WorldWideScience

Sample records for asthmatic chronic rhinosinusitis

  1. Chronic rhinosinusitis.

    Science.gov (United States)

    Ocampo, Christopher J; Grammer, Leslie C

    2013-01-01

    A 50-year-old woman with nonallergic rhinitis, asthma, and aspirin intolerance presented with worsening symptoms of nasal congestion, purulent drainage, and anosmia. Nasal polyps were visualized on anterior rhinoscopy, and there was evidence of chronic rhinosinusitis (CRS) on imaging studies during work-up for another medical condition. Over a 2-year period she had numerous bouts of acute exacerbations of CRS which required multiple courses of antibiotics; however, she was unwilling to undergo surgery to reduce polyp burden. She successfully underwent aspirin desensitization and experienced partial relief of symptoms with daily aspirin ingestion. Nasal obstruction is a common symptom that can result from multiple causes, including mucosal disorders (eg, allergic and nonallergic rhinitis, rhinosinusitis, sarcoid) and structural disorders (eg, nasal septal deviation, tumors, mucoceles). The various causes and work-up for nasal obstruction are discussed with emphasis placed on CRS, which is a prevalent disease characterized by inflammation of the nose and paranasal sinuses for a duration of >12 weeks. The different subtypes of CRS, including CRS with and without nasal polyps, allergic fungal rhinosinusitis, and aspirin-exacerbated respiratory disease, are discussed along with pathogenesis, diagnosis, and treatment options. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  2. Gene transcription changes in asthmatic chronic rhinosinusitis with nasal polyps and comparison to those in atopic dermatitis.

    Directory of Open Access Journals (Sweden)

    Douglas A Plager

    2010-07-01

    Full Text Available Asthmatic chronic rhinosinusitis with nasal polyps (aCRSwNP is a common disruptive eosinophilic disease without effective medical treatment. Therefore, we sought to identify gene expression changes, particularly those occurring early, in aCRSwNP. To highlight expression changes associated with eosinophilic epithelial inflammation, we further compared the changes in aCRSwNP with those in a second eosinophilic epithelial disease, atopic dermatitis (AD, which is also closely related to asthma.Genome-wide mRNA levels measured by exon array in both nasosinus inflamed mucosa and adjacent polyp from 11 aCRSwNP patients were compared to those in nasosinus tissue from 17 normal or rhinitis subjects without polyps. Differential expression of selected genes was confirmed by qRT-PCR or immunoassay, and transcription changes common to AD were identified. Comparison of aCRSwNP inflamed mucosa and polyp to normal/rhinitis tissue identified 447 differentially transcribed genes at > or = 2 fold-change and adjusted p-value < 0.05. These included increased transcription of chemokines localized to chromosome 17q11.2 (CCL13, CCL2, CCL8, and CCL11 that favor eosinophil and monocyte chemotaxis and chemokines (CCL18, CCL22, and CXCL13 that alternatively-activated monocyte-derived cells have been shown to produce. Additional transcription changes likely associated with Th2-like eosinophilic inflammation were prominent and included increased IL1RL1 (IL33 receptor and EMR1&3 and decreased CRISP2&3. A down-regulated PDGFB-centric network involving several smooth muscle-associated genes was also implicated. Genes at 17q11.2, genes associated with alternative activation or smooth muscle, and the IL1RL1 gene were also differentially transcribed in AD.Our data implicate several genes or gene sets in aCRSwNP and eosinophilic epithelial inflammation, some that likely act in the earlier stages of inflammation. The identified gene expression changes provide additional diagnostic

  3. Diagnosing chronic rhinosinusitis

    DEFF Research Database (Denmark)

    Lange, B; Thilsing, T; Baelum, J

    2013-01-01

    The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic and endo- scopic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies the definition is based on symptoms only. The aim of this study was to evaluate the...

  4. Saline irrigation for chronic rhinosinusitis

    NARCIS (Netherlands)

    Chong, Lee Yee; Head, Karen; Hopkins, Claire; Philpott, Carl; Glew, Simon; Scadding, Glenis; Burton, Martin J; Schilder, Anne G M

    2016-01-01

    BACKGROUND: This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and is characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial

  5. Infectious Chronic Rhinosinusitis

    Science.gov (United States)

    Bose, Sumit; Grammer, Leslie C.; Peters, Anju T.

    2016-01-01

    Chronic rhinosinusitis (CRS) is a persistent inflammatory disease that affects a multitude of people worldwide. The pathogenesis of CRS involves many factors including genetics, status of the sinonasal microbiome, infections and environmental influences. Comorbidities associated with CRS include asthma, allergic rhinitis, bronchiectasis and certain kinds of immunodeficiency. CRS can be divided into different subtypes based on endotypes and phenotypes. Infectious CRS is one such category. The etiology of infectious CRS is usually secondary to chronic bacterial infection which commonly begins with a viral upper respiratory tract infection. Humoral antibody deficiencies can underlie difficult-to-treat or recurrent CRS. Infectious CRS can be treated with antimicrobials, topical or oral corticosteroids and nasal saline irrigations. Patients with CRS and humoral immunodeficiency may require an aggressive treatment approach including immunoglobulin replacement therapy. Despite advancements in the field of CRS, targeted therapies and reliable biomarkers are still lacking. PMID:27393772

  6. Immunopathology of chronic rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Atsushi Kato

    2015-04-01

    Full Text Available Chronic rhinosinusitis (CRS is a heterogeneous disease characterized by local inflammation of the upper airways and sinuses which persists for at least 12 weeks. CRS can be divided into two phenotypes dependent on the presence of nasal polyps (NPs; CRS with NPs (CRSwNP and CRS without NPs (CRSsNP. Immunological patterns in the two diseases are known to be different. Inflammation in CRSsNP is rarely investigated and limited studies show that CRSsNP is characterized by type 1 inflammation. Inflammation in CRSwNP is well investigated and CRSwNP in Western countries shows type 2 inflammation and eosinophilia in NPs. In contrast, mixed inflammatory patterns are found in CRSwNP in Asia and the ratio of eosinophilic NPs and non-eosinophilic NPs is almost 50:50 in these countries. Inflammation in eosinophilic NPs is mainly controlled by type 2 cytokines, IL-5 and IL-13, which can be produced from several immune cells including Th2 cells, mast cells and group 2 innate lymphoid cells (ILC2s that are all elevated in eosinophilic NPs. IL-5 strongly induces eosinophilia. IL-13 activates macrophages, B cells and epithelial cells to induce recruitment of eosinophils and Th2 cells, IgE mediated reactions and remodeling. Epithelial derived cytokines, TSLP, IL-33 and IL-1 can directly and indirectly control type 2 cytokine production from these cells in eosinophilic NPs. Recent clinical trials showed the beneficial effect on eosinophilic NPs and/or asthma by monoclonal antibodies against IL-5, IL-4Rα, IgE and TSLP suggesting that they can be therapeutic targets for eosinophilic CRSwNP.

  7. Systemic and topical antibiotics for chronic rhinosinusitis

    NARCIS (Netherlands)

    Head, Karen; Chong, Lee Yee; Piromchai, Patorn; Hopkins, Claire; Philpott, Carl; Schilder, Anne G M; Burton, Martin J

    2016-01-01

    BACKGROUND: This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and is characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial

  8. Chronic rhinosinusitis: observation or treatment.

    Science.gov (United States)

    Prokopakis, Emmanuel; Vlastos, Ioannis; Pant, Harshita; Ferguson, Berrylin J

    2013-02-01

    Several treatment options have been proposed for chronic rhinosinusitis (CRS). Our purpose is to present a protocol/tool to treat patient symptoms, which is initially independent of assessment for presence of CRS. This protocol is called the Rational Patient Experiment (RPE), and its concept is largely based on the fact that CRS is overrepresented in incidence based on surveys, because symptoms of CRS are nonspecific and overlap multiple other disorders. Patients whose symptoms persist, despite the RPE, require further objective assessment of CRS with endoscopy and computed tomography. This review outlines the RPE and the evidence base for observation versus treatment with saline washes, steroids, or antibiotics.

  9. Sleep disruption in chronic rhinosinusitis.

    Science.gov (United States)

    Mahdavinia, Mahboobeh; Schleimer, Robert P; Keshavarzian, Ali

    2017-05-01

    Chronic rhinosinusitis (CRS) is a common disease of the upper airways and paranasal sinuses with a marked decline in quality of life (QOL). CRS patients suffer from sleep disruption at a significantly higher proportion (60 to 75%) than in the general population (8-18 %). Sleep disruption in CRS causes decreased QOL and is linked to poor functional outcomes such as impaired cognitive function and depression. Areas covered: A systematic PubMed/Medline search was done to assess the results of studies that have investigated sleep and sleep disturbances in CRS. Expert commentary: These studies reported sleep disruption in most CRS patients. The main risk factors for sleep disruption in CRS include allergic rhinitis, smoking, and high SNOT-22 total scores. The literature is inconsistent with regard to the prevalence of sleep-related disordered breathing (e.g. obstructive sleep apnea) in CRS patients. Although nasal obstruction is linked to sleep disruption, the extent of sleep disruption in CRS seems to expand beyond that expected from physical blockage of the upper airways alone. Despite the high prevalence of sleep disruption in CRS, and its detrimental effects on QOL, the literature contains a paucity of studies that have investigated the mechanisms underlying this major problem in CRS.

  10. Treatment of acute and chronic rhinosinusitis.

    Science.gov (United States)

    Casiano, R R

    2000-09-01

    Rhinosinusitis is a common health complaint that is often seen by primary care physicians and otolaryngologists in the United States. The complicated anatomy of the paranasal sinuses, as well as the multiple etiologies, contributes to the complexity that one often faces in trying to ameliorate or eradicate this disease in affected individuals. A full understanding of the fundamentals of rhinosinusitis, as well as the treatment options available for the different types, is important. It is very important for the physician to take an organized, step-by-step approach to the management of each patient with this complicated disease. As most cases of rhinosinusitis presenting to the generalist's office will be of viral origin, antibiotics should not be given unless the patient has purulent rhinorrhea or worsening symptoms lasting more than 5 days, or total symptoms lasting longer than 10 days. When medical treatment fails or is incomplete, adjunctive surgical treatment becomes an option. Generally, the symptoms that are most helped by surgery include persistent headaches, nasal obstruction, and recurrent or persistent purulent rhinorrhea unresponsive to medical management. Appropriate and timely referral for specialty care will result in the definitive management of recalcitrant rhinosinusitis when medical management alone fails or in cases where a complication or malignancy is suspected. This article reviews the current understanding of the anatomy, pathophysiology, classification, diagnosis, and potential complications of rhinosinusitis. It also describes the current approach to the treatment of both acute and chronic rhinosinusitis.

  11. Diagnosing Chronic Rhinosinusitis: a Literature update | Lobo ...

    African Journals Online (AJOL)

    Diagnosing chronic rhinosinusitis has undergone significant changes since the advent of sensitive but costly diagnostic aids like endoscopy, computed tomography scanning and magnetic resonance imaging. Other new conditions like migraine without aura, mid-segment facial pain and atypical facial pain can present with ...

  12. Complement defects in patients with chronic rhinosinusitis

    DEFF Research Database (Denmark)

    Gaunsbaek, Maria Quisgaard; Lange, Bibi; Kjeldsen, Anette D

    2012-01-01

    The complement system is an important part of our immune system, and complement defects lead generally to increased susceptibility to infections and autoimmune diseases. We have studied the role of complement activity in relation with chronic rhinosinusitis (CRS), and more specifically studied wh...

  13. Chronic rhinosinusitis: management for optimal outcomes

    NARCIS (Netherlands)

    Aukema, Albertien A. C.; Fokkens, Wytske J.

    2004-01-01

    Chronic rhinosinusitis is characterized by nasal purulence accompanied by malaise, postnasal drip and nasal dryness or crusting. It is a condition that is very difficult to treat and can be very disabling to the patients. A clinical diagnosis is based on history and evaluation with endoscopy, and

  14. Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis

    NARCIS (Netherlands)

    Chong, Lee Yee; Head, Karen; Hopkins, Claire; Philpott, Carl; Schilder, Anne G M; Burton, Martin J

    2016-01-01

    BACKGROUND: This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and is characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, rhinorrhoea, facial

  15. Different types of intranasal steroids for chronic rhinosinusitis

    NARCIS (Netherlands)

    Chong, Lee Yee; Head, Karen; Hopkins, Claire; Philpott, Carl; Burton, Martin J; Schilder, Anne G M

    2016-01-01

    BACKGROUND: This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and is characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial

  16. Expression of Pendrin Periostin in Allergic Rhinitis Chronic Rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Akihiro Ishida

    2012-01-01

    Conclusions: : Production of pendrin and periostin is upregulated in allergic rhinitis, chronic rhinosinusitis with nasal polyps, and aspirin-induced asthma. These findings suggest that pendrin can induce mucus production and that periostin can induce tissue fibrosis and remodeling in the nasal mucosa. Therefore, these mediators may be therapeutic target candidates for allergic rhinitis, chronic rhinosinusitis with nasal polyps, and aspirin- induced asthma.

  17. INCIDENCE OF ALLERGIC FUNGAL SINUSITIS AMONG PATIENTS WITH CHRONIC RHINOSINUSITIS

    Directory of Open Access Journals (Sweden)

    Vivek Gupta

    2017-09-01

    Full Text Available BACKGROUND This study aims to evaluate the incidence of allergic fungal sinusitis among patients with chronic rhinosinusitis. Chronic rhinosinusitis (CRS is a widely prevalent condition globally as well as in India. Fungal rhinosinusitis is classified into two subgroups: three invasive forms (acute necrotizing, chronic invasive, granulomatous invasive, and two noninvasive forms (fungal ball and allergic fungal. MATERIALS AND METHODS Patients attending the Department of ENT at Adesh institute of medical science & research, Bathinda (Punjab between Jan 2016 and Dec 2016 one year duration 82 cases were included in this retrospective analysis with features suggestive of chronic rhinosinusitis. Based on clinical, endoscopic and radiological parameters, 82 cases were diagnosed to have rhinosinusitis. In these cases, postoperatively after HPE examination, 16 cases were confirmed to have mycotic infection. RESULTS Out of 16 cases, In Allergic fungal rhino sinusitis(AFRS, Aspergillus flavus (A. flavus was the most common fungus isolated ten cases (71.42%.. In fungal ball, A. flavus was isolated in two cases (14.25% and Aspergillus niger (A. niger was isolated in two cases (14.25%. In invasive fungal rhinosinusitis (IFRS mucormycosis was isolated in two cases (12.5%. CONCLUSION The incidence of ARFS is about 12.2% of chronic rhinosinusitis. The commonest age group is second & third decade

  18. Systemic and topical antibiotics for chronic rhinosinusitis.

    Science.gov (United States)

    Head, Karen; Chong, Lee Yee; Piromchai, Patorn; Hopkins, Claire; Philpott, Carl; Schilder, Anne G M; Burton, Martin J

    2016-04-26

    This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is common and is characterised by inflammation of the lining of the nose and paranasal sinuses leading to nasal blockage, nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Systemic and topical antibiotics are used with the aim of eliminating infection in the short term (and some to reduce inflammation in the long term), in order to normalise nasal mucus and improve symptoms. To assess the effects of systemic and topical antibiotics in people with chronic rhinosinusitis. The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; CENTRAL (2015, Issue 8); MEDLINE; EMBASE; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 29 September 2015. Randomised controlled trials (RCTs) with a follow-up period of at least three months comparing systemic or topical antibiotic treatment to (a) placebo or (b) no treatment or (c) other pharmacological interventions. We used the standard methodological procedures expected by Cochrane. Our primary outcomes were disease-specific health-related quality of life (HRQL), patient-reported disease severity and the commonest adverse event - gastrointestinal disturbance. Secondary outcomes included general HRQL, endoscopic nasal polyp score, computerised tomography (CT) scan score and the adverse events of suspected allergic reaction (rash or skin irritation) and anaphylaxis or other very serious reactions. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. We included five RCTs (293 participants), all of which compared systemic antibiotics with placebo or another pharmacological intervention.The varying study characteristics made comparison difficult. Four studies recruited only adults and one only

  19. Chronic rhinosinusitis, endothelial dysfunction, and atherosclerosis.

    Science.gov (United States)

    Elcioglu, Omer Celal; Afsar, Baris; Bakan, Ali; Takir, Mumtaz; Ozkok, Abdullah; Oral, Alihan; Kostek, Osman; Basci, Semih; Kanbay, Asiye; Toprak, Aybala Erek; Bahat, Kubra Aydin; Kalcioglu, M Tayyar; Kanbay, Mehmet

    2016-05-01

    Chronic inflammation is associated with accelerated atherosclerosis, endothelial dysfunction (ED), and cardiovascular diseases. Because chronic rhinosinusitis (CRS) is an inflammatory disease, it may be associated with the development of ED and accelerated atherosclerosis. To investigate the relationship between CRS and carotid intima-media thickness (CIMT), flow-mediated dilation (FMD) of the brachial artery, and microalbuminuria. This cross-sectional study included 38 patients with CRS and 29 healthy controls. In addition to measuring spot urine albumin-creatinine ratios, FMD of the brachial artery and CIMT were assessed noninvasively. Patients with CRS had lower FMD scores (p = 0.031), higher CIMT scores (p = 0.005), and a higher urinary albumin-creatinine ratio (p = 0.036) compared with healthy controls. In a multivariate analysis, CIMT and FMD were independently associated with the presence of CRS. However, the relationship between urinary albumin and creatinine, and the presence of CRS was no longer observed. CRS is associated with ED and atherosclerosis, as indicated by decreased FMD and increased CIMT in patients with CRS. Further studies are necessary to identify the exact pathophysiologic mechanisms responsible for our findings.

  20. Cystic fibrosis chronic rhinosinusitis: A comprehensive review

    Science.gov (United States)

    Chaaban, Mohamad R.; Kejner, Alexandra; Rowe, Steven M.

    2013-01-01

    Background: Advances in the care of patients with cystic fibrosis (CF) have improved pulmonary outcomes and survival. In addition, rapid developments regarding the underlying genetic and molecular basis of the disease have led to numerous novel targets for treatment. However, clinical and basic scientific research focusing on therapeutic strategies for CF-associated chronic rhinosinusitis (CRS) lags behind the evidence-based approaches currently used for pulmonary disease. Methods: This review evaluates the available literature and provides an update concerning the pathophysiology, current treatment approaches, and future pharmaceutical tactics in the management of CRS in patients with CF. Results: Optimal medical and surgical strategies for CF CRS are lacking because of a dearth of well-performed clinical trials. Medical and surgical interventions are supported primarily by level 2 or 3 evidence and are aimed at improving clearance of mucus, infection, and inflammation. A number of novel therapeutics that target the basic defect in the cystic fibrosis transmembrane conductance regulator channel are currently under investigation. Ivacaftor, a corrector of the G551D mutation, was recently approved by the Food and Drug Administration. However, sinonasal outcomes using this and other novel drugs are pending. Conclusion: CRS is a lifelong disease in CF patients that can lead to substantial morbidity and decreased quality of life. A multidisciplinary approach will be necessary to develop consistent and evidence-based treatment paradigms. PMID:24119602

  1. Chronic invasive fungal granulomatous rhino-sinusitis: a case report ...

    African Journals Online (AJOL)

    Fungal Rhino-Sinusitis (FRS) is a relatively uncommon entity. The chronic invasive granulomatous form of FRS (FGRS) is a slowly progressive form of fungal infection characterized by chronic granulomatous process with a time course of longer than 12 weeks. The aim of this report is to draw the attention of colleagues to ...

  2. Risk Factors and Comorbidities in Chronic Rhinosinusitis.

    Science.gov (United States)

    Tint, Derrick; Kubala, Stephanie; Toskala, Elina

    2016-02-01

    Chronic rhinosinusitis (CRS) is a heterogeneous disorder that creates a significant burden on the healthcare system. It is caused by a combination of inflammatory, environmental, and host factors; however, the precise mechanism of how each factor leads to CRS continues to be a source of debate. Previous data regarding this topic is often inconsistent or of lower quality. In this article, we review the recent literature on the risk factors and comorbidities in CRS. Large population-based studies have helped establish smoking as a significant risk factor for CRS. The focus has now shifted towards smoking and its effect on long-term outcomes after endoscopic sinus surgery (ESS). Ciliary dyskinesia, both primary and secondary, can affect both the sinonasal cavity and lower airways simultaneously by decreasing the beat frequency of cilia and inducing mucostasis. The effects of secondary dyskinesia may be reversible and there is some evidence to suggest the use of topical mucolytics in patients with CRS. Allergy and variants of sinonasal anatomy have been hypothesized to increase the risk of developing CRS by inducing chronic inflammation and obstructing the sinus ostia. Nevertheless, emerging data regarding these topics continue to produce inconclusive results. Inflammation of the upper and lower airways can occur simultaneously as seen in patients with asthma and aspirin sensitivity. The connection between these pro-inflammatory disease states has been known for many years. Newer evidence include large population-based studies and studies that correlate objective tests, such as computer tomography scans to pulmonary function tests. However, the treatment of CRS and its effects on obstructive airway disease continues to be a topic of debate. More large prospective studies are needed in order to continue refining our knowledge of the disease processes in CRS.

  3. Quality of life and associated factors in persons with Chronic Rhinosinusitis in the general population

    DEFF Research Database (Denmark)

    Lange, B; Holst, R; Thilsing, T

    2013-01-01

    The European Position Paper on Rhinosinusitis and Nasal Polyps describes methods to perform population-based and clinical studies on Chronic Rhinosinusitis in a standardized way and it also describes how to clinical investigate CRS. The aim of this cross sectional study was to evaluate Quality of...... of life and objective findings in persons with Chronic Rhinosinusitis recruited from the general population....

