis,AR）者为Ⅱ组,BA和AR均得到确诊者为Ⅲ组,根据患者的服药情况将各组分为规律服药和未规律服药两个亚组,分别比较各规律服药亚组和未规律服药亚组的治疗效果有无差异。结果所有CARAS患者中坚持规律服药的患者仅占36．72％,I组的规律服药亚组和未规律服药亚组的BA控制率分别是45．71％和4．41％,两组比较差异有统计学意义（x2=23．52,P〈0．05）;Ⅱ组的规律服药亚组和未规律服药亚组的AR控制率分别是61．54％和21．47％,两组比较差异有统计学意义（x2=8．64,P〈0．05）;Ill组的规律服药亚组和未规律服药亚组总的临床控制率分别为45．。0％和4．65％,两组比较差异有统计学意义（x2=12．75,P〈0．05）,对：BA和AR控制率分别进行比较差异有统计学意义（x2BA=13．08,P〈0．05;x2AR=24．63,P〈O．05）。结论目前重庆地区大部分CARAS患者未规律服药,而坚持规律服药有助于疾病的控制。只有坚持规范、长期、规律的药物治疗才能有效控制上、下气道炎症、减少急性发作、提高生活质量和改善预后。     

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.     

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.     

雷暴哮喘

在过去的30余年,全球范围内关于雷暴相关严重哮喘发作事件的报道逐年增加,主要集中于澳大利亚、英国。这种因天气因素导致的哮喘发作或加重多发生于花粉季节,认为与花粉或霉菌过敏有关。雷暴哮喘发生机制可能是花粉颗粒在雷暴天气时溶胀、崩解释放大量具有变应原性的碎片,使空气中变应原浓度短时间内明显升高,气道高反应个体暴露后出现哮喘症状。花粉或霉菌导致的过敏性鼻炎、哮喘患者是雷暴哮喘的高危人群。了解雷暴哮喘有助于对其预防,并降低其对患者生命健康及公共卫生服务的危害。     

Occurrence and risk factors of asthma,allergic rhinoconjunctivitis and allergic sensitisation in rural and urban Mongolia

Introduction: The prevalence of atopic diseases varies widely throughout the world. The increase in the risk of these types of diseases has been associated with a western lifestyle. The aim of this study was to investigate the role of environment and lifestyle changes on the risk of atopy in Mongolia, a country in transition between nomadic and western lifestyles. Objective: To study the prevalence and risk factors of asthma, allergic rhinoconjunctivitis and allergic sensitisation in Mongolia in areas with different levels of urbanisation: villages, rural towns and Ulaanbaatar city. Materials and Methods: In the screening study, questionnaire data were obtained from 9453 subjects aged 10–60 years. In the clinical study, a subsample of 869 subjects (participation rate 50.0%), enriched with symptomatic subjects, was examined. A detailed questionnaire‐based interview, clinical examination, skin‐prick tests, spirometry, and bronchodilation tests or methacholine challenge tests were carried out. Asthma, allergic rhinoconjunctivitis and allergic sensitisation were defined by the clinical examination. The results were related to the population level using sampling weights. The prevalence rates were evaluated in the villages, rural towns and Ulaanbaatar city. Multiple logistic regression analysis was used for the investigation of risk factors. Results: The prevalence rate of current asthma was low, 1.1%–2.4%, depending on the study area. The prevalence rate of allergic rhinoconjunctivitis was high in relation to the prevalence rate of asthma, but low compared internationally, 9.3%–18.4%. The prevalence rate of allergic sensitisation was 13.6%–31.0%. The prevalence rates were lowest in the villages. A significant increase was seen in the prevalence rates of allergic rhinoconjunctivitis and allergic sensitisation with increasing exposure to town environment in analyses of current place of residence and also in analyses considering relocation from rural to urban areas. Keeping herd animals did not explain the protective effect of living in a village, but exposure to both herd animals and to dung heating was associated with a reduced risk for allergic sensitisation and allergic rhinoconjunctivitis. Keeping animals was a risk factor for asthma in the city, but not in the rural areas. Conclusions: The prevalence rate of atopic disorders was low in rural Mongolia, but it increased with increasing urbanisation. Moving from a village to a town increased the risk of atopy, but the risk was highest among those living in a town since birth. An environment with exposure to dung heating and herd animals protected against atopy in rural Mongolia, which suggests the importance of exposure to environmental microbes for protection.     

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.     

The effects of antifungal therapy on severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis

Background and objective:   Very little is known about the response rates to or appropriateness of treatment for patients with allergic fungal diseases of the lung. This study assessed the effect of antifungal therapy in patients with severe asthma with fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA).
Methods:   A retrospective cohort study of 33 adult patients who fulfilled the criteria for either SAFS ( n  = 22) or ABPA ( n  = 11) was conducted. All patients had received antifungal therapy for at least 6 months. The primary study end point was the effect of antifungal therapy on patients' lung function.
Results:   Overall, total IgE values and radioallergosorbent test (RAST) for A. fumigatus markedly decreased after 6 months of therapy in both SAFS and ABPA patients ( P  = 0.004 and P  = 0.005, respectively). Reduction was seen in the eosinophil count ( P  = 0.037), dose of oral steroids ( P  = 0.043) and courses of systemic steroids required ( P  = 0.041). Lung function also improved ( P  = 0.016). Four of 10 patients discontinued oral steroids after 6 months of therapy. Reduction in IgE levels ( P  = 0.015) and RAST for A. fumigatus was also observed ( P  = 0.006) for those patients treated for at least 1 year with antifungal drugs.
Conclusions:   Both ABPA and SAFS patients benefited from oral antifungal therapy. The antifungal therapy may act by reducing the antigenic load, interacting with corticosteroids or by a direct immunological effect.     

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。     

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。     

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.     

真菌致敏与严重支气管哮喘

真菌致敏与严重支气管哮喘(简称哮喘)密切相关.目前已提出了一些真菌过敏引起严重哮喘的发病机制.真菌致敏引起的严重哮喘是指对一种或多种真菌致敏的难以控制的严重哮喘,但未达到变应性支气管肺曲霉菌病诊断标准的一种疾病.两项研究证实伊曲康唑治疗真菌致敏引起的严重哮喘有效.