  4. Asthma onset pattern and patient outcomes in a chronic rhinosinusitis population.

    Science.gov (United States)

    John Staniorski, Christopher; Price, Caroline P E; Weibman, Ava R; Welch, Kevin C; Conley, David B; Shintani-Smith, Stephanie; Stevens, Whitney W; Peters, Anju T; Grammer, Leslie; Lidder, Alcina K; Schleimer, Robert P; Kern, Robert C; Tan, Bruce K

    2018-04-01

    Chronic rhinosinusitis (CRS) is strongly associated with comorbid asthma. This study compares early-onset and late-onset asthma in a CRS population using patient-reported and clinical characteristics. At enrollment into a clinical registry, CRS patients completed the 22-item Sino-Nasal Outcome Test (SNOT-22), Asthma Control Test (ACT), mini-Asthma Quality of Life Questionnaire (miniAQLQ), the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29), and medication use questionnaires. Patients also reported comorbid asthma and age at first asthma diagnosis. Early-onset (18 years) asthma groups were defined. Analysis of variance (ANOVA), chi-square, and Kruskal-Wallis tests were used to compare patient responses. A total of 199 non-asthmatic (56.1%), 71 early-onset asthmatic (20.0%), and 85 late-onset asthmatic (23.9%) CRS patients completed the survey. Body mass index (BMI) was significantly higher in late-onset asthmatic (p = 0.046) while age, gender, race, and smoking history did not differ with time of asthma onset. SNOT-22, ACT, and miniAQLQ were not different between asthma groups, but late-onset asthmatics had significantly lower physical function than non-asthmatics (p = 0.008). Compared to non-asthmatics, late-onset asthmatics showed increased rates of nasal polyps (p < 0.001), higher Lund-Mackay scores (p = 0.005), and had received more oral steroid courses (p < 0.001) and endoscopic surgeries (p = 0.008) for CRS management. Late-onset asthmatics compared to early-onset asthmatics showed increased nasal polyposis (p = 0.011) and oral steroid courses for CRS (p = 0.003). While CRS-specific and asthma-specific patient-reported outcome measures (PROMs) were not significantly different among groups, CRS patients with late-onset asthma had poorer physical function, more frequent nasal polyposis, and required increased treatment for CRS. Late-onset asthma may predict more severe disease in CRS. © 2018 ARS-AAOA, LLC.

  5. CHronic Rhinosinusitis Outcome MEasures (CHROME), developing a core outcome set for trials of interventions in chronic rhinosinusitis

    NARCIS (Netherlands)

    Hopkins, C.; Hettige, R.; Soni-Jaiswal, A.; Lakhani, R.; Carrie, S.; Cervin, A.; Douglas, R.; Fokkens, W. J.; Harvey, R.; Hellings, P. W.; Leunig, A.; Lund, V. J.; Philpott, C.; Smith, T.; Wang, D. Y.; Rudmik, L.

    2018-01-01

    Evaluating the effectiveness of treatments in chronic rhinosinusitis (CRS) have been limited by both a paucity of high quality randomised trials, and the heterogeneity of outcomes in those that have been reported. Core outcome sets (COS) are an agreed, standardized set of outcomes that should be

  6. SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases

    NARCIS (Netherlands)

    Prokopakis, E. P.; Vlastos, I. M.; Ferguson, B. J.; Scadding, G.; Kawauchi, H.; Georgalas, C.; Papadopoulos, N.; Hellings, P. W.

    2014-01-01

    Our objective is to present recent research findings on recalcitrant chronic rhinosinusitis (CRS) in relation to "Severe Chronic Upper Airway Disease" (SCUAD). Literature review using Medline and Em base databases (search terms 'chronic rhinosinusitis'; "chronic sinusitis" or"Severe Chronic Upper

  7. The Prevalence of Allergic Rhinitis in Patients with Chronic Rhinosinusitis

    OpenAIRE

    Mehdi Bakhshaee; Farahzad Jabari; Mohammad Mehdi Ghassemi; Shiva Hourzad; Russell Deutscher; Kianoosh Nahid

    2014-01-01

    Introduction: Chronic rhinosinusitis (CRS) is a multifactorial disease. Allergies are considered a predisposing factor to CRS; however, this remains controversial. The objective of this research was to investigate the prevalence of co-morbidities and allergic reaction, and to specify the most common allergens in patients with confirmed CRS.   Materials and Methods: One hundred patients with signs and symptoms of CRS who met the diagnostic endoscopic and radiologic criteria of chronic rhinosi...

  8. Efficiency of hypertonic and isotonic seawater solutions in chronic rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Josip Čulig

    2010-08-01

    Full Text Available Aim To compare the efficiency of isotonic and hypertonic seawatersolutions used for nasal lavage and quality of life of the patientswith chronic rhinosinusitis. Methods A random and controlled clinical study was performed. The study included 60 patients with history of chronic rhinosinusitis. At the beginning of the study, each subject was given a Patient Lobook, which needed to be filled ut daily during the 15-day tudy period. There were three visits per each patient during the study. Results Patient Logbook notes showed significant statistical differences inall symptoms in the group of patients using hypertonic seawater solution. However, while the notes showed significant statistical differences in congestion and rhinorrhea, in the group of patients using isotonic seawater solution, other symptoms showed no major changes during the study period. Conclusion Hypertonic seawater solution has been proven to bebetter than isotonic seawater solution in eliminating the symptomsof nasal congestion, rhinorrhea, cough, headache and waking up duringthe night.

  9. The Prevalence of Allergic Rhinitis in Patients with Chronic Rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Mehdi Bakhshaee

    2014-10-01

    Full Text Available Introduction: Chronic rhinosinusitis (CRS is a multifactorial disease. Allergies are considered a predisposing factor to CRS; however, this remains controversial. The objective of this research was to investigate the prevalence of co-morbidities and allergic reaction, and to specify the most common allergens in patients with confirmed CRS.   Materials and Methods: One hundred patients with signs and symptoms of CRS who met the diagnostic endoscopic and radiologic criteria of chronic rhinosinusitis were selected. They filled out a questionnaire and underwent a skin prick test for the common inhalant allergens. Allergic rhinitis was diagnosed according to the history and positive skin prick tests.   Results: The mean age of patients was 34. Males were slightly more involved (54%. The prevalence of polypoid and none-polypoid rhinosinusitis was 54% and 46% respectively. The patients’ most common symptoms were nasal discharge (95%, blockage (94%, smell disorders (63%, cough (45%, halitosis (41%, lethargy (37%, and aural fullness (36%. Allergy to at least one allergen was noted in 64% of the CRS patients which is higher than general population in Mashhad, Iran with allergic rhinitis (22.4%. Salsola was the most common allergen. There was no significant difference in allergic reactions between polypoid and non-polypoid CRS patients.   Conclusion:  Allergic reactions was found in Iranian CRS patients with or without polyposis to be much higher than general population in Mashhad with allergic rhinitis alone.

  10. Chronic rhinosinusitis and age: is the pathogenesis different?

    Science.gov (United States)

    Mahdavinia, Mahboobeh; Grammer, Leslie C

    2013-10-01

    Chronic rhinosinusitis (CRS) is a common disease with a significant impact on quality of life, which is seen across all age groups. There are differences in symptomatology, histopathology and associated diseases when comparing pediatric versus adult patients with CRS. Nasal polyposis tends to be less commonly seen in pediatric CRS compared with adults except in children with cystic fibrosis or allergic fungal rhinosinusitis. The differences in histopathology of CRS in different age groups include higher cellularity and more prominent lymphocytic infiltration in children compared with adults who tend to have a stronger eosinophilic infiltration and more prominent glandular hyperplasia. There are data supporting a stronger association of gastroesophageal reflux disease and otitis media with CRS in children compared with adults. Adenoids may play a role in pediatric, but not adult CRS. Immunodeficiencies and asthma are strongly associated with CRS in all age groups. There is a paucity of data on pathophysiology of disease on elderly CRS.

  11. Short-course oral steroids as an adjunct therapy for chronic rhinosinusitis

    NARCIS (Netherlands)

    Head, Karen; Chong, Lee Yee; Hopkins, Claire; Philpott, Carl; Schilder, Anne G M; Burton, Martin J

    2016-01-01

    BACKGROUND: This review is one of a suite of six Cochrane reviews looking at the primary medical management options for patients with chronic rhinosinusitis.Chronic rhinosinusitis is a common condition involving inflammation of the lining of the nose and paranasal sinuses. It is characterised by

  12. Clinical implications of microbial biofilms in chronic rhinosinusitis and orbital cellulitis

    OpenAIRE

    Nayak, Niranjan; Satpathy, Gita; Prasad, Sujata; Thakar, Alok; Chandra, Mahesh; Nag, TC

    2016-01-01

    Background Discovery of sessile mode of microbial existence (Biofilm state) focussed much interest, during the recent years, on the study of biofilms in many recurring and chronic infections. However, the exact role of microbial biofilms in chronic rhinosinusitis and orbital cellulitis were not elucidated earlier. The purpose of the present study was to look for the adherent property and biofilm producing ability of the clinical isolates in chronic rhinosinusitis and orbital cellulitis, and t...

  13. Alcohol hyper-responsiveness in chronic rhinosinusitis with nasal polyps.

    Science.gov (United States)

    De Schryver, Els; Derycke, Lara; Campo, Paloma; Gabriels, Eline; Joos, Guy F; Van Zele, Thibaut; Bachert, Claus; Hellings, Peter W; Gevaert, Philippe

    2017-02-01

    An important percentage of subjects diagnosed with chronic upper airway disease report alcohol-induced worsening of their symptoms. The prevalence and characteristics of respiratory reactions provoked by alcohol-containing drinks have not been fully investigated yet. The aim of this study was to estimate the prevalence and characteristics of alcohol hyper-responsiveness in patients with chronic airway disease and healthy controls. Furthermore, nasal inflammation was evaluated in nasal polyp patients with and without hyper-responsiveness. We evaluated the prevalence and characteristics of alcohol-induced respiratory complaints in 1281 subjects. Chronic rhinosinusitis with nasal polyps (CRSwNP) patients with and without NSAID exacerbated respiratory disease (NERD), chronic rhinosinusitis patients without nasal polyps (CRSsNP), allergic rhinitis (AR) patients and healthy controls were approached by means of a questionnaire. Inflammatory markers (eosinophilic cationic protein (ECP), IL-5, IgE, SAE-specific IgE, IL-17, TNFα and IFNγ) in tissue were then compared between alcohol hyper-responsive and non-hyper-responsive CRSwNP patients. The highest prevalence of nasal and bronchial alcohol hyper-responsiveness was observed in patients with NERD, followed by CRSwNP, and less frequent in CRSsNP, AR and healthy controls. Alcohol hyper-responsiveness is significantly more prevalent in CRSwNP patients suffering from recurrent disease and in patients with severe symptomatology. In nasal tissue of the hyper-responsive CRSwNP group, we observed significantly higher nasal levels of the eosinophilic biomarker ECP. Nasal hyper-responsiveness to alcohol is significantly more prevalent in severe eosinophilic upper airway disease. © 2016 John Wiley & Sons Ltd.

  14. Canadian clinical practice guidelines for acute and chronic rhinosinusitis.

    Science.gov (United States)

    Desrosiers, Martin; Evans, Gerald A; Keith, Paul K; Wright, Erin D; Kaplan, Alan; Bouchard, Jacques; Ciavarella, Anthony; Doyle, Patrick W; Javer, Amin R; Leith, Eric S; Mukherji, Atreyi; Robert Schellenberg, R; Small, Peter; Witterick, Ian J

    2011-05-01

    This document provides health care practitioners with information regarding the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis (ABRS) and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007, but these are either limited in their coverage of the subject of CRS, do not follow an evidence-based strategy, or omit relevant stakeholders in the development of guidelines and do not address the particulars of the Canadian health care environment.Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally, and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation), which have led to changes in therapeutic approaches (eg, increased use of corticosteroids). The role of bacteria in the persistence of chronic infections and the roles of surgical and medical management are evolving. Although evidence is limited, guidance for managing patients with CRS would help practitioners less experienced in this area offer rational care. It is no longer reasonable to manage CRS as a prolonged version of ARS, but, rather, specific therapeutic strategies adapted to pathogenesis must be developed and diffused.Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. This document is focused on readability

  15. Canadian clinical practice guidelines for acute and chronic rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Desrosiers Martin

    2011-02-01

    Full Text Available Abstract This document provides healthcare practitioners with information regarding the management of acute rhinosinusitis (ARS and chronic rhinosinusitis (CRS to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis (ABRS and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007, but these are either limited in their coverage of the subject of CRS, do not follow an evidence-based strategy, or omit relevant stakeholders in guidelines development, and do not address the particulars of the Canadian healthcare environment. Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation, which have led to changes in therapeutic approaches (eg, increased use of corticosteroids. The role of bacteria in the persistence of chronic infections, and the roles of surgical and medical management are evolving. Although evidence is limited, guidance for managing patients with CRS would help practitioners less experienced in this area offer rational care. It is no longer reasonable to manage CRS as a prolonged version of ARS, but rather, specific therapeutic strategies adapted to pathogenesis must be developed and diffused. Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. This document is focused on

  16. Activity of Bacteriophages in Removing Biofilms of Pseudomonas aeruginosa Isolates from Chronic Rhinosinusitis Patients

    NARCIS (Netherlands)

    Fong, Stephanie A.; Drilling, Amanda; Morales, Sandra; Cornet, Marjolein E.; Woodworth, Bradford A.; Fokkens, Wytske J.; Psaltis, Alkis J.; Vreugde, Sarah; Wormald, Peter-John

    2017-01-01

    Introduction:Pseudomonas aeruginosa infections are prevalent amongst chronic rhinosinusitis (CRS) sufferers. Many P. aeruginosa strains form biofilms, leading to treatment failure. Lytic bacteriophages (phages) are viruses that infect, replicate within, and lyse bacteria, causing bacterial death.

  17. [Chronic rhinosinusitis with bronchial asthma, what should we concern about?].

    Science.gov (United States)

    Shi, Jianbo; Chen, Fenghong

    2016-03-01

    There is a strong association between chronic rhinosinusitis (CRS) and asthma. Approximately 10%-50% of CRS patients also have comorbid asthma. These patients are more likely to have severe CRS and asthma and higher recurrence rates after sinus surgery. Also there may be acute asthma attack during the perioperative period. Therefore, we should pay more attention to these patients. Assessment of the control level of asthma and pulmonary function should be performed preoperatively. And asthma needs to be fully managed in the perioperative period to avoid acute asthma attack. Extensive sinus surgery is recommended in these patients to reduce the inflammation load. Long-term medical treatment and regular follow-up are suggested to achieve well control of CRS and asthma.

  18. Sleep Quality and Disease Severity in Patients with Chronic Rhinosinusitis

    Science.gov (United States)

    Alt, Jeremiah A.; Smith, Timothy L.; Mace, Jess C.; Soler, Zachary M.

    2013-01-01

    Objective To evaluate sleep quality in patients with chronic rhinosinusitis (CRS) using a validated outcome measure and compare measures of CRS disease severity with sleep dysfunction. Study Design Cross-sectional evaluation of a multi-center cohort Methods Patients with CRS according to the 2007 Adult Sinusitis Guidelines were prospectively enrolled from four academic, tertiary care centers across North America. Each subject completed the Pittsburgh Sleep Quality Index (PSQI) instrument, in addition to CRS-specific measures of quality-of-life (QOL), endoscopy, computed tomography (CT), and olfaction. Patient demographics, comorbid conditions, and clinical measures of disease severity were compared between patients with “good” (PSQI; ≤ 5) and “poor” (PSQI; >5) sleep quality. Results Patients (n=268) reported a mean PSQI score of 9.4(range: 0–21). 75.0% of patients reported PSQI scores above the traditional cut-off indicating poor sleep quality. Patients with poor sleep quality were found to have significantly worse QOL scores on both the Rhinosinusitis Disability Index (p<0.001) and 22-item Sinonasal Outcome Test (p<0.001). No significant differences in average endoscopy, CT, or olfactory function scores were found between patients with good or poor sleep quality. Tobacco smokers reported worse average PSQI total scores compared to non-smokers(p=0.030). Patients reporting poor sleep were more likely to have a history of depression, even after controlling for gender (p=0.020). Conclusion The majority of patients with CRS have a poor quality of sleep as measured by the PSQI survey. Poor sleep quality is significantly associated with CRS-specific QOL, gender, comorbid depression, and tobacco use but not CT score or endoscopy grade. PMID:23918740

  19. Exophiala oligosperma involved in a refractory chronic rhinosinusitis.

    NARCIS (Netherlands)

    Badali, H.; Hedayati, M.T.; Bahoosh, M.; Kasir, A.; Ghasemi, M.; Motahari, J.; Meis, J.F.G.M.; Hoog, G.S. de

    2011-01-01

    Fungal rhinosinusitis refers to a wide variety of conditions caused by fungal infections of the paranasal sinuses. Allergic fungal rhinosinusitis and sinus fungus balls are mostly noted in healthy individuals. Aspergillus species are supposed to be the most common etiologic agents of the disorder,

  20. [Mechanisms underlying glucocorticoid resistance in chronic rhinosinusitis with nasal polyps].

    Science.gov (United States)

    Zhang, Y Y; Lou, H F; Wang, C S; Zhang, L

    2018-02-07

    Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease that occurs in the nasal and sinus mucosa, which is a common disease in otorhinolaryngology. At present, CRSwNP can be effectively treated by glucocorticoids (GC). GC binds to GC receptors in the nasal mucosa, affects the expression of inflammatory genes, inhibits the activation and action of eosinophils, T cell-associated inflammatory responses in nasal polyps, as well as tissue remodeling. However, there are some patients fall reponse to GC, so called GC resistance. The study suggests that the possible mechanism of CRSwNP GC resistance is mainly related to GC receptor abnormal, the role of cytokines and transcription factors, such as Th cells and IL-8. In addition, MAPK-related kinases and histone deacetylase in the GC signaling pathway also play important roles in the GC resistance process. This paper reviews the mechanism of GC treatment of CRSwNP, the mechanism of GC resistance and alternative treatment of GC.

  1. Biofilms in chronic rhinosinusitis: Pathophysiology and therapeutic strategies

    Directory of Open Access Journals (Sweden)

    Judd H. Fastenberg

    2016-12-01

    Full Text Available Background: There is increasing evidence that biofilms are critical to the pathophysiology of chronic infections including chronic rhinosinusitis (CRS. Until relatively recently, our understanding of biofilms was limited. Recent advances in methods for biofilm identification and molecular biology have offered new insights into the role of biofilms in CRS. With these insights, investigators have begun to investigate novel therapeutic strategies that may disrupt or eradicate biofilms in CRS. Objective: This review seeks to explore the evidence implicating biofilms in CRS, discuss potential anti-biofilm therapeutic strategies, and suggest future directions for research. Results: The existing evidence strongly supports the role of biofilms in the pathogenesis of CRS. Several anti-biofilm therapies have been investigated for use in CRS and these are at variable stages of development. Generally, these strategies: 1 neutralize biofilm microbes; 2 disperse existing biofilms; or 3 disrupt quorum sensing. Several of the most promising anti-biofilm therapeutic strategies are reviewed. Conclusions: A better understanding of biofilm function and their contribution to the CRS disease process will be pivotal to the development of novel treatments that may augment and, potentially, redefine the CRS treatment paradigm. There is tremendous potential for future research. Keywords: Sinusitis, Biofilms, Anti-bacterial agents, Quorum sensing, Surface-active agents, Active immune response, Innate immune response

  2. Sudden sensorineural hearing loss is associated with chronic rhinosinusitis: population-based study.

    Science.gov (United States)

    Hung, S H; Lin, H C; Kao, L T; Wu, C S; Chung, S D

    2016-06-01

    This study aimed to evaluate the association of chronic rhinosinusitis with sudden sensorineural hearing loss using a population-based database. Sampled subject data were obtained from the Taiwan Longitudinal Health Insurance Database 2000. A total of 3325 patients with sudden sensorineural hearing loss were identified and 9975 controls were randomly selected. A conditional logistic regression was used to calculate the odds ratio for having been previously diagnosed with chronic rhinosinusitis, for cases and controls. The adjusted odds ratio of having prior chronic rhinosinusitis among cases compared to controls was 1.36 (95 per cent confidence interval = 1.16-1.60). The significant relationship between sudden sensorineural hearing loss and chronic rhinosinusitis was most pronounced among those patients aged 44 years or less (compared to controls) (odds ratio = 2.18; 95 per cent confidence interval = 1.63-2.92). However, the significant relationship between sudden sensorineural hearing loss and prior chronic rhinosinusitis was not sustained for patients older than 60 years compared to controls.

  3. Reliability and validity study of Sino-nasal outcome test 22 (Thai version) in chronic rhinosinusitis.

    Science.gov (United States)

    Lumyongsatien, Jate; Yangsakul, Waralak; Bunnag, Chaweewan; Hopkins, Claire; Tantilipikorn, Pongsakorn

    2017-01-01

    Chronic rhinosinusitis (CRS) is one of common health conditions that affects patients' health-related quality of life. Our purpose is to assess the reliability and validity of Thai-version of Sino-Nasal Outcome Test 22 in chronic rhinosinusitis. Permission for translation of SNOT-22 from English language to Thai language was obtained from the developer. The translation process was done based on the international standard of translation method. A total of 80 subjects were recruited into the study and divided into two groups comprising of 50 patients with chronic rhinosinusitis and 30 healthy volunteers. Cronbach's α and Intraclass correlation coefficient were evaluated for its reliability. Validity test was evaluated against VAS score, SF-36 (Thai version) questionnaire and CT scan (based on Lund-Mackay score). Responsiveness was assessed between pre-operative and post-operative scores in 34 patients. The Thai version of SNOT-22 showed good reliability according to high value of Cronbach's α coefficient ( r  = 0.929) and intraclass correlation coefficient ( r  = 0.935). It also showed good validity by its ability to differential the patients with chronic rhinosinusitis from normal ( p  reliability and validity, suitable for evaluation of chronic rhinosinusitis symptoms together with severity of the disease and response to treatment. Thai clinical trials registry TCTR20170320003. Date of registration 20/03/2017 (retrospectively registered).

  4. NEW METHOD OF CONSERVATIVE TREATMENT OF CHRONIC RHINOSINUSITIS IN CHILDREN WITH CYSTIC FIBROSIS

    Directory of Open Access Journals (Sweden)

    S.G. Ushakova

    2010-01-01

    Full Text Available Development of new methods of treatment of cystic fibrosis (CF is necessary because of severe clinical course of this disease and frequent development of rhinosinusitis in children. Rhinosinusitis in patients with CF has chronic clinical course, frequent exacerbation and it is hardly treated with traditional therapy. Authors studied effectiveness of treatment of chronic sinusitis with inhalations of dornase alfa in accessory sinuses of nose with compressor inhalator PARI LC SINUS. 23 children with severe clinical course of CF, chronic sinusitis and rhinitis remaining despite recommended treatment were observed during the study. Treatment with inhalations of dornase alfa with PARI LC SINUS had beneficial effect, and it can be recommended for inclusion in pediatric practice. Key words: children, cystic fibrosis, chronic rhinosinusitis, dornase alfa, PARI LC SINUS, conservative therapy.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(5:72-79

  5. Reappraising the role of radiography in the diagnosis of chronic rhinosinusitis.

    Science.gov (United States)

    Leo, Gualtiero; Triulzi, Fabio; Consonni, Dario; Cazzavillan, Alessandro; Incorvaia, Cristoforo

    2009-09-01

    To revaluate the role of radiography in the diagnosis of chronic rhinosinutis, versus the currently suggested standards of computed tomography (CT) or nasal endoscopy. In total, 269 children consecutively admitted to our Unit for symptoms suggestive of chronic rhinosinusitis were included in this study; of these 222 were confirmed by fiberoptic nasopharyngeal endoscopy to have chronic rhinosinusitis, while 47 were not. Analysis of sensitivity and specificity of plain radiography by Waters' projection was carried. Radiography had a sensitivity of 84.2% (95% confidence interval 78.8 to 88.8), and a specificity of 76.6% (95% confidence interval 62.0 to 87.7) against the standard of nasal endoscopy. In routine practice, the clinical diagnosis of chronic rhinosinusitis may be obtained in many cases by Waters' projection radiography, limiting more expensive CT scanning or endoscopic techniques, which remain the reference diagnostic tools, to a smaller number of patients.

  6. Productivity costs in patients with refractory chronic rhinosinusitis.

    Science.gov (United States)

    Rudmik, Luke; Smith, Timothy L; Schlosser, Rodney J; Hwang, Peter H; Mace, Jess C; Soler, Zachary M

    2014-09-01

    Disease-specific reductions in patient productivity can lead to substantial economic losses to society. The purpose of this study was to: 1) define the annual productivity cost for a patient with refractory chronic rhinosinusitis (CRS) and 2) evaluate the relationship between degree of productivity cost and CRS-specific characteristics. Prospective, multi-institutional, observational cohort study. The human capital approach was used to define productivity costs. Annual absenteeism, presenteeism, and lost leisure time was quantified to define annual lost productive time (LPT). LPT was monetized using the annual daily wage rates obtained from the 2012 U.S. National Census and the 2013 U.S. Department of Labor statistics. A total of 55 patients with refractory CRS were enrolled. The mean work days lost related to absenteeism and presenteeism were 24.6 and 38.8 days per year, respectively. A total of 21.2 household days were lost per year related to daily sinus care requirements. The overall annual productivity cost was $10,077.07 per patient with refractory CRS. Productivity costs increased with worsening disease-specific QoL (r = 0.440; p = 0.001). Results from this study have demonstrated that the annual productivity cost associated with refractory CRS is $10,077.07 per patient. This substantial cost to society provides a strong incentive to optimize current treatment protocols and continue evaluating novel clinical interventions to reduce this cost. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Rosacea and Chronic Rhinosinusitis: A Case-Controlled Study

    Science.gov (United States)

    Al-Balbeesi, Amal O.

    2014-01-01

    Objective To determine the relationship between rosacea, chronic rhinosinusitis (CRS), and the clinical presentation of rosacea. Subjects and Method Twenty-eight female Saudi patients diagnosed with rosacea at the Dermatology Clinic, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, between September 2011 and September 2012 and 20 age- and sex-matched control patients were included in the study. Paranasal sinus X-rays and assessments of the serum concentration of IgE (ImmunoCAP test; Phadia Laboratory Systems) were performed in both groups. Result The rosacea patients had significantly more radiological evidence of CRS than the patients without rosacea [19 (67.9%) vs. 4 (20%), p = 0.003]. The median IgE concentration was similar in both groups (225.4 vs. 223.1 kU/l). Nine rosacea patients (32.1%) without radiological evidence of CRS did not have a significantly different median concentration of IgE compared with those who had radiological evidence of CRS (190.5 vs. 111.5 kU/l, p = 0.859). Erythematotelangiectatic severity was significantly associated with CRS (p = 0.038). Serum IgE did not correlate with the severity of the facial condition. Conclusion Patients with rosacea and CRS manifested severe erythematotelangiectatic rosacea. There was enough evidence to suggest an association between rosacea and CRS. Clinical and radiological assessments of the paranasal sinuses are recommended. PMID:25060422

  8. The in vitro effect of xylitol on chronic rhinosinusitis biofilms.

    Science.gov (United States)

    Jain, R; Lee, T; Hardcastle, T; Biswas, K; Radcliff, F; Douglas, R

    2016-12-01

    Biofilms have been implicated in chronic rhinosinusitis (CRS) and may explain the limited efficacy of antibiotics. There is a need to find more effective, non-antibiotic based therapies for CRS. This study examines the effects of xylitol on CRS biofilms and planktonic bacteria. Crystal violet assay and spectrophotometry were used to quantify the effects of xylitol (5% and 10% solutions) against Staphylococcus epidermidis, Pseudomonas aeruginosa, and Staphylococcus aureus. The disruption of established biofilms, inhibition of biofilm formation and effects on planktonic bacteria growth were investigated and compared to saline and no treatment. Xylitol 5% and 10% significantly reduced biofilm biomass (S. epidermidis), inhibited biofilm formation (S. aureus and P. aeruginosa) and reduced growth of planktonic bacteria (S. epidermidis, S. aureus, and P. aeruginosa). Xylitol 5% inhibited formation of S. epidermidis biofilms more effectively than xylitol 10%. Xylitol 10% reduced S. epidermidis planktonic bacteria more effectively than xylitol 5%. Saline, xylitol 5% and 10% disrupted established biofilms of S. aureus when compared with no treatment. No solution was effective against established P. aeruginosa biofilm. Xylitol has variable activity against biofilms and planktonic bacteria in vitro and may have therapeutic efficacy in the management of CRS.

  9. The Sinonasal Outcome Test 22 score in persons without chronic rhinosinusitis

    DEFF Research Database (Denmark)

    Lange, Bibi; Thilsing, T; Baelum, J

    2016-01-01

    -67 with a mean score of 10.5 (CI: 9.1 - 11.9) and the median score was 7. Persons with allergic rhinitis and blue collar workers had a significant higher score. CONCLUSION: The median value of 7 is taken as the normal SNOT 22 score in persons without CRS and can be used as a reference in clinical settings......OBJECTIVES: To determine the Sino Nasal Outcome Test 22 (SNOT 22) score in persons without chronic rhinosinusitis. DESIGN AND SETTING: As part of a trans-European study selected respondents to a survey questionnaire were invited for a clinical visit. Subjective symptoms and rhinoscopy were used...... for the clinical diagnosis of chronic rhinosinusitis according to EPOS. PARTICIPANTS: A total of 366 persons participated at the clinical visit and of these 268 did not have chronic rhinosinusitis. All participants completed the SNOT 22. MAIN OUTCOME MEASURES: The SNOT 22. RESULTS: The SNOT 22 score ranged from 0...

  10. CHronic Rhinosinusitis Outcome MEasures (CHROME), developing a core outcome set for trials of interventions in chronic rhinosinusitis.

    Science.gov (United States)

    Hopkins, C; Hettige, R; Soni-Jaiswal, A; Lakhani, R; Carrie, S; Cervin, A; Douglas, R; Fokkens, W J; Harvey, R; Hellings, P W; Leunig, A; Lund, V J; Philpott, C; Smith, T; Wang, D Y; Rudmik, L

    2018-03-01

    Evaluating the effectiveness of treatments in chronic rhinosinusitis (CRS) have been limited by both a paucity of high quality randomised trials, and the heterogeneity of outcomes in those that have been reported. Core outcome sets (COS) are an agreed, standardized set of outcomes that should be measured and reported by future trials as a minimum and will facilitate future meta-analysis of trial results in systematic reviews (SRs). We set out to develop a core outcome set for interventions for adults with CRS. A long-list of potential outcomes was identified by a steering group utilising a literature review, thematic analysis of a wide range of stakeholders' views and systematic analysis of currently available Patient Reported Outcome Measures (PROMs). A subsequent e-Delphi process allowed 110 patients and healthcare practitioners to individually rate the outcomes in terms of importance, on a Likert scale. After 2 rounds of the iterative Delphi process, the 54 initial outcomes were distilled down to a final core-outcome set of 15 items, over 4 domains. The authors hope inclusion of these core outcomes in future trials will increase the value of research on interventions for CRS in adults. It was felt important to make recommendations regarding how these outcomes should be measured, although additional work is now required to further develop and revalidate existing outcome measures.

  11. Acute versus Chronic Invasive Fungal Rhinosinusitis: A Case-Control Study

    Directory of Open Access Journals (Sweden)

    Patorn Piromchai

    2012-01-01

    Full Text Available Introduction Invasive fungal rhinosinusitis is a challenging condition that can be found mostly in immunocompromised patients. Failure to diagnose and treat this entity promptly usually results in rapid progression and death. The purpose of this study was to determine clinical presentation, complication and morbidity in patients with acute versus chronic invasive fungal rhinosinusitis. Setting and design Case-control study at Srinagarind Hospital, Khon Kaen University between January 1998 and May 2008. Methods The patient's data with the diagnosis of invasive fungal rhinosinusitis was included. Demographic data, underlying diseases, presenting symptoms, histologic sinonasal tissue evaluations, sinonasal tissue cultures, CT scan findings, surgical interventions, morbidity, and mortality were collected. Results Sixty-five patients were diagnosed as invasive fungal rhinosinusitis between January 1998 and May 2008. The data of six patients were unable to obtain. Fifty-nine patients were included in this study. Patients with immunocompromised status have significant greater risk for acute than chronic IFS, OR = 6.5 ( P = 0.004. Patients with mucosal necrosis have the significant higher risk for acute IFS, OR = 5.5 ( P = 0.01. There was no significant difference in orbital complications proportion between acute and chronic invasive fungal rhinosinusitis, OR = 2.42 ( P = 0.15. Sinus wall erosion have found significantly in chronic IFS group, OR = 0.24 ( P = 0.02. The average hospital stayed was 30.58 ± 26.43 days with no difference between groups ( P = 0.50. Fourteen patients in acute IFS group were dead (31.11% while all patients in chronic IFS group were survived. Conclusions Invasive fungal rhinosinusitis continues to present a challenge to the otolaryngologist. Acute IFS was found most commonly in immunocompromised patients. The most consistent finding of acute IFS was mucosal necrosis and black crust/debris. The CT finding of sinus wall erosion

  12. Olfactory function in patients with chronic rhinosinusitis before and after functional endoscopic sinus surgery.

    Science.gov (United States)

    Jiang, Rong-San; Lu, Fung-Jou; Liang, Kai-Li; Shiao, Jiun-Yi; Su, Mao-Chang; Hsin, Chung-Han; Chen, Wen-Kang

    2008-01-01

    The olfactory loss in patients with chronic rhinosinusitis has been measured by different methods. However, the results have been variable and it is not clear whether functional endoscopic sinus surgery (FESS) significantly improves olfactory function. This study was performed to evaluate the influences of FESS on olfactory function in patients with chronic rhinosinusitis using three different types of olfactory tests. Seventy patients with chronic rhinosinusitis were administered the University of Pennsylvania Smell Identification Test (UPSIT), a single staircase phenyl ethyl alcohol odor detection threshold test (STT), and a short-term odor memory/discrimination test a day before and 6 months after FESS. A questionnaire inquiring about the patients' self-perception of olfactory function was administered also. Independent ratings of the severity of chronic rhinosinusitis before FESS were established from CT scans. Fifty-two (74.3%) of the patients reported that their olfactory function was impaired before surgery, and 68.6% of the patients reported impaired olfactory function after surgery, a difference that was not significant. No meaningful changes in any of the olfactory test scores were noted 6 or more months after FESS. Preoperatively, small correlations between CT scores and the symptom scores (r = 0.278; p = 0.024), threshold scores (r = -0.27; p = 0.031), and UPSIT scores (r = -0.36; p = 0.003) were observed. In patients with severe rhinosinusitis, FESS had little impact on the ability to smell, regardless of the method for assessing smell function. Subtle associations between olfactory function and the severity of chronic rhinosinusitis determined by CT were observed, however, preoperatively. The olfactory test measures were correlated with one another both pre- and postoperatively.

  13. Asthma in adults and its association with chronic rhinosinusitis: The GA(2) LEN survey in Europe

    DEFF Research Database (Denmark)

    Jarvis, D; Newson, R; Lotvall, J

    2011-01-01

    -based epidemiological surveys. Methods:  The Global Allergy and Asthma Network of Excellence (GA(2) LEN) conducted a postal questionnaire in representative samples of adults living in Europe to assess the presence of asthma and CRS defined by the European Position Paper on Rhinosinusitis and Nasal Polyps....... Conclusion:  Geographical variation in the prevalence of self-reported asthma was observed across Europe, but overall, self-reported asthma was more common in young adults, women and smokers. In all age groups, men and women, and irrespective of smoking behaviour, asthma was also associated with CRS........ Asthma in adults and its association with chronic rhinosinusitis: The GA(2) LEN survey in Europe. Allergy 2011; DOI: 10.1111/j.1398-9995.2011.02709.x ABSTRACT: Background:  The prevalence of asthma and its association with chronic rhinosinusitis (CRS) have not been widely studied in population...

  14. Compliance and efficacy of saline irrigation in pediatric chronic rhinosinusitis.

    Science.gov (United States)

    Hong, Sang Duk; Kim, Joon Ho; Kim, Hyo Yeol; Jang, Min-Seok; Dhong, Hun-Jong; Chung, Seung-Kyu

    2014-02-01

    The objective of this study was to evaluate compliance with and effectiveness of nasal irrigation in children with chronic rhinosinusitis (CRS) and to assess its clinical course. Seventy-seven children with refractory CRS resistant to medical treatment including antibiotics and nasal corticosteroids were included. We evaluated patients' nasal symptom and Lund Mackay CT scores at baseline. All patients were educated about nasal irrigation and encouraged to perform nasal irrigation 1-3 times a day. After 1 month, patients were reevaluated regarding compliance with the protocol and improvement of CRS by assessing symptom score and endoscopic evaluation. The patients were followed up for at least two months to assess need for further treatment including surgery. Mean age of patients was 8.3 years ranging from 4 to 13 years. Mean follow-up duration with nasal saline irrigation was 6.2 months (2-32 months). Forty nine patients (63.6%) successfully carried out nasal irrigation during follow-up (good compliance [GC] group) and 28 patients (36.4%) did not successfully carry out nasal irrigation (poor compliance [PC] group). There were no significant differences between GC and PC groups regarding clinical characteristics and baseline Lund-MacKay CT scores. Subjective and objective improvements were observed in 36 patients (73.5%) in the GC group and 14 patients (50.0%) in the PC group. Surgery including endoscopic sinus surgery and/or adenoidectomy was performed in 8 patients (16.3%) in the GC group and 12 patients (42.9%) in the PC group. The rate of surgical treatment was significantly different between the groups (p=0.019). Nasal irrigation in children with long standing CRS is relatively well tolerated (63.6%) and effective. Nasal saline irrigation should be considered as a primary treatment tool in CRS even in pediatric age group. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. The personal financial burden of chronic rhinosinusitis: A Canadian perspective.

    Science.gov (United States)

    Yip, Jonathan; Vescan, Allan D; Witterick, Ian J; Monteiro, Eric

    2017-07-01

    Previous studies describe the financial burden of chronic rhinosinusitis (CRS) from the perspective of third-party payers, but, to our knowledge, none analyze the costs borne by patients (i.e., out-of-pocket expenses [OOPE]). Furthermore, this burden has not been previously investigated in the context of a publicly funded health care system. The purpose of this study was to characterize the financial impact of CRS on patients, specifically by evaluating its associated OOPEs and the perceived financial burden. The secondary aim was to determine the factors predictive of OOPEs and perceived burden. Patients with CRS at a tertiary care sinus center completed a self-administered questionnaire that assessed their socioeconomic characteristics, disease-specific quality of life (22-item Sino-Nasal Outcome Test [SNOT-22]), workdays missed due to CRS, perceived financial burden, and direct medical and nonmedical OOPEs over a 12-month period. Total OOPEs were calculated from the sum of direct medical and nonmedical OOPEs. Regression analyses determined factors predictive of OOPEs and the perceived burden. A total of 84 patients completed the questionnaires. After accounting for health insurance coverage and the median direct medical, direct nonmedical, and total OOPEs per patient over a 12-month period were Canadian dollars (CAD) $336.00 (2011) [U.S. $339.85], CAD $129.87 [U.S. $131.86], and CAD $607.10 [U.S. $614.06], respectively. CRS resulted in an average of 20.6 workdays missed over a 12-month period. Factors predictive of a higher financial burden included younger age, a greater number of previous sinus surgeries, financial burden and consider counseling them on strategies to offset expenses, including obtaining travel grants, using telemedicine for follow-up assessments, providing drug samples, and streamlining diagnostic testing with medical visits.

  16. Expression of immunoglobulin D is increased in chronic rhinosinusitis.

    Science.gov (United States)

    Sokoya, Mofiyinfolu; Ramakrishnan, Vijay R; Frank, Daniel N; Rahkola, Jeremy; Getz, Anne; Kingdom, Todd T; Kofonow, Jennifer M; Nguyen, Quyen; Janoff, Edward N

    2017-10-01

    Immunoglobulin (Ig) D is largely localized to the upper airway and reacts with colonizing respiratory pathogens. To determine whether chronic rhinosinusitis (CRS) is associated with increased IgD expression. We performed immunofluorescent staining for cytoplasmic IgD, IgA, IgM, and surface plasma cell marker CD138 (syndecan-1) in sinus tissue of patients with CRS with and without nasal polyps (CRSwNP and CRSsNP, respectively) and control subjects without CRS (n = 6 each). Sinonasal mucus antibody levels of patients with CRSwNP or CRSsNP and control subjects were measured by enzyme-linked immunosorbent assay (n = 13, 11, and 9 subjects, respectively). Cells per square millimeter and antibody levels were compared by analysis of variance. Histopathology was performed with sinus tissue from subjects in the 3 groups (n = 6, 8, and 13 subjects respectively). Cells expressing cytoplasmic IgD exceeded those with cytoplasmic IgA and IgM and represented most CD138 + plasma cells in the lamina propria. The frequencies of IgD + plasma cells were significantly higher in patients with CRSsNP and CRSwNP compared with control subjects (P < .01). Only patients with CRSwNP showed increased frequencies of IgM and IgA plasma cells (P < .01). In contrast to high plasma cell frequencies in tissues, the levels of secreted IgD were lower than those of IgA, IgM, and IgG but were highest in the CRSwNP group compared with the other groups (P < .05). IgD plasma cells are prominent in sinus tissues and are increased in CRS. That IgD protein also shows the lowest concentration of antibodies in secretions suggests that its activity might be targeted to the tissue rather than secretions. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  17. Reversal of Smoking Effects on Chronic Rhinosinusitis after Smoking Cessation.

    Science.gov (United States)

    Phillips, Katie M; Hoehle, Lloyd; Bergmark, Regan W; Caradonna, David S; Gray, Stacey T; Sedaghat, Ahmad R

    2017-10-01

    Objective To understand whether the impact of smoking on chronic rhinosinusitis (CRS) is reversible after smoking cessation. Study Design Cross-sectional study. Setting Academic tertiary care rhinology clinic. Subjects and Methods A total of 103 former-smoker CRS patients and 103 nonsmoker CRS patients were prospectively recruited. The primary outcome measure was sinonasal symptom severity measured with the 22-item Sinonasal Outcomes Test (SNOT-22), and secondary outcome measures were general health-related quality of life (QOL) measured with the 5-dimensional EuroQol visual analog scale (EQ-5D VAS) and patient-reported CRS-related antibiotic and oral corticosteroid usage in the past year. Outcome measures were compared between cohorts and checked for association with time since cessation of smoking for former smokers. Results Compared with nonsmokers, former smokers had worse SNOT-22 score ( P = .019) and EQ-5D VAS score ( P = .001) and reported using more CRS-related antibiotics ( P = .003) and oral corticosteroids in the past year ( P = .013). In former smokers, every year was associated with a statistically significant improvement in SNOT-22 score (β = -0.48; 95% CI, -0.91 to -0.05; P = .032), EQ-5D VAS score (β = 0.46; 95% CI, 0.02-0.91; P = .046), and CRS-related oral corticosteroid use (relative risk = 0.95; 95% CI, 0.91-0.98; P = .001). Given the differences in our study outcome measures between former smokers and nonsmokers, we estimate that the reversible impacts of smoking on CRS may resolve after 10 to 20 years. Conclusions CRS patients who are former smokers have worse sinonasal symptomatology, QOL, and CRS-related medication usage than nonsmokers. Every year since cessation of smoking is associated improvements in sinonasal symptomatology, QOL, and CRS-related oral corticosteroid use, potentially reaching nonsmoker levels after 10 to 20 years.

  18. A STUDY OF CORRELATION BETWEEN NASAL ENDOSCOPY AND CT SCAN IN CASES OF CHRONIC RHINOSINUSITIS

    Directory of Open Access Journals (Sweden)

    Arun Kumar

    2015-07-01

    Full Text Available BACKGROUND: The accurate diagnosis of Chronic Rhinosinusitis (CRS is still a challenge therefore, the American Academy of Otorhinolaryngology - Head and Neck Surgery (AAO - HNS 1 has met in a multidisciplinary encounter and formulated a consensus based on only clinical symptoms. The computed tomography (CT scan and the nasal endoscopy (NE were introduced to make an accurate diagnosis of CRS and verify the disease severity. AIM: The aim of this study is to make a correlation between nasal endoscopy and CT scan in cases of clinically diagnosed Chronic Rhinosinusitis patients. METHOD: A study was carried out on 90 patients at Jhalawar Medical College, Jhalawar (Raj. during Sept. 20 12 to Dec. 2014. Diagnostic Nasal Endoscopy and CT Scan PNS done in patients, suffering from Chronic Rhinosinusitis. As a classification instruments, Metson / Gliklich's classification was used to evaluate the tomographic diagnosis and the Stankiewicz / Chow' s classification to evaluate the endoscopic diagnosis of Chronic Rhinosinusitis. RESULTS: Our study showed high specificity of endoscopy in comparison to CT scan though CT scan results are more sensitive. CONCLUSION: Endoscopy can confirm a Chronic Rhinosi nusitis diagnosis, but cannot rule it out, and that CT should be performed in cases of suspected CRS even if mucopurulence is not noted on endoscopy. The CT scan and the nasal endoscopy making easier the treatment planning and the disease resolution.

  19. Preliminary efficacy of fluticasone delivered by a novel device in recalcitrant chronic rhinosinusitis

    NARCIS (Netherlands)

    Hansen, F. S.; Djupesland, P. G.; Fokkens, W. J.

    2010-01-01

    Objective: To assess whether delivery of fluticasone propionate using a novel bi-directional delivery device (Opt-FP) offers therapeutic benefits in patients with chronic rhinosinusitis (CRS). Methods: A prospective, single centre, randomized, double-blind, placebo (PBO)-controlled, parallel group

  20. Some Chronic Rhinosinusitis Patients Have Significantly Elevated Populations of Seven Fungi in their Sinuses

    Science.gov (United States)

    Abstract: Objectives/Hypothesis: To measure the populations of 36 fungi in the homes and sinuses of chronic rhinosinusitis (CRS) and non-CRS patients. Study Design: Single-blind cross-sectional study. Methods: Populations of 36 fungi were measured in sinus samples and in the home...

  1. Asthma in ear, nose, and throat primary care patients with chronic rhinosinusitis with nasal polyps

    DEFF Research Database (Denmark)

    Frendø, Martin; Håkansson, Kåre; Schwer, Susanne

    2016-01-01

    BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder associated with asthma. This association is well described in patients with CRSwNP undergoing endoscopic sinus surgery (ESS); however, some patients are never referred for surgery, and the frequency of...

  2. Differential expression of interleukin-32 in chronic rhinosinusitis with and without nasal polyps

    NARCIS (Netherlands)

    Keswani, A.; Chustz, R.T.; Suh, L.; Carter, R.; Peters, A.T.; Tan, B.K.; Chandra, R.; Kim, S.H.; Azam, T.; Dinarello, C.A.; Kern, R.C.; Schleimer, R.P.; Kato, A.

    2012-01-01

    BACKGROUND: Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by local inflammation of the upper airways and sinuses and is frequently divided into polypoid CRS (CRSwNP) and nonpolypoid CRS (CRSsNP). However, the mechanism of inflammation in CRS has still not been fully

  3. Association of Mucosal Organisms with Patterns of Inflammation in Chronic Rhinosinusitis.

    Directory of Open Access Journals (Sweden)

    Thanit Chalermwatanachai

    Full Text Available Chronic rhinosinusitis is a multifactorial process disease in which bacterial infection or colonization may play an important role in the initiation or persistence of inflammatory response. The association between mucosal bacteria presence and inflammatory patterns has only been partially explored.To demonstrate specific mucosal microorganisms possible association with inflammatory patterns.We collected nasal polyps or sinus tissues from a clinical selection of six patient groups with defined sinus disease using tissue biomarkers. In the tissues, we detected bacteria using peptide nucleic acid fluorescence in situ hybridization (PNA-FISH.After reviewing a total of 115 samples (15-20 samples per group, the mucosal presence of Staphylococcus aureus was correlated with IL-5 and SE-IgE positive chronic rhinosinusitis with nasal polyps and nasal polyps from cystic fibrosis patients. Chronic rhinosinusitis without nasal polyps with TNFα >20 pg/ml was associated with the mucosal presence of Pseudomonas aeruginosa.This study identifies the relationship between intramucosal microbes and inflammatory patterns, suggesting that bacteria may affect the type of inflammation in chronic rhinosinusitis. Additional investigation is needed to further identify the nature of the relationship.

  4. Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation

    NARCIS (Netherlands)

    Georgalas, C.; Vlastos, I.; Picavet, V.; van Drunen, C.; Garas, G.; Prokopakis, E.

    2014-01-01

    The relationship between allergic rhinitis and chronic rhinosinusitis has been assessed in a number of observational and experimental studies. In this review, we attempt their synthesis and evaluation using the modified Bradford Hill guidelines for causation. Although there is no proof of causation,

  5. The mold conundrum in chronic rhinosinusitis: where do we stand today?

    NARCIS (Netherlands)

    Ebbens, Fenna A.; Fokkens, Wytske J.

    2008-01-01

    Chronic rhinosinusitis (CRS) is an inflammatory disorder affecting the nose and paranasal sinuses. Although bacteria have long been implicated as pathogens in most forms of CRS, fungi may be responsible for some forms. Several recent studies demonstrated that, under optimal conditions, fungi can be

  6. [Clinical effect of clarithromycin therapy in patients with chronic rhinosinusitis].

    Science.gov (United States)

    Luo, Qing; Deng, Jie; Xu, Rui; Zuo, Kejun; Li, Huabin; Shi, Jianbo

    2014-02-01

    To evaluate the efficacy of clarithromycin (CAM) treatment in adult Chinese patients suffering from chronic rhinosinusitis with nasal polyps (CRSwNP) or without nasal polyps (CRSsNP). A prospective, open and self-controlled clinical trial on patients with CRS was conducted. Fifty patients met inclusion criteria. Of 50 patients, there were 33 patients with CRSsNP and 17 patients with CRSwNP. CAM was administered at 250 mg/d and the duration of administration was 12 weeks. Outcome measures included assessments of visual analogue scale (VAS), the sino-nasal outcome test-20(SNOT-20), the medical outcomes study short-form 36 items(SF-36), Lund-Kennedy endoscopy score, and Lund-Mackay computed tomography score. Before starting the treatment, 2 months after treatment and at the end of treatment, each patient had to complete all the measures except Lund-Mackay computed tomography score, which was only conducted before and after treatment. In order to evaluate the safety of CAM, liver function and renal function in all patients were detected before and after treatment. SPSS 16.0 software was used to analyze the data. Forty-five patients completed 3 months follow-up and 5 patients withdrew due to different reasons. The results were as follows: (1) Thirty-three patients with CRSsNP's VAS scores of four time point were 5.81 ± 1.69, 3.76 ± 1.94, 2.98 ± 1.95, 2.06 ± 2.13, respectively, there were statistically significant improvements in turn (t values were 5.910, 8.090, 8.932, all P 0.05). Endoscopy score of four time point were 10.65 ± 1.77, 9.35 ± 1.93, 8.65 ± 2.76, 8.47 ± 2.76, respectively, there were statistically significant improvements in turn(t values were 4.068, 4.863, 5.156, all P CAM treatment, 1 patient reported a tolerable headache and weakness and 1 patient had abdominal pain after two months treatment, all the symptoms disappeared while they were asked to stop the drug. Liver function and renal function were detected in 40 patients, the differences

  7. Diagnosis of Adult Chronic Rhinosinusitis: Can Nasal Endoscopy Predict Intrasinus Disease?

    Directory of Open Access Journals (Sweden)

    Arif Ali Kolethekkat

    2013-11-01

    Full Text Available Objectives: To define the role of endoscopic evaluation of middle meatus in adult patients clinically diagnosed to have chronic rhino-sinusitis and its ability to predict intra-sinus mucosal involvement as compared to CT scan.Methods: This prospective analytical study was conducted on consecutive patients with diagnosis of chronic rhino-sinusitis who were symptomatic and fulfilled the American Academy of Otolaryngology - Head and Neck Surgery Task Force criteria. The patients were enrolled prospectively and were subjected to rigid diagnostic nasal endoscopy and classified as defined by the revised Sinus Allergy Health Partnership Task Force criteria. The patients then underwent non contrast CT sinuses on the same day. Results were analyzed as a diagnostic test evaluation using CT as a gold standard.Results: Among the 75 study patients with symptom based chronic rhino-sinusitis, nasal endoscopy was abnormal in 65 patients (87%. Of these patients, 60/65 (92% showed positive findings on CT scan. Ten patients had normal endoscopy, of these 6/10 (60% had abnormal CT scan. Sensitivity and specificity of diagnostic nasal endoscopy against CT scan were 91% (95% CI: 81-97 and 44% (95% CI: 14-79, respectively. The likelihood ratio for positive nasal endoscopy to diagnose chronic rhino-sinusitis was 1.6 and the likelihood ratio to rule out chronic rhino-sinusitis when endoscopy was negative was 0.2.Conclusion: Nasal endoscopy is a valid and objective diagnostic tool in the work up of patients with symptomatic chronic rhino-sinusitis. When clinical suspicion is low (90% of patients when clinical suspicion is high (88% as defined in this study by AAO-HNS Task Force criteria. Negative endoscopy, however, does not totally exclude the sinus disease in patients fulfilling task force criteria. CT scan may be needed on follow-up if there is clinical suspicion in 10% of these patients who are negative on endoscopy if symptoms persists. It is thus possible to reduce

  8. Inconclusive evidence for allergic rhinitis to predict a prolonged or chronic course of acute rhinosinusitis.

    Science.gov (United States)

    Frerichs, Kristine A; Nigten, Gea; Romeijn, Kalynda; Kaper, Nina M; Grolman, Wilko; van der Heijden, Geert J M G

    2014-01-01

    To systematically review the evidence on allergic rhinitis as a predictor for a prolonged or chronic course in adult patients with acute rhinosinusitis. Pubmed, EMBASE, and the Cochrane library. A systematic literature search was performed on March 15, 2013. During screening of title and abstract, 3 authors independently selected studies on allergic rhinitis as a predictor for the course of acute rhinosinusitis in adults. The reported study design was assessed for directness of evidence and risk of bias. We aimed to extract prior and posterior probabilities for a prolonged or chronic course of acute rhinosinusitis. Of 13,202 retrieved articles, 2 articles were eligible for study assessment. They provided a high directness of evidence but carried a high risk of bias. The studies showed an incidence of a prolonged and chronic course of, respectively, .19 (95% confidence interval [CI] .16-.23) and .05 (95% CI, .02-.13). In patients with allergic rhinitis, the incidence was .25 (95% CI, .18-.35) and .14 (95% CI, .04-.34), so the added value of allergic rhinitis to predict a prolonged course is 6% and to predict a chronic course 8%. While the 2 included studies suggest that allergic rhinitis adds little to the prediction of a prolonged or chronic course in patients with acute rhinosinusitis, they carry a high risk of bias. As the available evidence does not provide grounds for different management of patients with and without allergic rhinitis, namely, according to clinical practice guidelines, both can be managed with expectant observation and symptomatic treatment.

  9. Mupirocin in the Treatment of Staphylococcal Infections in Chronic Rhinosinusitis: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Jong Seung Kim

    Full Text Available Saline irrigation of the nasal cavity is a classic and effective treatment for acute or chronic rhinosinusitis. Topical antibiotics such as mupirocin have been widely used for recalcitrant chronic rhinosinusitis. Therefore, the purpose of this study was to evaluate the effect of saline irrigation using mupirocin.A systematic literature review and meta-analysis of mupirocin saline irrigation were performed using EMBASE, MEDLINE, and Cochrane library through December 2015. Data were analyzed with R 3.2.2 software. A random effects model was used because of the diversity of included studies. Sensitivity analysis of particular tested groups and single proportion tests were also performed. The main outcome measure was residual staphylococcal infection, as confirmed by culture or PCR.Two RCTs, two prospective studies and two retrospective studies were included. A random effects model meta-analysis of the pooled data identified a relative risk of residual infection of 0.13 (95% CI: 0.06-0.26, p<0.05 with low heterogeneity (I2 = 0%. The proportion of residual staphylococcal infections after 1 month was 0.08 (95% CI: 0.04-0.16. However, this proportion increased to 0.53 at 6 months (95% CI: 0.27-0.78.The short-term use of mupirocin has a strongly reductive effect on staphylococcal infection in chronic rhinosinusitis. Although there is currently a lack of clear evidence, future studies with well-designed inclusion criteria and randomized controlled trials are needed to examine mupirocin's long-term effect on chronic rhinosinusitis.

  10. Long-lasting airplane headache in a patient with chronic rhinosinusitis.

    Science.gov (United States)

    Pfund, Z; Trauninger, A; Szanyi, I; Illes, Z

    2010-04-01

    The authors report long-lasting airplane headache in a patient with non-allergic, chronic rhinosinusitis. Association of mucosal inflammation with compromised sinonasal ventilation and sinus barotrauma created a base for not only the pain but also for the prolongation of symptoms. Effective therapy with antihistamine and nasal decongestant supports the theory that sinonasal barotrauma plays a triggering role in the pathophysiology of airplane headache.

  11. Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation.

    Science.gov (United States)

    Georgalas, C; Vlastos, I; Picavet, V; van Drunen, C; Garas, G; Prokopakis, E

    2014-07-01

    The relationship between allergic rhinitis and chronic rhinosinusitis has been assessed in a number of observational and experimental studies. In this review, we attempt their synthesis and evaluation using the modified Bradford Hill guidelines for causation. Although there is no proof of causation, especially in the pediatric literature, an evaluation of underlying allergies is recommended at least as an initial measure of symptoms relief. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Elimination of pain improves specificity of clinical diagnostic criteria for adult chronic rhinosinusitis.

    Science.gov (United States)

    Hirsch, Scott D; Reiter, Evan R; DiNardo, Laurence J; Wan, Wen; Schuman, Theodore A

    2017-05-01

    Determine whether the elimination of pain improves accuracy of clinical diagnostic criteria for adult chronic rhinosinusitis. Retrospective cohort study. History, symptoms, nasal endoscopy, and computed tomography (CT) results were analyzed for 1,186 adults referred to an academic otolaryngology clinic with presumptive diagnosis of chronic rhinosinusitis. Clinical diagnosis was rendered using the 1997 Rhinosinusitis Taskforce (RSTF) Guidelines and a modified version eliminating facial pain, ear pain, dental pain, and headache. Four hundred seventy-nine subjects (40%) met inclusion criteria. Among subjects positive by RSTF guidelines, 45% lacked objective evidence of sinonasal inflammation by CT, 48% by endoscopy, and 34% by either modality. Applying modified RSTF diagnostic criteria, 39% lacked sinonasal inflammation by CT, 38% by endoscopy, and 24% by either modality. Using either abnormal CT or endoscopy as the reference standard, modified diagnostic criteria yielded a statistically significant increase in specificity from 37.1% to 65.1%, with a nonsignificant decrease in sensitivity from 79.2% to 70.3%. Analysis of comorbidities revealed temporomandibular joint disorder, chronic cervical pain, depression/anxiety, and psychiatric medication use to be negatively associated with objective inflammation on CT or endoscopy. Clinical diagnostic criteria overestimate the prevalence of chronic rhinosinusitis. Removing facial pain, ear pain, dental pain, and headache increased specificity without a concordant loss in sensitivity. Given the high prevalence of sinusitis, improved clinical diagnostic criteria may assist primary care providers in more accurately predicting the presence of inflammation, thereby reducing inappropriate antibiotic use or delayed referral for evaluation of primary headache syndromes. 4. Laryngoscope, 127:1011-1016, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  13. Patient and Public Outreach Initiatives in Chronic Rhinosinusitis from the Canadian Sinusitis Working Group: Support for Affected Patients and Extending an Understanding of CRS to the General Public.

    Science.gov (United States)

    Nayan, Smriti; Kilty, Shaun; Lloyd, Helen Buckie; Desrosiers, Martin

    2017-07-01

    Chronic rhinosinusitis is an important disease entity that affects patients worldwide, yet there is limited public awareness regarding the disease. The Canadian Rhinosinusitis Working Group, a group of diverse medical professionals, has made a multitude of efforts to help improve the health literacy of patients and important stakeholders, as well as the quality of life of patients with chronic rhinosinusitis. This review will aim to outline these initiatives.

  14. Evaluation of Malassezia and Common Fungal Pathogens in Subtypes of Chronic Rhinosinusitis.

    Science.gov (United States)

    Gelber, Jonathan T; Cope, Emily K; Goldberg, Andrew N; Pletcher, Steven D

    2016-09-01

    Fungal hypersensitivity and fungal microbiome dysbiosis are possible etiologies of chronic rhinosinusitis. The sinus fungal microbiome is not well characterized; novel sinus-associated fungi, including Malassezia, have only recently been described. The goals for this study were to verify Malassezia as a dominant component of the sinus microbiome, to speciate sinus Malassezia, and to compare select fungal species in chronic rhinosinusitis (CRS) subtypes with known fungal association to chronic rhinosinusitis with polyps (CRSwNP) and healthy controls. Twenty-eight patients were enrolled and categorized as CRSwNP (n = 15), fungus ball (n = 3), allergic fungal rhinosinusitis (AFRS, n = 3), or healthy control (n = 7). Brush samples were taken from ethmoid or maxillary sinus mucosa and tested for DNA from 7 index fungi using quantitative polymerase chain reaction. Index fungal species were chosen based on existing data of the sinus fungal microbiome. Malassezia species were detected in 68% of patients, without variation among clinical phenotypes (p > 0.99). Malassezia restricta was more commonly detected than Malassezia globosa (p = 0.029). Presence of one Malassezia species predicted the presence of the other (p = 0.035). Aspergillus was identified in 2 of 3 of fungus ball patients (both A. fumigatus) and 2 of 3 AFRS patients (1 A. fumigatus and 1 A. flavus). Aspergillus was absent in control and CRSwNP patients (p Malassezia in healthy and diseased sinuses. Presence of Malassezia species in all groups suggests a commensal role for the fungus. Future work will determine whether Malassezia influences CRS pathogenesis. Aspergillus species were identified in fungal CRS subtypes despite negative surgical cultures, highlighting the importance of culture-independent technology. © 2016 ARS-AAOA, LLC.

  15. Do patients with chronic rhinosinusitis benefit from consultation with an ENT-doctor?

    DEFF Research Database (Denmark)

    Lange, Bibi; Thilsing, Trine; Baelum, Jesper

    2015-01-01

    CONCLUSION: By consulting an ENT-doctor, patients with chronic rhinosinusitis (CRS), in the general population, receive disease information and adjustment of treatment which can improve disease-specific Quality-of-Life and may improve objective measurements. OBJECTIVES: This study aims to follow...... persons with clinical diagnosed CRS from the general population, to evaluate their benefit from consultation with an ENT-doctor in terms of severity of symptoms and Quality-of-Life. METHODS: As part of a trans-European study, selected respondents to a survey questionnaire were invited for a clinical visit....... Based on the European Position Paper on Rhinosinusitis and Nasal Polyps, persons were diagnosed with CRS and followed for 2 years. Quality-of-Life was measured using the Sino Nasal Outcome Test 22 and European Quality-of-Life - 5 Dimensions. Clinical examination included rhinoscopy, acoustic rhinometry...

  16. Increased level of interleukin-13, but not interleukin-4 and interferon-γ in chronic rhinosinusitis with nasal polyps.

    Science.gov (United States)

    Nabavi, M; Arshi, S; Bahrami, A; Aryan, Z; Bemanian, M H; Esmaeilzadeh, H; Jalali, F; Pousti, S B; Rezaei, N

    2014-01-01

    This study was performed to investigate the serum level of interleukin (IL)-13, IL-4, and interferon (IFN)-γ in chronic rhinosinusitis with nasal polyps (CRSwNP) and subsequent inflammation pattern and comorbidities including asthma and aspirin intolerance. A case-control study was conducted on 60 adult patients with CRSwNP with mean age of 37.7±12.7 (ranging from 18 to 70) years, and on 20 healthy controls. Serum levels of IL-13, IL-4, and IFN-γ were assessed, using enzyme-linked immunosorbent assay to be compared between case and control groups. Serum level of total immunoglobulin (Ig) E was also assessed in the patients with CRSwNP. Serum level of IL-13 in the patients with CRSwNP was significantly higher than the controls (0.98±1.56 vs. 0.34±0.16 pg/ml, respectively, p=0.002). IL-4 and IFN-γ did not differ significantly between the two groups. Total IgE level was significantly increased in the patients with CRSwNP, compared to the normal values (301.43±516.54 IU/ml, p=0.033). Among the patients with CRSwNP, 12/60 (20%) had aspirin intolerance and 44/60 (73.3%) had asthma. IgE was also higher in asthmatics than non-asthmatics patients (364.9±586.6 vs. 126.7±135.7, respectively, p=0.015). Patients with aspirin intolerance had higher levels of IFN-γ (4.7±1.4 vs. 4.1±0.6, respectively, p=0.022). IL-13 with high level of total IgE was observed in the patients with CRSwNP, which predisposes them to have concomitant asthma. IFN-γ seems to be down-regulated in the patients with CRSwNP, but could be over-expressed in the presence of aspirin intolerance. Copyright © 2013 SEICAP. Published by Elsevier Espana. All rights reserved.

  17. Is nasal steroid spray bottle contamination a potential issue in chronic rhinosinusitis?

    Science.gov (United States)

    Tan, N C-W; Drilling, A J; Jardeleza, C; Wormald, P-J

    2014-01-01

    Intranasal steroids are the first line of treatment for chronic rhinosinusitis. Although contamination of adjunctive devices (e.g. irrigation bottles) has been much investigated, little is known about nasal contamination of the metered-dose spray bottles used to deliver intranasal steroids, and the potential influence on disease chronicity. Twenty-five prospectively recruited patients with stable chronic rhinosinusitis underwent microbiological analysis of their nasal vestibule and middle meatus and also of their steroid bottle tip and contents. Additionally, bottle tips were inoculated in vitro with Staphylococcus aureus and various sterilisation techniques tested. For 18 of the 25 (72 per cent) patients, both nasal and bottle tip swabs grew either Staphylococcus aureus or coagulase-negative staphylococci. Staphylococcus aureus was cultured from 7 of the 25 (28 per cent) patients, and 5 of these 7 had concomitant bacterial growth from both nose and steroid bottle. Thus, the cross-contamination rate was 71 per cent for Staphylococcus aureus infected patients and 20 per cent overall. Sterilisation was effective with boiling water, ethanol wipes and microwaving, but not with cold water or dishwashing liquid. Nasal steroid spray bottle tips can become contaminated with sinonasal cavity bacteria. Simple sterilisation methods can eliminate this contamination. Patient education on this matter should be emphasised.

  18. Sleep and Quality of Life Improvements after Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis

    Science.gov (United States)

    Alt, Jeremiah A.; Smith, Timothy L.; Schlosser, Rodney J.; Mace, Jess C.; Soler, Zachary M.

    2014-01-01

    Background Recent investigation has demonstrated that approximately 75% of patients with medically refractory chronic rhinosinusitis (CRS) report abnormal sleep quality, with strong correlation between worse sleep quality and more severe CRS disease severity. It remains unknown whether the treatment effect of endoscopic sinus surgery (ESS) for CRS results in appreciable sleep quality improvements. Methods Adult patients (aged ≥18 years) with a current diagnosis of recalcitrant chronic rhinosinusitis (CRS), who voluntarily elected ESS as the next treatment modality (n=301), were prospectively evaluated within four academic, tertiary care centers using treatment outcome instruments: the Rhinosinusitis Disability Index, the 22-item Sinonasal Outcome Test, the 2-item Patient Health Questionnaire, and the Pittsburgh Sleep Quality Index (PSQI) both before and after ESS. Results 72% of patients with CRS were found to have poor sleep (>5) at baseline with a mean global PSQI score of 9.4(4.6). Surgery improved overall mean global PSQI scores (2.2 points), and all 7 subdomain scores of the PSQI. Similarly, the odds of good sleep quality (PSQI ≤5) in patients treated with sinus surgery increased significantly (OR: 5.94, 95% CI: 3.06, 11.53; p<0.001). Stepwise multivariate linear regression found that ASA intolerance (β= −1.94(0.93); 95% CI: −3.77, −0.11; p=0.038), history of prior sinus surgery (β=1.10(0.54); 95% CI: 0.03, 2.16; p=0.044), and frontal sinusotomy (β= −1.03(0.62); 95% CI: −2.26, 0.20; p=0.099) were found to significantly associate with improvement in PSQI sleep scores. Conclusions Among patients with CRS, reduced sleep quality, poor disease-specific quality of life, and greater disease severity were improved following ESS. PMID:25079334

  19. Home telemonitoring of severe chronic respiratory insufficient and asthmatic patients

    Directory of Open Access Journals (Sweden)

    Manuela Zamith

    2009-05-01

    Full Text Available For 9 months we evaluated a portable device to transfer patient-clinician data by Internet: oximetry, ECG, clinical questionnaires and messages from the doctor. Fifty-one patients with severe chronic respiratory insufficiency (CRI were followed at the hospital Pulido Valente and Espirito Santo and 21 asthmatics (A were followed at the latter hospital. The use and acceptance of this device was evaluated through questionnaires soliciting patients’ and health professionals’ opinions. Patients with CRI followed in Lisbon were also asked about hospital admissions and quality of life compared with a nine month period before the monitoring programme.CRI patients found learning to use the system more difficult; the majority (80% reported problems with the equipment, qualified as rare/occasional in 62% of the cases. For 31 CRI patients followed in Lisbon, the use of the system was classified as correct in 12 patients, incorrect in 7 and reasonable in 12 patients. The first group had a reducded number and duration of hospital admissions and also improved quality of life. With this remote monitoring system 80% of CRI patients reported they were more/much more supported and 33 patients (75% would use this system in the future. 81% of asthmatic patients would also like to maintain this type of monitoring. The service was considered useful by the researchers. We concluded that home telemonitoring was a positive contribution to the management of chronic patients and raised awareness of it should be considered in the future. Resumo: Durante nove meses avaliámos umdispositivo portátil para transferência de dados pelaInternet entre doentes e profissionais de saúde: oximetria,ECG, respostas a questionários e mensagens. Foramincluídos 51 insuficientes respiratórioscrónicos (IRC graves acompanhados no Hospital de PulidoValente (Lisboa e no Hospital do Espírito Santo(Évora e 21 asmáticos deste último hospital. Autiliza

  20. Comparison of Sinonasal Symptoms in Patients with Nasal Septal Deviation and Patients with Chronic Rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Mohammad Naeimi

    2013-01-01

    Full Text Available Introduction: Disorders of the nose and paranasal sinuses are among the most common chronic illnesses. Although considerable progress has been made in the medical and surgical control of these diseases, a large number of questions relating to the diagnosis, evaluation, and treatment of these conditions remain unanswered. The aim of the present study was to evaluate differences in the frequency of symptoms and disease severity in patients with nasal septal deviation (NSD compared with chronic rhinosinusitis (CRS.  Materials and Methods: A total of 156 patients, divided into NSD and CRS groups, were studied in relation to symptoms and disease severity. Patients were selected from those referred to the Ear, Nose, and Throat (ENT Wards of the Imam Reza and Ghaem Hospitals, who had not responded to a variety of treatments. Depending on the type of disease, patients were candidates for either septoplasty or endoscopic sinus surgery. The Rhinosinusitis Symptom Inventory was administered to measure the severity of symptoms, with scores assigned based on the answers given by patients (Likert scale.  Scores were compared between the CRS and NSD groups.  Results: A total of 156 patients (78 with NDS and 78 with CRS entered the study in overall sinonasal symptoms were more prevalent in CRS group. Nasal congestion, runny nose, earache, toothache, and smelling disorder were significantly more common in the CRS group (P0.05.  Conclusion:  Patients with CRS manifested statistically significantly greater sinonasal symptom scores than patients with NSD.

  1. Comparison of sinonasal symptoms in patients with nasal septal deviation and patients with chronic rhinosinusitis.

    Science.gov (United States)

    Naeimi, Mohammad; Garkaz, Maria; Naeimi, Mohammad Reza

    2013-01-01

    Disorders of the nose and paranasal sinuses are among the most common chronic illnesses. Although considerable progress has been made in the medical and surgical control of these diseases, a large number of questions relating to the diagnosis, evaluation, and treatment of these conditions remain unanswered. The aim of the present study was to evaluate differences in the frequency of symptoms and disease severity in patients with nasal septal deviation (NSD) compared with chronic rhinosinusitis (CRS). A total of 156 patients, divided into NSD and CRS groups, were studied in relation to symptoms and disease severity. Patients were selected from those referred to the Ear, Nose, and Throat (ENT) Wards of the Imam Reza and Ghaem Hospitals, who had not responded to a variety of treatments. Depending on the type of disease, patients were candidates for either septoplasty or endoscopic sinus surgery. The Rhinosinusitis Symptom Inventory was administered to measure the severity of symptoms, with scores assigned based on the answers given by patients (Likert scale). Scores were compared between the CRS and NSD groups. A total of 156 patients (78 with NDS and 78 with CRS) entered the study in overall sinonasal symptoms were more prevalent in CRS group. Nasal congestion, runny nose, earache, toothache, and smelling disorder were significantly more common in the CRS group (P0.05). Patients with CRS manifested statistically significantly greater sinonasal symptom scores than patients with NSD.

  2. Long-term results of functional endoscopic sinus surgery in children with chronic rhinosinusitis with nasal polyps

    NARCIS (Netherlands)

    Cornet, M. E.; Georgalas, C.; Reinartz, S. M.; Fokkens, W. J.

    2013-01-01

    Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is rare in children and has a major impact on Quality of Life (QoL). Functional endoscopic sinus surgery (FESS) has proven to be an effective treatment, but it is still unclear what long-term outcomes are in children with CRSwNP.The

  3. Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study

    NARCIS (Netherlands)

    Rudmik, Luke; Soler, Zachary M.; Hopkins, Claire; Schlosser, Rodney J.; Peters, Anju; White, Andrew A.; Orlandi, Richard R.; Fokkens, Wytske J.; Douglas, Richard; Smith, Timothy L.

    2016-01-01

    Appropriate indications for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) are currently poorly defined. The lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates and contributes to reduced quality of care. The objective of

  4. The effect of thyme honey nasal spray on chronic rhinosinusitis: a double-blind randomized controlled clinical trial.

    Science.gov (United States)

    Hashemian, Farnaz; Baghbanian, Neda; Majd, Zahra; Rouini, Mohammad-Reza; Jahanshahi, Javaneh; Hashemian, Farshad

    2015-06-01

    Chronic rhinosinusitis is a common disease which causes persisting inflammatory conditions of one or more sinuses. This study was designed to evaluate the effect of thyme honey nasal spray as an adjunctive medication on chronic rhinosinusitis after functional endoscopic sinus surgery. This was a randomized, placebo controlled, double-blind clinical study. 64 patients with chronic rhinosinusitis undergoing functional endoscopic sinus surgery were enrolled in this study. Patients were randomized and blinded to receive either placebo or thyme honey nasal spray in addition to the standard regimen postoperatively. Patients were visited on postoperative days 7, 30 and 60. The sino-nasal outcome test, endoscopic grading system and sinus CT-scan were scored before operation and on the day 60 after surgery. 54 patients completed the study. Significant improvement was observed in both treatment groups. There were no significant changes in SNOT-22, endoscopy and CT-scan scores between the two study groups. However, a greater reduction in endoscopic scores was shown in thyme honey group. The incidence of adverse effects was not significantly different between the groups, but synechiae formation and epistaxis were lower in treatment group. Thyme honey nasal spray seems to be a low-priced potential adjuvant remedy with excellent safety profile, to reduce inflammation and polyp formation and also fostering mucosal healing for patients suffering from chronic rhinosinusitis. However, further studies are recommended.

  5. Clinical implications of microbial biofilms in chronic rhinosinusitis and orbital cellulitis.

    Science.gov (United States)

    Nayak, Niranjan; Satpathy, Gita; Prasad, Sujata; Thakar, Alok; Chandra, Mahesh; Nag, T C

    2016-09-21

    Discovery of sessile mode of microbial existence (Biofilm state) focussed much interest, during the recent years, on the study of biofilms in many recurring and chronic infections. However, the exact role of microbial biofilms in chronic rhinosinusitis and orbital cellulitis were not elucidated earlier. The purpose of the present study was to look for the adherent property and biofilm producing ability of the clinical isolates in chronic rhinosinusitis and orbital cellulitis, and to look for the effects of antimicrobial agents on these biofilms by colorimetric assay and ultrastructural analysis. Organisms were isolated and identified from various clinical samples in patients with chronic sinusitis and orbital cellulitis. Antimicrobial sensitivity testing was carried out by the standard protocol. Biofilms were developed; quantified and antimicrobial drug perfusion through the biofilm model was evaluated by the earlier devised procedure. Electronmicroscopic study of the biofilm was performed by the recommended technique. Of the total of 70 clinical samples processed, 48 i.e. 68.5 % grew bacteria and 13 i.e.(18.6 %) fungi. Staphylococcus aureus (20), S epidermidis (16) and Pseudomonas aeruginosa (6) accounted for the majority of the bacterial isolates. Aspergillus flavus (8), however was the commonest amongst the fungi. A total of 40 bacteria and 8 fungi could be tested for biofilm production. Eighteen (45 %) of the 40 bacterial isolates and 4(50 %) out of the 8 A flavus isolates were found to be biofilm producers. In vitro adherence testing revealed that majority i.e. 16 (88.8 %) of the 18 biofilm positive bacteria were adherent to artificial surfaces. Antimicrobial drug perfusion through the biofilm model was poor. Antimicrobial treatment was totally ineffective against strong biofilm producers, whose electron microscopic picture was quite similar to that observed for biofilm producers without any antimicrobial pre-treatment. Filamentous fungi, like bacteria

  6. The symptom burden of autonomic dysfunction is positively associated with chronic rhinosinusitis status.

    Science.gov (United States)

    Chen, W C; Chang, Y T; Chen, S F; Lin, W C; Su, Y Y; Luo, S D

    2018-03-21

    Dysregulation of the autonomic system can affect sinonasal physiological function and may exacerbate the symptom burden associated with rhinosinusitis. However, the association between autonomic dysfunction and chronic rhinosinusitis (CRS) has seldom been studied. Here, we investigated the relationship between autonomic dysfunction and CRS. Patients with CRS who failed medical treatment were prospectively enrolled. All patients underwent pre-operative examinations and completed questionnaires, including the reflux symptom index (RSI) and the Sino-nasal Outcome Test-22 (SNOT-22). Autonomic dysfunction was scored using the 31-item Composite Autonomic Symptom Score (COMPASS 31), a validated simple instrument used to evaluate dysautonomia. We prospectively enrolled a total of 89 CRS patients, including 37 with polyps (CRSwNP) and 52 without polyps (CRSsNP). The most common dysautonomic symptoms were dry eye, dry mouth, postural dizziness, and a sensation of excessive fullness after meals. Significant positive correlations were evident between COMPASS 31 and SNOT-22 scores in CRSwNP patients. CRS-associated symptoms, including cough, post-nasal drip, sleep, and psychological dysfunction, were correlated with the level of autonomic dysfunction. We found a positive correlation between the symptom burdens of autonomic dysfunction and CRSwNP. The relationship between autonomic dysfunction and CRS is highly complex; further work is needed.

  7. Effects of manual therapy on craniofacial pain in patients with chronic rhinosinusitis: a case series.

    Science.gov (United States)

    Méndez-Sánchez, Roberto; González-Iglesias, Javier; Puente-González, Ana Silvia; Sánchez-Sánchez, Jose Luis; Puentedura, Emilio J; Fernández-de-Las-Peñas, César

    2012-01-01

    Chronic rhinosinusitis (CRS) is thought to develop through an inadequate drainage of nasal and sinus secretions and perpetuated by local mechanical and autonomic nervous system factors. Manual therapy may have an effect on these factors providing symptomatic relief of CRS symptoms. The purpose of this prospective case series was to report the results of manual therapy on a set of patients with craniofacial pain and a diagnosis of CRS. Fourteen consecutive patients presenting with a primary report of craniofacial pain and a diagnosis CRS completed self-report questionnaires including the Sinonasal Assessment Questionnaire, Rhinosinusitis Task Force, visual analog scale for craniofacial pain, and pressure pain threshold over 4 sinus points on the face. Patients were seen once a week for 7 consecutive weeks and completed all outcome measures at baseline and subsequent weekly sessions. They received manual therapy interventions only on the second, third, and fifth weekly sessions. No significant changes in outcome measures were observed from baseline to 1 week, where no intervention was applied. Significant improvements were observed on all outcome measures (Ps ≤ .015) for pre- and post-first treatment session, as well as from baseline to 7 weeks (Ps reported less severity of their symptoms. Patients with craniofacial pain and CRS who were treated with manual therapy demonstrated improvements in all outcome measures only after each treatment session. Our results suggest that manual therapy treatment could be considered as an appropriate alternative treatment of CRS. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  8. Classical complement pathway activation in the nasal tissue of patients with chronic rhinosinusitis.

    Science.gov (United States)

    Van Roey, Griet A; Vanison, Christopher C; Wu, Jeffanie; Huang, Julia H; Suh, Lydia A; Carter, Roderick G; Norton, James E; Shintani-Smith, Stephanie; Conley, David B; Welch, Kevin C; Peters, Anju T; Grammer, Leslie C; Harris, Kathleen E; Hulse, Kathryn E; Kato, Atsushi; Stevens, Whitney W; Kern, Robert C; Schleimer, Robert P; Tan, Bruce K

    2017-07-01

    Complement plays a major role in inflammatory diseases, but its involvement and mechanisms of activation in patients with chronic rhinosinusitis (CRS) are not known. After earlier studies discovering autoantibodies in patients with CRS, we sought to investigate the nature, extent, and location of complement activation in nasal tissue of patients with CRS. Specifically, we were interested in whether antibody-mediated activation through the classical pathway was a major mechanism for complement activation in patients with CRS. Nasal tissue was obtained from patients with CRS and control subjects. Tissue homogenates were analyzed for complement activation products (ELISA-C5b-9, C4d, activated C1, and C5a) and major complement-fixing antibodies (Luminex). Tissue sections were stained for C5b-9, C4d, and laminin. Antibodies were purified with protein A/G columns from nasal polyps (NP), matching patient serum, and control serum and assayed for basement membrane binding by means of ELISA. C5b-9 levels were significantly increased in NP tissue compared with uncinate tissue (UT) of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and those with chronic rhinosinusitis without nasal polyps (CRSsNP; P < .01). Similarly, C4d levels were increased in NPs compared with UT of patients with CRSwNP, patients with CRSsNP, and control subjects (P < .05). Activated C1 levels were also increased in NP tissue compared with UT of patients with CRSsNP and control subjects (P < .05) and correlated with levels of C5a (P < .01), local immunoglobulins (especially IgM, P < .0001), and anti-double-stranded DNA IgG (P < .05). Immunofluorescence showed that C5b-9 and C4d deposition occurred linearly along the epithelial basement membrane. NP tissue extracts had significantly more anti-basement membrane antibodies than sera from patients with CRSwNP and control subjects (P < .0001). Levels of C5b-9, C4d, and activated C1 were significantly increased locally in NP tissue

  9. The evaluation of pattern and quality of sleep in patients with chronic rhinosinusitis with nasal polyps.

    Science.gov (United States)

    Uz, Uzdan; Günhan, Kıvanç; Yılmaz, Hikmet; Ünlü, Halis

    2017-12-01

    The goal of this study is to evaluate the impact of chronic rhinosinusitis with nasal polyps (CRSwNP) on sleep pattern and sleep quality before and after functional endoscopic sinus surgery using subjective and objective parameters. Twenty-two patients with CRSwNP were evaluated. All subjects underwent assessment by nasal endoscopy, rhinomanometry and computed tomography. Sleep pattern and sleep quality were evaluated by Pittsburgh sleep quality index (PSQI) and polysomnography (PSG). All patients were reassessed 6 months after surgery. Nasal resistance decreased after the surgery (psleep pattern and sleep quality. CRSwNP may be a predisposing factor for sleep related respiratory disorders. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Medical management of chronic rhinosinusitis - a review of traditional and novel medical therapies.

    Science.gov (United States)

    Schwartz, Joseph S; Tajudeen, Bobby A; Cohen, Noam A

    2017-10-01

    Chronic rhinosinusitis (CRS) is a commonly seen persistent inflammatory disease process affecting the paranasal sinuses with extensively reported economic implications. Despite an elusive pathophysiologic mechanism underlying this disease process, treatment outcomes are encouraging with the employment of an array of medical and surgical therapies. Areas covered: The goal of this paper is to provide a comprehensive, up to date analysis of the literature concerning the medical management of CRS by summarizing the evidence in support of traditional medical therapies for the management of CRS in addition to highlighting novel medical therapies currently under investigation. Expert opinion: The current staples of medical therapy for CRS based on the strength of available evidence include topical and oral corticosteroids, oral antibiotics and topical saline. The introduction of immunomodulatory therapies ('Biologics') for the treatment of CRS shows promise but have yet to be employed in a widespread fashion due to the need for additional research to better elucidate their role.

  11. Airway Inflammation in Chronic Rhinosinusitis with Nasal Polyps and Asthma: The United Airways Concept Further Supported

    DEFF Research Database (Denmark)

    Håkansson, Kåre; Bachert, Claus; Konge, Lars

    2015-01-01

    Background It has been established that patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often have co-existing asthma. Objective We aimed to test two hypotheses: (i) upper and lower airway inflammation in CRSwNP is uniform in agreement with the united airways concept; and (ii......) bronchial inflammation exists in all CRSwNP patients irrespective of clinical asthma status. Methods We collected biopsies from nasal polyps, inferior turbinates and bronchi of 27 CRSwNP patients and 6 controls. All participants were evaluated for lower airway disease according to international guidelines...... cytokines measured, IL-13 was significantly increased in bronchial biopsies from CRSwNP patients with, but not without asthma. Conclusion Our findings support the united airways concept; however, we did not find evidence for subclinical bronchial inflammation in CRSwNP patients without asthma. Finally...

  12. The impact of asthma on the cost effectiveness of surgery for chronic rhinosinusitis with nasal polyps.

    Science.gov (United States)

    Scangas, George A; Remenschneider, Aaron K; Su, Brooke M; Shrime, Mark G; Metson, Ralph

    2017-11-01

    The objective of this work was to evaluate the impact of asthma on the cost-effectiveness profile of endoscopic sinus surgery (ESS) compared to medical therapy for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The study design consisted of a cohort-style Markov decision-tree cost utility analysis with a 35-year time horizon. Matched cohorts of CRSwNP patients with (n = 95) and without (n = 95) asthma who underwent ESS were compared with cohorts of patients from the national Medical Expenditures Survey Panel (MEPS) database who underwent medical management for chronic rhinosinusitis (CRS). Baseline, 1-year, and 2-year health utility values were calculated from responses to the EuroQol-5 Dimension (EQ-5D) instrument in both cohorts. The primary outcome measure was the incremental cost effectiveness ratio (ICER) for each cohort. The reference cases for CRSwNP patients with and without asthma yielded ICERs for ESS vs medical therapy alone of $12,066 per quality-adjusted life year (QALY) and $7,369 per QALY, respectively. At a willingness-to-pay threshold of $50,000/QALY, the ICER scatter plots demonstrated 86% and 99% certainty that the ESS strategy was the most cost-effective option for CRSwNP patients with and without asthma, respectively. ESS was not significantly more cost effective for CRSwNP patients without asthma (p = 0.494). ESS remains cost effective compared to medical therapy for patients both with and without asthma. While the comorbidity of asthma results in an inferior ICER result, it does not result in a statistically significant negative impact on the overall cost effectiveness of ESS. © 2017 ARS-AAOA, LLC.

  13. Topical therapies in the management of chronic rhinosinusitis: an evidence-based review with recommendations.

    Science.gov (United States)

    Rudmik, Luke; Hoy, Monica; Schlosser, Rodney J; Harvey, Richard J; Welch, Kevin C; Lund, Valerie; Smith, Timothy L

    2013-04-01

    Topical therapies have become an integral component in the management plan for chronic rhinosinusitis (CRS). Several topical therapy strategies have been evaluated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the utilization of topical therapies in the management of CRS. A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; and clearly defined primary clinical end-point. We focused on reporting higher-quality studies (level 2b or higher), but reported on lower-level studies if the topic contained insufficient evidence. We excluded drug-eluting spacer and stent therapy from this review. This review identified and evaluated the literature on 5 topical therapy strategies for CRS: saline irrigation, topical steroid, topical antibiotic, topical antifungal, and topical alternatives (surfactant, manuka honey, and xylitol irrigations). Based on the available evidence, sinonasal saline irrigation and standard topical nasal steroid therapy are recommended in the topical treatment of CRS. Nonstandard (off-label) topical sinonasal steroid therapies can be an option for managing CRS. The evidence recommends against the use of topical antifungal therapy and topical antibiotic therapy delivered using nebulized and spray techniques in routine cases of CRS. There is insufficient clinical research to provide recommendations for alternative therapies or topical antibiotic therapy delivered using other delivery methods (eg, irrigations). © 2013 ARS-AAOA, LLC.

  14. Impact of synechiae after endoscopic sinus surgery on long-term outcomes in chronic rhinosinusitis

    Science.gov (United States)

    Henriquez, Oswaldo A.; Schlosser, Rodney J.; Mace, Jess. C; Smith, Timothy L.; Soler, Zachary M.

    2013-01-01

    Introduction Synechiae are one of the most common unwanted outcomes after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). However, there has been scant investigation into the true significance of synechiae formation after ESS. The aim of this study was to evaluate the impact of synechiae formation on quality-of-life (QOL) outcomes after ESS in patients with CRS. Study Design Prospective, multi-institutional cohort. Methods Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS) scores were measured in adult patients before and after undergoing ESS for CRS. Differences in QOL were evaluated between those who developed sinonasal synechiae and those who did not, controlling for demographic factors, medical comorbidities, and measures of disease severity at baseline. Results A total of 286 patients underwent ESS, with 55 (19.2%) developing synechiae in the follow-up period. Patients developing synechiae reported significantly less improvement on the RSDI total scores (13.5 vs. 21.4, p=0.008), RSDI physical subscores (5.3 vs. 8.3, p=0.007), RSDI emotional subscores (2.9 vs. 5.8, p=0.008), CSS total scores (14.5 vs. 21.2, p=0.093) and CSS symptom subscores (19.9 vs 30.3, p=0.069) compared to those who did not develop synechiae postoperatively. These differences persisted even after controlling for baseline differences in disease severity. Conclusions Synechiae of the sinonasal cavity commonly occurs following ESS, particularly in those undergoing revision surgeries. Although both groups improve, the degree of QOL improvement appears to be less in those who form postoperative synechaie after surgery compared to those who do not. PMID:23670876

  15. [The observation and analysis the function and morphology of the eustachian tube in secretory otitis media and chronic rhinosinusitis in children].

    Science.gov (United States)

    Xia, Zhongfang; Wang, Zhinan; Xu, Zhongxiang; Cui, Long; Wei, Cuifen; Liu, Yan; Huang, Fang

    2014-07-01

    To observe and analyze the function and morphology of pharyngeal ostium of the eustachian tubes in secretory otitis media and chronic rhinosinusitis in children under direct vision,in order to provide an objective basis for clinical treatments. Fifty cases of secretory otitis media,50 cases of chronic rhinosinusitis and a control group of 50 cases with hoarseness were examined under video laryngoscope to observe the pharyngeal ostium morphological changes of the eustachian tubes, and their functional statuses were tested by using acoustic impedance instrument. All the data were analyzed by statistical methods. (1) In the secretory otitis group, the abnomal rate of the pharyngeal ostium of the eustachian tubes was 94% while the chronic rhinosinusitis group was 80%,and between them there was no significant differences (P > 0.05). But both of them had significant differences with the control group (P otitis group, the rate of the eustachian tube dysfunction was 70% while the chronic rhinosinusitis group was 26%, and between them there was significant differences (P otitis media and chronic rhinosinusitis in children. Eustachian tube dysfunction played a dominant role in the pathogenesis of secretory otitis media in children rather than the morphological change did compared to the chronic rhinosinusitis in children.

  16. Twenty-four-hour esophageal pH monitoring in children and adolescents with chronic and/or recurrent rhinosinusitis

    Directory of Open Access Journals (Sweden)

    V.R.S.G. Monteiro

    2005-02-01

    Full Text Available Gastroesophageal reflux (GER disorder was studied in children and adolescents with chronic and/or recurrent rhinosinusitis not associated with bronchial asthma. Ten children with a clinical and radiological diagnosis of chronic and/or recurrent rhinosinusitis, consecutively attended at the Pediatric Otolaryngology Outpatient Clinic, Federal University of São Paulo, were evaluated. Prolonged esophageal pH monitoring was used to investigate GER disorder. The mean age of the ten patients evaluated (eight males was 7.4 ± 2.4 years. Two patients presented vomiting as a clinical manifestation and one patient presented retrosternal pain with a burning sensation. Twenty-four-hour esophageal pH monitoring was performed using the Sandhill apparatus. An antimony probe electrode was placed in the lower third of the esophagus, confirmed by fluoroscopy and later by a chest X-ray. The parameters analyzed by esophageal pH monitoring included: total percent time of the presence of acid esophageal pH, i.e., pH below 4 (<4.2%; total number of acid episodes (<50 episodes; number of reflux episodes longer than 5 min (3 or less, and duration of the longest reflux episode (<9.2 min. One patient (1/10, 10% presented a 24-h esophageal pH profile compatible with GER disorder. This data suggest that an association between chronic rhinosinusitis not associated with bronchial asthma and GER disorder may exist in children and adolescents, especially in those with compatible GER disorder symptoms. In these cases, 24-h esophageal pH monitoring should be performed before indicating surgery, since the present data suggest that 10% of chronic rhinosinusitis surgeries can be eliminated.

  17. Can we use the questionnaire SNOT-22 as a predictor for the indication of surgical treatment in chronic rhinosinusitis?

    Science.gov (United States)

    Marambaia, Pablo Pinillos; Lima, Manuela Garcia; Guimarães, Marina Barbosa; Gomes, Amaury de Machado; Marambaia, Melina Pinillos; Santos, Otávio Marambaia Dos; Gomes, Leonardo Marques

    Chronic rhinosinusitis is a prevalent disease that has a negative impact on the lives of sufferers. SNOT-22 is considered the most appropriate questionnaire for assessing the quality of life of these patients and a very effective method of evaluating therapeutic interventions; however it is not used as a tool for decision-making. To test the hypothesis that the SNOT-22 score can predict the outcome of surgical treatment. A retrospective, longitudinal and analytical study. We evaluated the medical records of patients with chronic rhinosinusitis that completed the SNOT-22 at the time of diagnosis. All the patients were consecutively receiving care at an otolaryngology service in Salvador, Bahia from August 2011 to June 2012. The outcomes of the surgical treatment of these patients were obtained from their medical records. The initial score was compared to a group of patients who were not referred for surgery. All the patients completed and signed a consent form. Of the 88 patients with chronic rhinosinusitis, 26 had evolved to surgery over the last 3 years. The groups were homogeneous regarding gender and respiratory and medication allergies. The patients of the surgical group were 44.8+13.8 years old and the patients of the clinical group were 38.2+12.5 years old (p=0.517). The average SNOT-22 score of the case group was 49+19 and the average score of the control group was 49+27 (p=0.927). The SNOT-22 was unable to predict the outcome of surgical patients with chronic rhinosinusitis. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  18. Perspectives on the etiology of chronic rhinosinusitis: An immune barrier hypothesis

    Science.gov (United States)

    Kern, Robert C.; Conley, David B.; Walsh, William; Chandra, Rakesh; Kato, Atsushi; Tripathi-Peters, Anju; Grammer, Leslie C.; Schleimer, Robert P.

    2009-01-01

    Background Chronic rhinosinusitis (CRS) has been defined as persistent symptomatic inflammation of the nasal and sinus mucosa resulting from the interaction of multiple host and environmental factors. Recent studies have implicated Alternaria fungi or toxigenic Staphylococcus aureus as critical agents in CRS pathogenesis. The emphasis on environmental agents in CRS etiology has focused interest toward elimination of those agents as the prime mechanism of therapy. This viewpoint is in marked contrast to the current perspective on some other chronic inflammatory epithelial disorders that afflict the skin, lungs, and gut, wherein host factors are believed to predispose to disease expression in the presence of ubiquitous environmental agents. Methods The current review evaluates CRS etiology from this perspective and considers that CRS develops, in part, as an outcome of a dysfunctional host response. Specifically, evidence from our laboratory and others will be reviewed indicating that CRS is associated with a failure of the mechanical and immunologic barriers across the nasal mucosa. The hypothesis would further propose that genetic and epigenetic variation predisposes susceptible individuals to barrier failure in the presence of environmental stress leading to CRS. Results From this unifying perspective, bacteria and fungi are seen as disease modifiers rather than primary etiologic agents. Conclusion The goal is to place concepts of CRS pathophysiology in a framework consistent with a current understanding of chronic inflammation in general and epithelial disease in particular. PMID:18786300

  19. Emerging Role of Proteases in the Pathogenesis of Chronic Rhinosinusitis with Nasal Polyps

    Directory of Open Access Journals (Sweden)

    Dawei Wu

    2018-01-01

    Full Text Available Chronic rhinosinusitis with nasal polyps (CRSwNP is a heterogeneous upper airway disease with multiple etiologies. Clinically, CRSwNP can be classified into either eosinophilic or non-eosinophilic subtypes. The eosinophilic phenotype of CRSwNP is widely thought to be highly associated with recurrence of nasal polyps or surgical failure. Epithelial cells have a crucial role in the development of Th2-biased airway diseases. Recent studies have shown that a wide range of external stimuli such as allergens and microorganisms can elicit the release of epithelial-derived Th2-driving cytokines and chemokines. Protease activity is a feature common to these multiple environmental insults and there is growing evidence for the concept that an imbalance of proteases and protease inhibitors in the epithelial barrier leads to both the initiation and maintenance of chronic eosinophilic airway inflammation. In this review, we analyze recent work on the role of proteases in the development of the sinonasal mucosal type 2 immune response with an emphasis on the molecular pathways promoting adaptive Th2 cell immunity.

  20. Expression of eicosanoid receptors subtypes and eosinophilic inflammation: implication on chronic rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Van Cauwenberge Paul

    2006-05-01

    Full Text Available Abstract Background Eicosanoid receptors are G-protein-coupled receptors playing an important immunomodulatory role in airway diseases. However, there is little information on the expression of these receptors and their link with eosinophilic inflammation in paranasal sinus diseases. We aimed with this study to investigate the tissue expression of leukotrienes and prostaglandin E2 receptors in chronic rhinosinusitis patients and the link of this regulation with eosinophilic inflammation. Methods Samples were prepared from nasal tissue of patients with chronic rhinosinusitis without nasal polyps (CRS, n = 11, with nasal polyps (CRS-NP, n = 13 and healthy subjects (Controls, n = 6. mRNA expression of CysLT1, CysLT2, BLT1, BLT2, E-prostanoid receptors (EP1, EP2, EP3, EP4 and sol-IL-5Rα was determined by real-time PCR. Concentrations of PGE2, LTC4/D4/E4, LTB4 and sol-IL-5Rα were determined by ELISA and of ECP by ImmunoCap. Protein expression and tissue localization of eicosanoid receptors and activated eosinophils were evaluated by immunohistochemistry. Results CysLT1 mRNA expression was significantly increased in CRS-NP compared to CRS and controls, and CRS compared to controls, whereas CysLT2 mRNA was enhanced in both CRS groups without differences between them. Levels of both receptors correlated to the number of activated eosinophils, sol-IL-5Rα, ECP and LTC4/D4/E4 concentrations in the disease groups. PGE2 protein concentrations and prostanoid receptors EP1 and EP3 were down-regulated in the CRS-NP tissue vs. CRS and controls, whereas EP2 and EP4 expression was enhanced in CRS and CRS-NP patients vs. controls. No differences in BLT receptors were observed between patients and controls. Conclusion CyLTs receptors are up-regulated in nasal polyp tissue and their expression correlate with eosinophilic inflammation supporting previous results. Eicosanoid receptors mRNA pattern observed suggests that down-regulation of EP1 and EP3 in CRS-NP and

  1. Role of Interleukin-10 on Nasal Polypogenesis in Patients with Chronic Rhinosinusitis with Nasal Polyps.

    Directory of Open Access Journals (Sweden)

    Jun Xu

    Full Text Available Interleukin 10 (IL-10 is a potent anti-inflammatory cytokine. The dysregulation of IL-10 is associated with an enhanced immunopathologic response to infection, as well as with an increased risk for developing numerous autoimmune diseases. In this study, we investigated IL-10 expression in chronic rhinosinusitis with nasal polyps (CRSwNP and assessed the possible role of IL-10 in the pathogenesis of CRSwNP.Thirty-five patients with CRSwNP, 12 patients with chronic rhinosinusitis without NP (CRSsNP and 10 control subjects were enrolled in this study. NP tissues and uncinated tissues (UT were collected for analysis. Dispersed NP cells (DNPCs were cultured in the presence or absence of IL-25 and IL-10, and a flow cytometric assay was performed to identify the constitutive cell populations of the DNPCs. Murine NP (n = 18 models were used for the in vivo experiments. Real-time PCR, immunohistochemistry, western blotting analysis and ELISA were performed to measure the expression levels of the selected inflammatory cytokines and inflammation-associated molecules.The mRNA expression levels of IL-10, IL-5, IL-17A, IL-25 and interferon gamma (IFN-γ were significantly higher in the NP tissues than in the UT tissues. Strong positive correlations were observed between IL-10 and a variety of inflammatory cytokines (IL-5, IL-17A, IL-25, IFN-γ and inflammation-associated molecules (B-cell activating factor; BAFF, CD19. Other than the IL-25 to IL-10 ratio, the expression ratios of the other measured inflammatory cytokines to IL-10 were significantly lower in the CRSwNP group than in the CRSsNP or control groups. Administrating IL-25 into the cultured DNPCs significantly increased the production of IL-10, but administrating IL-10 had no effect on the production of IL-25.Increased expression of IL-10, IL-10 related inflammatory cytokine, and IL-10 related B cell activation indicated that IL-10, a potent anti-inflammatory cytokine, has a pivotal role in the

  2. Ectopic lymphoid tissues support local immunoglobulin production in patients with chronic rhinosinusitis with nasal polyps.

    Science.gov (United States)

    Song, Jia; Wang, Hai; Zhang, Ya-Na; Cao, Ping-Ping; Liao, Bo; Wang, Zhe-Zheng; Shi, Li-Li; Yao, Yin; Zhai, Guan-Ting; Wang, Zhi-Chao; Liu, Li-Meng; Zeng, Ming; Lu, Xiang; Wang, Heng; Yang, Xiang-Ping; Yu, Di; Bachert, Claus; Liu, Zheng

    2018-03-01

    The contribution of ectopic lymphoid tissues (eLTs) to local immunoglobulin hyperproduction in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) is unclear. We sought to explore the cellular basis, formation mechanisms, and function of eLTs in patients with CRSwNP. We graded lymphoid aggregations in sinonasal mucosa and histologically studied their structures. The expression of lymphorganogenic factors and molecules required for immunoglobulin production was measured by using real-time PCR, and their localization was analyzed by means of immunohistochemistry and immunofluorescence. The phenotype of follicular helper T cells was analyzed by performing flow cytometry. Immunoglobulin levels were quantified by using the Bio-Plex assay or ImmunoCAP system. Nasal tissue explants were challenged ex vivo with Dermatophagoides pteronyssinus group 1 (Der p 1), and the expression of Iε-Cμ and Iε-Cγ circle transcripts was detected by using seminested PCR. Increased formation of eLTs with germinal center-like structures was discovered in patients with eosinophilic (20.69%) and noneosinophilic (17.31%) CRSwNP compared with that in patients with chronic rhinosinusitis without nasal polyps (5.66%) and control subjects (3.70%). The presence of eLTs was associated with increased expression of lymphorganogenic and inflammatory chemokines and cytokines, as well as their receptors. The expression of molecules required for immunoglobulin production, generation of follicular helper T cells, and production of IgE in eosinophilic polyps and IgG and IgA in both eosinophilic and noneosinophilic polyps were predominantly upregulated in patients with eLTs. After Der p 1 challenge ex vivo, Iε-Cμ transcript was detected only in eosinophilic polyps with eLTs but not in polyps without eLTs and noneosinophilic polyps. eLTs might support local immunoglobulin production and therefore significantly contribute to the development of CRSwNP. Copyright © 2017 American Academy of

  3. Antimicrobial Resistance Patterns of Aerobic Organisms in Patients With Chronic Rhinosinusitis in Hamadan, Iran

    Directory of Open Access Journals (Sweden)

    Farahani

    2014-08-01

    Full Text Available Background Although effective strategies have been presented for preventing the spread of antibiotic resistance in Iran, recent reports have revealed increasing antibiotic resistance among children and adults. Objectives In the present study, we tried to provide a clear view of the antibiotic resistance status of aerobic organism as the most prevalent organism in patients with rhinosinusitis in Hamadan, Iran. Patients and Methods A cross-sectional study was conducted on 216 consecutive patients referred to otolaryngology clinics of Imam Khomeini and Besat University hospitals in Hamadan with clinical and radiological manifestations of chronic rhinosinusitis. Two specimens were taken from each patient; one from the affected maxillary sinus by aspiration and another from the middle meatus and nasopharynx by swabbing. Antibiotic susceptibility was tested by Kirby Bauer’s method; distributions of the isolates from middle meatus, nasopharynx and sinus were determined and the results of susceptibility test were analyzed. Results Among the aerobic organism from meatus and oropharynx, the most frequent isolated strains were alpha-hemolytic Streptococcus (15.4%, followed by coagulase-negative Staphylococcus (14.6%, and Branhamella catarrhalis (13.2%, and the most prevalent isolated strains from sinus were S. aureus (19.1%, Klebsiella pneumonia (16.4%, and B. catarrhalis (15.6%, respectively. The highest antibiotic susceptibility was detected to ciprofloxacin and ceftriaxone in most of the strains; susceptibility to ciprofloxacin ranged from 76.7% (for Pseudomonas aeruginosa to 100% (for Escherichia coli and Haemophilus influenza; susceptibility to ceftriaxone ranged from 71.4% (for Acinetobacter baumannii to 100% (for S. pneumonia, Corynebacterium diphtheria, and H. influenza. Besides, regardless of strain, the highest resistance was mostly detected to penicillin (ranging from 33.3% to 91.7%, and to ampicillin (ranging from 38.4% to 83.7%. Conclusions

  4. Squeeze bottle versus saline spray after endoscopic sinus surgery for chronic rhinosinusitis: a pilot multicentre trial.

    Science.gov (United States)

    Macdonald, K I; Wright, E D; Sowerby, L J; Rotenberg, B W; Chin, C J; Rudmik, L; Sommer, D D; Nayan, S; DesRosiers, M; Tewfik, M A; Valdes, C J; Massoud, E; Thomas, D; Kilty, S J; Vescan, A; Mechor, B; Lavigne, F; Fandino, M; Javer, A R; Witterick, I J

    2015-01-01

    There is a need for controlled trials to guide the perioperative management of patients undergoing endoscopic sinus surgery (ESS). The authors performed a pilot multicenter trial to compare two types of saline delivery devices in this population. Patients were randomized to high volume saline irrigation with a squeeze bottle and low volume saline spray after ESS in patients with chronic rhinosinusitis (CRS). Surgeons were blinded to treatment, and one-month postoperative scores for sinonasal outcomes [Sinonasal Outcome Test-22 (SNOT-22)] scale, nasal and sinus symptom score (NSS), and perioperative sinus endoscopy (POSE) scale were compared with preoperative scores. Nine centers provided data for 86 patients. All three outcomes measures improved significantly for both groups. Saline spray: SNOT-22 48.8 versus. 23.7, treatment effect 25.1 (95% confidence interval [CI], 17.9-32.2), POSE 21.1 versus. 8.4, treatment effect 12.7 (95% CI, 9.2-16.1), and NSS 8.2 versus 5.0, treatment effect 3.1 (95% CI, 1.4-4.9) pre- and postoperatively, respectively (all p spray showed significant improvement in SNOT-22, POSE, and NSS scores at one-month postoperatively. Because the study was nonpowered, we cannot rule out a potential difference between the two treatment groups.

  5. Direct measurement of upper airway inflammation in children with chronic rhinosinusitis: implications for asthma.

    Science.gov (United States)

    Demirdag, Yesim Y; Ramadan, Hassan H

    2016-02-01

    Chronic rhinosinusitis (CRS) is a common heterogenous multifactorial disorder affecting children and adults. The exact mechanism is not completely understood. In this review, we aim to summarize our recent findings regarding etiologies and pathogenesis of CRS in children and review recent studies investigating inflammatory patterns in the upper airways in children and adults with CRS. There are only a few small studies measuring upper airway inflammation in children with CRS. These studies demonstrated more toward eosinophilic and T-cell driven inflammatory pattern. Cytokine patterns in upper airways seem to correlate with asthma symptoms in children with CRS. Adult studies demonstrate eosinophilic and Th-2 (T helper-1) driven inflammation in CRS with nasal polyps and Th-1 (T helper-2) driven inflammation in CRS without nasal polyps. Current knowledge about the characteristics of tissue inflammation in upper airways in children with CRS is limited. More studies are needed to better understand the pathogenesis and better define the subgroups of CRS. The findings of such studies will lead to identifying the biological targets to treat this condition.

  6. The role of trigeminal function in the sensation of nasal obstruction in chronic rhinosinusitis.

    Science.gov (United States)

    Saliba, Joe; Fnais, Naif; Tomaszewski, Marcel; Carriere, Junie S; Frenkiel, Saul; Frasnelli, Johannes; Tewfik, Marc A

    2016-05-01

    Trigeminal sensation (TS) within the nasal cavity is important for the perception of nasal airflow. The objective of this study is to examine whether impaired TS contributes to the sensation of nasal obstruction in patients with chronic rhinosinusitis (CRS). Prospective case-control study conducted in a tertiary referral rhinology clinic. Cases consisted of CRS patients with subjective nasal obstruction, not previously treated with oral corticoids. Controls consisted of patients without CRS. Neither group demonstrated obvious anatomical obstructions. Both groups underwent peak nasal inspiratory flows (PNIF), olfactory testing (quick eight-item odor identification test), and trigeminal testing (lateralization task using eucalyptol and odorless solvent). A total of 28 subjects (14 CRS patients and 14 controls) were recruited. Analyses revealed no statistical differences in age (P = .93), gender (P = .47), or PNIF (P = .82) between the two groups, but they differed in Lund-Mackay scores (P sensation of nasal obstruction in CRS. 3b. Laryngoscope, 126:E174-E178, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Suzie Hyeona Kang

    2015-02-01

    Full Text Available Although cystic fibrosis (CF is an irreversible genetic disease, advances in treatment have increased the life expectancy of CF patients. Upper airway involvement, which is mainly due to pathological changes in the paranasal sinuses, is prevalent in CF patients, although many are only mildly symptomatic (with few symptoms. The objective of this literature review was to discuss the pathophysiology and current therapeutic management of chronic rhinosinusitis (CRS in CF patients. The review was based on current evidence, which was classified in accordance with the Oxford Centre for Evidence-Based Medicine criteria. When symptomatic, CRS with nasal polyps can affect quality of life and can lead to pulmonary exacerbations, given that the paranasal sinuses can be colonized with pathogenic bacteria, especially Pseudomonas aeruginosa. Infection with P. aeruginosa plays a crucial role in morbidity and mortality after lung transplantation in CF patients. Although clinical treatment of the upper airways is recommended as initial management, this recommendation is often extrapolated from studies of CRS in the general population. When sinonasal disease is refractory to noninvasive therapy, surgery is indicated. Further studies are needed in order to gain a better understanding of upper airway involvement and improve the management of CRS in CF patients, with the objective of preserving lung function and avoiding unnecessary invasive procedures.

  8. Omalizumab treats chronic rhinosinusitis with nasal polyps and asthma together-a real life study.

    Science.gov (United States)

    Bidder, T; Sahota, J; Rennie, C; Lund, V J; Robinson, D S; Kariyawasam, H H

    2018-03-01

    Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma often coexist and thus treating both with one intervention is an attractive strategy. To prospectively evaluate whether treatment with the monoclonal antibody against IgE Omalizumab for severe allergic asthma also effectively treats co-existent CRSwNP. SNOT-22 and the ACQ-7 scores were recorded at 4 and 16 weeks of treatment in a cohort of patients with both CRSwNP and severe refractory allergic asthma treated with Omalizumab (n=13) according to UK guidelines for their severe asthma. SNOT-22 in a surgery only treated CRSwNP with asthma group (n=24) was compared. Rapid improvement was seen at 4 weeks and 16 weeks of treatment in both CRSwNP and asthma control. The improvement in CRSwNP with Omalizumab was similar to that seen in a group of patients who received upper airway surgery. Omalizumab treatment for severe allergic asthma also improves co-existent CRSwNP. Further clinical studies of current and emerging biological agents for severe asthma should include upper airway outcomes. These agents may be effective for severe CRSwNP and comparative studies with surgery are warranted.

  9. The influence of spray cryotherapy on wound healing following endoscopic sinus surgery in chronic rhinosinusitis.

    Science.gov (United States)

    Albu, Silviu; Trombitas, Veronica; Vlad, Diana; Emanuelli, Enzo

    2016-01-01

    The aim of this study was to assess the influence of spray cryotherapy on wound healing following endoscopic sinus surgery (ESS). A prospective, randomized, double-blinded, controlled trial. The study included 22 consecutive adult patients with chronic rhinosinusitis with and without polyps scheduled for bilateral ESS. At the end of the surgical procedure, patients were randomized to the distribution of spray cryotherapy in one middle meatus and saline contralaterally. Outcomes were only measured for endoscopy scores. Thus, postoperative healing and the amount of edema, crusting, secretions, and scarring were assessed using the validated Lund-Kennedy and Perioperative Sinus Endoscopy (POSE) scores. There were no baseline differences concerning POSE and Lund-Kennedy scores between the two groups. Nevertheless, a significant difference was recorded at one, 2, 4, 8, and 12 weeks in both POSE (P = .001, P = .012, P = .02, P = .006, P = .001) and Lund-Kennedy (P = .002, P = .005, P = .02, P = .02, P = .03) scores. These preliminary results reveal an improvement in postoperative scores, demonstrating enhanced healing following spray cryotherapy. However, without patient subjective outcomes, the study is limited. Additional studies with longer follow-up and larger samples are needed to describe the effects of cryotherapy on wound healing. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  10. Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis.

    Science.gov (United States)

    Kosugi, Eduardo Macoto; Moussalem, Guilherme Figner; Simões, Juliana Caminha; Souza, Rafael de Paula e Silva Felici de; Chen, Vitor Guo; Saraceni Neto, Paulo; Mendes Neto, José Arruda

    2016-01-01

    Chronic rhinosinusitis (CRS) is termed difficult-to-treat when patients do not reach acceptable level of control despite adequate surgery, intranasal corticosteroid treatment and up to 2 short courses of systemic antibiotics or corticosteroids in the preceding year. Recently, high-volume corticosteroid nasal irrigations have been recommended for CRS treatment. To assess high-volume budesonide nasal irrigations for difficult-to-treat CRS. Prospective uncontrolled intervention trial. Participants were assessed before- and 3 months after nasal irrigation with 1mg of budesonide in 500 mL of saline solution daily for 2 days. Subjective (satisfactory clinical improvement) and objective (SNOT-22 questionnaire and Lund-Kennedy endoscopic scores) assessments were performed. Sixteen patients were included, and 13 (81.3%) described satisfactory clinical improvement. SNOT-22 mean scores (50.2-29.6; p=0.006) and Lund-Kennedy mean scores (8.8-5.1; p=0.01) improved significantly. Individually, 75% of patients improved SNOT-22 scores, and 75% improved Lund-Kennedy scores after high volume budesonide nasal irrigations. High-volume corticosteroid nasal irrigations are a good option in difficult-to-treat CRS control of disease, reaching 81.3% success control and significant improvement of SNOT-22 and Lund-Kennedy scores. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  11. Symptom-Based Clustering in Chronic Rhinosinusitis Relates to History of Aspirin Sensitivity and Postsurgical Outcomes.

    Science.gov (United States)

    Divekar, Rohit; Patel, Neil; Jin, Jay; Hagan, John; Rank, Matthew; Lal, Devyani; Kita, Hirohito; O'Brien, Erin

    2015-01-01

    Symptoms burden in chronic rhinosinusitis (CRS) may be assessed by interviews or by means of validated tools such as the 22-item SinoNasal Outcome Test (SNOT-22). However, when only the total SNOT-22 scores are used, the pattern of symptom distribution and heterogeneity in patient symptoms is lost. To use a standardized symptom assessment tool (SNOT-22) on preoperative symptoms to understand symptom heterogeneity in CRS and to aid in characterization of distinguishing clinical features between subgroups. This was a retrospective review of 97 surgical patients with CRS. Symptom-based clusters were derived on the basis of presurgical SNOT-22 scores using unsupervised analysis and network graphs. Comparison between clusters was performed for clinical and demographic parameters, postsurgical symptom scores, and presence or absence of a history of aspirin sensitivity. Unsupervised analysis reveals coclustering of specific symptoms in the SNOT-22 tool. Using symptom-based clustering, patients with CRS were stratified into severe overall (mean total score, 90.8), severe sinonasal (score, 62), moderate sinonasal (score, 40), moderate nonsinonasal (score, 37) and mild sinonasal (score, 16) clusters. The last 2 clusters were associated with lack of history of aspirin sensitivity. The first cluster had a rapid relapse in symptoms postoperatively, and the last cluster demonstrated minimal symptomatic improvement after surgery. Symptom-based clusters in CRS reveal a distinct grouping of symptom burden that may relate to aspirin sensitivity and treatment outcomes. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  12. Osteomeatal complex obstruction is not associated with adjacent sinus disease in chronic rhinosinusitis with polyps.

    Science.gov (United States)

    Leung, Randy M; Kern, Robert C; Conley, David B; Tan, Bruce K; Chandra, Rakesh K

    2011-01-01

    It is universally accepted that osteomeatal complex (OMC) disease is linked to the subsequent development of chronic rhinosinusitis without nasal polyps (CRSsNPs) via postobstructive mechanisms. The role of OMC obstruction in the pathogenesis of CRSwNPs is less clear. This study was designed to identify if there is an association between OMC obstruction and inflammation of the adjacent sinuses, when patients are stratified by polyp status. This is a follow-up and expanded series of a previous pilot study from our group. CT scans of 144 patients with CRSsNPs and 123 patients with CRS with nasal polyps (CRSwNPs) were evaluated for each sinus and OMC. Patients had no previous surgeries for NPs. CT scans were obtained after a trial of maximal medical therapy. Increasing OMC involvement was associated with increasing Lund-Mackay score for both CRSsNPs and CRSwNPs. In CRSsNP patients, OMC status significantly correlated with adjacent sinus status (p OMC status does not correlate with adjacent sinus status (p = 0.328). OMC obstruction in the setting of CRSwNP may be a barometer of the overall disease process, but in this scenario, paranasal sinus inflammation can not be classified as a postobstructive phenomenon. These findings question the role of minimally invasive procedures in the management of CRSwNPs.

  13. Productivity costs decrease after endoscopic sinus surgery for refractory chronic rhinosinusitis.

    Science.gov (United States)

    Rudmik, Luke; Smith, Timothy L; Mace, Jess C; Schlosser, Rodney J; Hwang, Peter H; Soler, Zachary M

    2016-03-01

    The primary objective of this pilot study was to define the change in productivity costs following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Secondary objectives were to identify CRS-related characteristics that may influence the degree of productivity improvement after ESS. Prospective, multi-institutional, observational cohort study. The human capital approach was used to define productivity costs. Annual absenteeism, presenteeism, and lost leisure time were quantified to define annual lost productive time (LPT). LPT was monetized using the annual daily wage rates obtained from the 2012 US Census and the 2013 US Department of Labor statistics. Twenty-seven patients with refractory CRS who underwent ESS were followed for a mean of 15 months (range, 8-25 months). Following ESS, there were improvements in annual absenteeism (22 days reduced to 3 days), annual presenteeism (41 days reduced to 19 days), and annual household days lost (12 days reduced to 6 days). Overall, the preoperative productivity costs were reduced after ESS ($9,190 vs. $3,373, respectively; P productivity is negatively impacted by the presence of CRS. The outcomes from this study provide the first insights into the reduced productivity costs associated with receiving ESS for refractory CRS. Future studies with larger sample sizes will need to validate the results from this pilot study. 2c Laryngoscope, 126:570-574, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  14. [The standardized perioperative treatment of chronic rhinosinusitis with nasal polyps and asthma].

    Science.gov (United States)

    Li, Tingting; Ju, Jianbao; Yu, Hailing; Xie, Daoyu

    2015-04-01

    To discuss the perioperative treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma. Retrospective analysis of perioperative clinical data of 43 cases with CRSwNP and asthma. The admitted and under endoscopic surgery. Patients with preventing perioperative asthma attacks and corresponding standardized treatment were Observed. Thirty-five cases were stable during perioperative period and without asthma. Seven patients diagnosed as mild and moderate asthma attacks because of low pulse oximetry (SpO2 92%-95%) and scattered wheeze heard in the lungs. So these patients were sent to ICU for the treatment. They went back to ward after their conditions turned to stable and no asthma during perioperative. One patient diagnosed as severe asthma attack, because irritability and suffocation happened, SpO2 decreased from 99% to 84%-81%, diffuse wheeze could be heard in the whole lung . So we give him tracheal intubation and sent him to ICU for advanced treatment after breathing smooth. Five days later the patient retuned to the ward in stable condition and with no asthma attack again. Before operation the patients should be give some corresponding standardized comprehensive treatment according to the nasal symptoms and the degree of asthma attack, such as the application of topical steroid and antiallergic medicine. And some special treatment should be given to reduce airway hyperresponsiveness mucosa during anesthesia. These methods can reduce the risk of the asthma attacks and improve perioperative safety, prevent serious complications.

  15. Topical probiotics as a therapeutic alternative for chronic rhinosinusitis: A preclinical proof of concept.

    Science.gov (United States)

    Schwartz, Joseph S; Peres, Adam G; Mfuna Endam, Leandra; Cousineau, Benoit; Madrenas, Joaquin; Desrosiers, Martin

    2016-11-01

    Patients with chronic rhinosinusitis (CRS) have been shown to manifest a high inflammatory phenotype, with a sinus microbiome deficient in gram-positive bacteria. Gram-positive bacteria are capable of downregulating proinflammatory host responses via an interleukin (IL) 10 mediated response and may represent a potential therapeutic alternative for CRS. We wanted to (i) immunoprofile the IL-10 induction capacity of two gram-positive probiotic strains and (ii) verify the tolerance of these strains by the sinus epithelium. A peripheral blood mononuclear cell (PBMC) challenge model was used to document probiotic induction of IL-10 and tumor necrosis factor (TNF) alpha responses at various bacterial dilutions. Epithelial cell tolerance was demonstrated by using a primary epithelial cell model derived from patient biopsy specimens (six patients total [three with CRS and three controls]). After an incubation period with either a live or a heat-killed probiotic strain, cell viability was assessed by using light microscopy. Both probiotic strains induced high IL-10 secretion in PBMCs, with differing profiles of TNF alpha production. Microscopic evaluation after probiotic incubation demonstrated intact cell viability for all cell cultures. We identified well-tolerated, nonpathogenic, "generally recognized as safe" status gram-positive probiotics with anti-inflammatory properties. Topical probiotics represented a potential novel topical therapeutic strategy for CRS relevant for further clinical evaluation.

  16. The effect of systemic treatments on periostin expression reflects their interference with the eosinophilic inflammation in chronic rhinosinusitis with nasal polyps

    NARCIS (Netherlands)

    de Schryver, E.; Derycke, L.; Calus, L.; Holtappels, G.; Hellings, P. W.; van Zele, T.; Bachert, C.; Gevaert, P.

    2017-01-01

    Background: Periostin is a recently discovered biomarker for eosinophilic inflammation. Chronic rhinosinusitis with nasal polyps is a T-helper 2-skewed chronic inflammatory airway disease. Medical treatments aim to relieve symptoms and maintain clinical control by interfering with the inflammatory

  17. Do Aging Factors Influence the Clinical Presentation and Management of Chronic Rhinosinusitis?

    Science.gov (United States)

    Renteria, Axel E; Mfuna Endam, Leandra; Desrosiers, Martin

    2017-04-01

    Objective/Hypothesis Chronic rhinosinusitis (CRS) is a complex inflammatory disease of the upper respiratory airways resulting from the dysregulation of immunity and epithelial defenses. More recently, the contribution of an altered nasal microbiome to the development of CRS has also been proposed. However, the impact of aging on the development of CRS has been long overlooked. Here we propose, in a hypothesis piece, that aging can influence the physiopathology of CRS and its subsequent management in an elderly population. Data Sources We summarize the recent literature findings supporting that elderly patients with CRS could be a distinct population from those with adult CRS and might require different or adjunct therapeutic approaches. Methods Review of recent literature of the effect of aging and its possible effects in CRS using 3 different databases. Conclusions Age-dependent decrease in the levels of the S100 family proteins involved in epithelial proliferation, repair, and defenses combined with chronic inflammation might lead to an increased risk of abnormal microbial colonization and loss of microbiota diversity. Ultimately, these changes could have the potential to alter the physiopathology of CRS in the elderly. Implications Unlike in adults, in whom CRS T h 2-skewed responses with eosinophilia are thought to play a critical role, in aging populations, a microbiome and epithelial barrier dysfunctions may instead be the pivotal agents of disease development and persistence. This supports that therapies for elderly patients may require a different management or additional targeted therapies to control the disease. Prospective studies, however, are necessary to validate this concept.

  18. Clinical Characteristics of Adults with Chronic Rhinosinusitis and Specific Antibody Deficiency

    Science.gov (United States)

    Kashani, Sara; Carr, Tara F.; Grammer, Leslie C.; Schleimer, Robert P.; Hulse, Kathryn E.; Kato, Atsushi; Kern, Robert C.; Conley, David B.; Chandra, Rakesh K.; Tan, Bruce K.; Peters, Anju T.

    2015-01-01

    Background Specific antibody deficiency (SAD) involves a deficient response to a polysaccharide vaccine in the setting of normal IgG levels and chronic infections. Patients with chronic rhinosinusitis (CRS) are often evaluated for SAD. There is limited data describing patients with CRS and SAD. Objective To better characterize the role of SAD in CRS. Methods We reviewed electronic records of adults with CRS who were evaluated for immunodeficiency with quantitative immunoglobulin levels and pre- and post-antibody titers to a pneumococcal polysaccharide vaccine (PPV). Results 14 pneumococcal serotypes were determined in 239 subjects from 2002–2009. 64 subjects had adequate protective titers of 1.3 μg/mL or higher in 7 or more serotypes out of the 14 serotypes checked. 56 (23%) had less than 7 protective titers post-PPV and were diagnosed with SAD. 119 subjects had an adequate response to the vaccine with 7 or more serotypes being higher than 1.3 μg/mL (>50% response) and were characterized as “responders”. Subjects with SAD received more antibiotic courses relative to responders in the two years following immunization (3.19 ± 2.64 vs. 2.19 ± 2.24, p<0.05). Ten of 56 subjects (17.9%) with SAD received immunoglobulin (Ig) replacement therapy. Subjects receiving Ig had fewer numbers of protective pneumococcal titers post PPV and had more pneumonia (40.0%) versus subjects with SAD not receiving Ig (10.9%). Conclusions Of 239 CRS patients with normal IgG levels evaluated for immunodeficiency, 56 (23.4%) had SAD. A majority of patients with SAD may not need Ig replacement however, a subset of patients with SAD benefit from Ig replacement. PMID:25609325

  19. Long-term outcome of once daily nasal irrigation for the treatment of pediatric chronic rhinosinusitis.

    Science.gov (United States)

    Pham, Vinh; Sykes, Kevin; Wei, Julie

    2014-04-01

    Chronic rhinosinusitis(CRS) results in significant morbidity and health care expenditure. Safety and efficacy of nasal irrigation use in the treatment of pediatric CRS have been demonstrated, but long-term outcomes are unknown. We reviewed characteristics and treatment outcomes after 6 weeks of once daily nasal irrigation in pediatric CRS based on computed tomography (CT) scans, and summarized parental reports of subsequent use of nasal irrigation for recurring symptoms Retrospective cohort study and cross-sectional survey. Review and survey of 144 pediatric CRS patients diagnosed between July 2003 and January 2012. One hundred four patients were reviewed. Mean age was 8.0 years, and 65.4% were male. Presenting symptoms included congestion (95.2%), cough (79.8%), rhinorrhea (60.6%), headache (48.1%), and fatigue (40.4%). Comorbidities included positive allergy test (50%), asthma (57.3%), and gastroesophageal reflux disease (28.2%). After 6 weeks, 57.7% of patients reported complete resolution of symptoms. Reductions in Lund-Mackay CT scores were 4.14 and 4.38 on the left and right sides, respectively (P irrigation again in the past 12 months (median = 1, interquartile range = 3). Only nine patients underwent functional endoscopic sinus surgery (FESS) after the initial 6 weeks. Patients requiring FESS were, on average, 3.6 years older than those who did not receive FESS (P = 0.0005). Median length of follow-up was 48 months (range = 20-113). There were no significant differences in age, Lund-MacKay score changes, and symptom resolution proportions between those who completed the survey and those who did not. Nasal irrigation is effective as a first-line treatment for pediatric CRS and subsequent nasal symptoms, and reduces the need for FESS and CT imaging. 2b. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  20. Biofilm detection in chronic rhinosinusitis by combined application of hematoxylin-eosin and gram staining.

    Science.gov (United States)

    Tóth, László; Csomor, Péter; Sziklai, István; Karosi, Tamás

    2011-10-01

    The pathomechanism of chronic rhinosinusitis with nasal polyposis (CRS/NP) seems to be unclear. Bacterial-, fungal- and combined biofilms might play a potential role in the pathogenesis of various inflammatory diseases and recently in CRS/NP. A prospective, blinded observational study was performed to confirm that the combination of conventional hematoxylin-eosin (HE) and Gram staining protocols could be used to detect bacterial and fungal biofilms in patients with CRS/NP. A total of 50 patients with CRS/NP undergoing endoscopic sinus surgery (ESS) were analyzed. The negative control group consisted of 12 patients undergoing septoplasty for nasal obstruction without CRS/NP. The nasal polyps and inferior turbinate mucosa specimens applied as negative controls were processed to HE and Gram staining. Biofilm was detected in 44 of 50 patients with CRS/NP and in none of 12 negative controls. In our series, HE method showed an obvious correlation with the results of Gram staining and was allocated to be a good predictor of biofilm existence. It was found that the microscopic structure and thickness of biofilms were strongly associated with the integrity of nasal mucosa and with the characteristics of subepithelial cellular infiltration. This study confirmed the presence of bacterial and fungal biofilms on the surface of NPs obtained from patients with CRS. Since biofilms may affect the severity and recurrence rate of CRS treated by ESS they should be detected histologically. In conclusion, HE staining combined with Gram protocol is a robust and reliable method for the detection of bacterial and fungal biofilms in CRS/NP.

  1. Age-related prevalence of chronic rhinosinusitis and nasal polyps and their relationships with asthma onset.

    Science.gov (United States)

    Won, Ha-Kyeong; Kim, Young-Chan; Kang, Min-Gyu; Park, Han-Ki; Lee, Seung-Eun; Kim, Min-Hye; Yang, Min-Suk; Chang, Yoon-Seok; Cho, Sang-Heon; Song, Woo-Jung

    2018-02-09

    Chronic rhinosinusitis (CRS) is a major disease condition with high morbidity, and may influence lower airway disease status in adults. However, its associations with adult asthma onset and activity have not been examined in detail in a general adult population. To investigate the relationships between CRS with nasal polyps and asthma characteristics. A cross-sectional dataset from 17,506 adult participants (age≥18 years) in the Korean National Health and Nutrition Examination Survey 2010-2012 was analyzed. CRS was defined using structured questionnaires according to the international guideline, and presence of nasal polyps was objectively assessed using nasal endoscope. Presence of asthma and its onset and current activity were asked using structured questionnaires. CRS was significantly related with asthma, but the relationships were distinct by CRS and asthma status. CRS with nasal polyps (CRSwNP) was significantly associated with adult-onset asthma (onset after 18 years) or late-onset asthma (onset after 40 years), whereas CRS without nasal polyps (CRSsNP) were related to childhood-onset asthma (onset before 18 years) or early-onset asthma (onset before 40 years) in adults. Both CRS subgroups showed significant associations with current asthma but not with past asthma. However, comorbid asthma rate was less than 10% among subjects with CRS. This study found distinct age-related patterns of CRSwNP and asthma and demonstrated their significant associations in a general population. However, low prevalence of asthma in CRSwNP is in sharp contrast to the findings in Western populations, which warrants further investigation for ethnic or regional difference in CRSwNP-asthma relationships. Copyright © 2018. Published by Elsevier Inc.

  2. Mixed T helper cell signatures in chronic rhinosinusitis with and without polyps.

    Directory of Open Access Journals (Sweden)

    Lara Derycke

    Full Text Available In chronic rhinosinusitis (CRS different phenotypes have been reported based on cytokine profile and inflammatory cell patterns. The aim of this study was to characterize the intracytoplasmatic cytokines of T cells infiltrating the inflamed sinonasal mucosa.Infiltrated T cells and tissue homogenates from sinonasal mucosal samples of 7 healthy subjects, 9 patients with CRS without nasal polyp (CRSsNP, 15 with CRS with nasal polyps (CRSwNP and 5 cystic fibrosis patients (CF-NP were analyzed for cytokine expression using flow cytometry and multiplex analysis respectively. Intracytoplasmic cytokinesin T cells were analyzed after stimulation of nasal polyps with Staphylococcus aureus enterotoxin B for 24 hours.The number of T cells per total living cells was significantly higher in patients with CRSwNP vs. CRSsNP and controls. 85% of the CD4(+ T cells showed to be memory T cells. The effector T cells present in all tissues have a predominant Th1 phenotype. Only in CRSwNP, a significant fraction of T cells produced the Th2 cytokines IL-4 and IL-5, while nasal polyps from CF patients were characterized by a higher CD4/CD8 T cell ratio and an increased number of Th17 cells. 24 h stimulation with SEB resulted in a significant induction of CD4(+ T cells producing IL-10 (Tr1 cells.T cell cytokine patterns in healthy and inflamed sinonasal mucosa revealed that Th2 cells (IL-4 and IL-5 producing cells are significantly increased in CRSwNP mucosal inflammation. Exposure to SEB stimulates Tr1 cells that may contribute to the Th2 bias in CRSwNP.

  3. Prevalence of allergic rhinitis and asthma in patients with chronic rhinosinusitis and gastroesophageal reflux disease.

    Science.gov (United States)

    Mahdavinia, Mahboobeh; Bishehsari, Faraz; Hayat, Waqas; Codispoti, Christopher D; Sarrafi, Shahram; Husain, Inna; Mehta, Arpita; Benhammuda, Mohamed; Tobin, Mary C; Bandi, Sindhura; LoSavio, Philip S; Jeffe, Jill S; Palmisano, Erica L; Schleimer, Robert P; Batra, Pete S

    2016-08-01

    An association between chronic rhinosinusitis (CRS) and gastroesophageal reflux disease (GERD) has been previously reported; however, the underlying factors linking CRS and GERD remain to be elucidated. To assess the association of GERD and CRS using prospective and retrospective approaches. The retrospective study comprised a large cohort of CRS cases, whereas the prospective arm evaluated a series of CRS cases and controls. In the retrospective arm of the study, of the 1066 patients with CRS, 112 (10.5%) had GERD. Among patients with CRS, GERD was associated with higher body mass index, older age, and female sex. The odds ratios (ORs) for asthma and allergic rhinitis in the CRS group with GERD compared with the CRS group without GERD were 2.89 (95% confidence interval [CI], 1.905-4.389) and 2.021 (95% CI, 1.035-3.947). Furthermore, GERD was associated with a greater duration of CRS. Ninety patients with CRS and 81 controls were enrolled in the prospective arm of the study. In the CRS group, GERD was associated with asthma (OR, 4.77; 95% CI, 1.27-18.01). Patients with CRS and GERD had a longer duration and a younger age at onset of CRS. In controls, no association was found between GERD and asthma (OR, 0.67; 95% CI, 0.09-5.19) or allergic rhinitis (OR, 0.35; 95% CI, 0.05-2.59). Patients with CRS and GERD are more likely to have atopic conditions and asthma when compared with patients with CRS but without GERD. One of the potential explanations of this link is that comorbid GERD and atopic disease are potential risk factors for development of CRS. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  4. Efficacy of a marine bacterial nuclease against biofilm forming microorganisms isolated from chronic rhinosinusitis.

    Directory of Open Access Journals (Sweden)

    Robert C Shields

    Full Text Available BACKGROUND: The persistent colonization of paranasal sinus mucosa by microbial biofilms is a major factor in the pathogenesis of chronic rhinosinusitis (CRS. Control of microorganisms within biofilms is hampered by the presence of viscous extracellular polymers of host or microbial origin, including nucleic acids. The aim of this study was to investigate the role of extracellular DNA in biofilm formation by bacteria associated with CRS. METHODS/PRINCIPAL FINDINGS: Obstructive mucin was collected from patients during functional endoscopic sinus surgery. Examination of the mucous by transmission electron microscopy revealed an acellular matrix punctuated occasionally with host cells in varying states of degradation. Bacteria were observed in biofilms on mucosal biopsies, and between two and six different species were isolated from each of 20 different patient samples. In total, 16 different bacterial genera were isolated, of which the most commonly identified organisms were coagulase-negative staphylococci, Staphylococcus aureus and α-haemolytic streptococci. Twenty-four fresh clinical isolates were selected for investigation of biofilm formation in vitro using a microplate model system. Biofilms formed by 14 strains, including all 9 extracellular nuclease-producing bacteria, were significantly disrupted by treatment with a novel bacterial deoxyribonuclease, NucB, isolated from a marine strain of Bacillus licheniformis. Extracellular biofilm matrix was observed in untreated samples but not in those treated with NucB and extracellular DNA was purified from in vitro biofilms. CONCLUSION/SIGNIFICANCE: Our data demonstrate that bacteria associated with CRS form robust biofilms which can be reduced by treatment with matrix-degrading enzymes such as NucB. The dispersal of bacterial biofilms with NucB may offer an additional therapeutic target for CRS sufferers.

  5. Smoking: An independent risk factor for lost productivity in chronic rhinosinusitis.

    Science.gov (United States)

    Campbell, Adam P; Hoehle, Lloyd P; Phillips, Katie M; Caradonna, David S; Gray, Stacey T; Sedaghat, Ahmad R

    2017-08-01

    Chronic rhinosinusitis (CRS) is associated with a significant loss of patient productivity that costs billions of dollars every year. Smoking is associated with worsening sinonasal symptoms, but its effect on lost productivity in CRS patients has yet to be described. Therefore, we sought to determine the association between smoking and productivity in patients with CRS. Prospective cross-sectional cohort study of 140 patients with CRS. Sinonasal symptom severity was measured using the 22-item Sino-Nasal Outcomes Test. Lost productivity was assessed by asking participants how many days of work and/or school they missed in the last 3 months due to CRS. Associations were sought between lost productivity and smoking. Participants missed a mean of 3.0 days (standard deviation = 12.8 days) of work or school due to CRS. Having any history of smoking was associated with 6 days of lost productivity due to CRS (adjusted β = 6.20, 95% confidence interval [CI]: 0.64 to 11.77, P = .031). Although the number of active smokers in our study cohort was very small (N = 6), we performed a univariate association between smoking status, considering former smokers and active smokers separately, and found that active smoking (β = 11.75, 95% CI: 2.11 to 21.40, P = .018) had a much larger impact on CRS-related productivity loss than that experienced by former smokers (β = 4.45, 95% CI: -0.32 to 9.23, P = .070). Smoking (likely driven by active smoking) is independently associated with missed days of work or school in patients with CRS. Further study is needed to determine whether interventions directed at smoking may impact CRS-related productivity loss. 2c Laryngoscope, 127:1742-1745, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  6. What drives productivity loss in chronic rhinosinusitis? A SNOT-22 subdomain analysis.

    Science.gov (United States)

    Chowdhury, Naweed I; Mace, Jess C; Smith, Timothy L; Rudmik, Luke

    2018-01-01

    Previous studies have shown declines in productivity due to chronic rhinosinusitis (CRS) are correlated with disease-specific quality-of-life (QOL) measures. However, it is unclear which symptom domains contribute primarily to productivity loss. This investigation sought to assess the association between CRS-specific QOL subdomain impairment and productivity loss. Prospective, multi-institutional, observational cohort study. There were 198 patients with refractory CRS enrolled between August 2012 and June 2015. Baseline QOL measures were obtained across five subdomains of the 22-item SinoNasal Outcome Test (SNOT-22). Lost productivity time was determined from patient-reported measures of annual absenteeism, presenteeism, and lost leisure time, and then monetized using annual daily wage rates from the 2012 US National Census and 2013 Department of Labor statistics. Productivity losses correlated with impairments in both SNOT-22 psychological dysfunction (Spearman correlation coefficient [Rs] = 0.428, P productivity losses (Rs = 0.366, P productivity cost was $11,820/patient, whereas patients with comorbid immunodeficiency ($23,285/patient), tobacco use ($23,195/patient), and steroid dependency ($18,910/patient) reported higher than average annual productivity costs. Multivariate linear regression found maximum annual productivity costs in adjusted psychological ($13,300/patient, P productivity losses. Patients with comorbid immunodeficiency, smoking, and steroid dependency had higher than average productivity losses. Targeted management of psychological and sleep dysfunction in combination with standard symptom control may improve patient-centered care and reduce the annual economic burden of CRS. 2c. Laryngoscope, 128:23-30, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Prevalence of and associations with allergic rhinitis in children with chronic rhinosinusitis.

    Science.gov (United States)

    Sedaghat, Ahmad R; Phipatanakul, Wanda; Cunningham, Michael J

    2014-02-01

    Chronic rhinosinusitis (CRS) in children has been associated with a variety of disorders including atopic disease, cystic fibrosis, immunologic disorders and ciliary dyskinesia. Although a strong association, or even cause and effect relationship, between allergic rhinitis (AR) and CRS is commonly assumed, the epidemiologic relationship between these disorders has not yet been defined in children. A retrospective review of all children diagnosed with CRS on otolaryngology or allergy office evaluation at a large tertiary-care pediatric hospital over a ten-year period was performed. Demographic data and concomitant diagnoses of AR, cystic fibrosis, immunologic disorders and primary ciliary dyskinesia were analyzed for relationships with CRS. A total of 4044 children with an average age of 8.9 years and a slight male predominance (53.8%) with CRS were identified. Of these children, 0.2% had primary ciliary dyskinesia, 4.1% had cystic fibrosis, 12.3% had an immunologic disorder, and 26.9% had AR. A concomitant asthma diagnosis was positively associated with a diagnosis of AR (OR=6.24, 95% CI: 5.27-7.39, P<0.001), whereas a concomitant cystic fibrosis diagnosis was negatively associated (OR=0.12, 95% CI: 0.06-0.26, P<0.001). AR is more prevalent than the other comorbidities combined in children with CRS, and is independently associated with the presence of asthma. Formal allergy testing, guided by clinical history and regional allergen sensitivity prevalence, should be strongly considered in all children with CRS, in particular those with reactive airway disease. Copyright © 2013. Published by Elsevier Ireland Ltd.

  8. Association between systemic antibiotic and corticosteroid use for chronic rhinosinusitis and quality of life.

    Science.gov (United States)

    Yamasaki, Alisa; Hoehle, Lloyd P; Phillips, Katie M; Feng, Allen L; Campbell, Adam P; Caradonna, David S; Gray, Stacey T; Sedaghat, Ahmad R

    2018-01-01

    We sought to establish the significance of querying chronic rhinosinusitis (CRS) patients about their past CRS-related oral antibiotic and corticosteroid usage by determining the association between these metrics and patients' quality of life (QoL). Cross-sectional study. A total of 157 patients with CRS were prospectively recruited. CRS-specific QoL was measured using the 22-item Sinonasal Outcome Test (SNOT-22). General health-related QoL was measured using the EuroQoL five-dimensional questionnaire visual analog scale. Associations were sought between these measures of QoL and frequency of CRS-related oral antibiotic and corticosteroid usage reported by the participants in the prior 3 and 12 months. More frequent antibiotic and corticosteroid use was significantly associated with worse CRS-specific and general health-related QoL, whether querying medication use over the prior 3 months or over the prior 12 months (P antibiotic use during the prior 3 months on CRS-specific QoL (SNOT-22 score) was significantly greater than for use during the prior 12 months. However, there was no other statistically significant difference in effect size for association between QoL and CRS-related antibiotic or corticosteroid use in the prior 3 months versus prior 12 months. These results were independent of the presence or absence of polyps. More frequent past CRS-related oral antibiotic and corticosteroid use, regardless of time period queried (3 months or 12 months) is associated with significant decrease in CRS-specific and general health-related QoL. CRS-related systemic medication use is an important indicator of CRS patients' QOL that easily can be queried and utilized in both clinical and research settings. 2c. Laryngoscope, 128:37-42, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  9. Investigation of change in cardinal symptoms of chronic rhinosinusitis after surgical or ongoing medical management

    Science.gov (United States)

    DeConde, Adam S.; Mace, Jess C.; Alt, Jeremiah A.; Soler, Zachary M.; Orlandi, Richard R.; Smith, Timothy L.

    2014-01-01

    Background Chronic rhinosinusitis (CRS) has been defined as inflammation of the paranasal sinuses lasting at least 12-weeks with corresponding two or more “cardinal symptoms” that includes: 1) nasal obstruction, 2) thick nasal discharge, 3) facial pain/pressure, and 4) reduction or loss of sense of smell. Although prior studies have investigated symptoms of CRS after sinus surgery, none have compared the outcomes of these specific symptoms to on-going medical therapy. Methods Patients with CRS were prospectively enrolled into a multi-institutional, comparative effectiveness, cohort study. Subjects elected either continued medical management or endoscopic sinus surgery (ESS). Baseline characteristics and objective clinical findings were collected. Cardinal symptoms of CRS were operationalized by four questions on the 22-item SinoNasal Outcome Test (SNOT-22). Symptom improvement was evaluated in subjects with at least 6-month follow-up. Results 342 subjects were enrolled with 69 (20.2%) electing continued medical management while 273 (79.8%) elected ESS. Subjects electing surgical therapy were more likely to have a higher baseline aggregate SNOT-22 score (44.3(18.9) vs. 53.6(18.8); p<0.001). All subjects improved across all cardinal symptoms; however, subjects undergoing ESS were significantly more likely (p<0.013) to experience improvement in thick nasal discharge (OR=4.36), facial pain/pressure (OR=3.56), and blockage/congestion of nose (OR=2.76). Subjects with nasal polyposis were significantly more likely to report complete resolution of smell/taste following ESS compare to medical management (23.8% vs. 4.0%; p=0.026). Conclusions Across a large population, surgical management is more effective at resolving the cardinal symptoms of CRS than ongoing medical management with the exception of sense of smell/taste. PMID:25236780

  10. Longitudinal Improvement and Stability of Olfactory Function in the Evaluation of Surgical Management for Chronic Rhinosinusitis

    Science.gov (United States)

    Levy, Joshua M.; Mace, Jess C.; Sansoni, E. Ritter; Soler, Zachary M.; Smith, Timothy L.

    2016-01-01

    BACKGROUND Abnormal olfaction is common with chronic rhinosinusitis (CRS) and associates with various measures of sinonasal inflammation. The Brief Smell Identification Test (BSIT) has demonstrated improvements in abnormal olfactory detection following endoscopic sinus surgery (ESS), but olfaction remains understudied using this instrument. Discerning longitudinal, postoperative durability in olfaction is critical for patient counseling. METHODS Adult participants with medically recalcitrant CRS were prospectively enrolled into a multi-institutional cohort study and observed for 18-months following ESS. Olfaction was operationalized using BSIT scores collected at baseline, 6-months, 12-months, and 18-months postoperatively and compared using repeated measures ANOVA. RESULTS 122 participants met inclusion criteria and were recruited between March, 2011 and February, 2014. Improvement in mean BSIT scores at 6-month follow-up were reported for all participants (p=0.014) with greatest improvement in subjects with nasal polyposis (p=0.001). No differences in mean BSIT scores were found between 6-month and 18-months overall, however subjects with comorbid asthma (F(2)=5.29; p=0.010) and nasal polyposis (F(2)=3.99; p=0.033) reported significant mean worsening. Prevalence of abnormal olfaction decreased from 28% preoperatively to 17% at 6-months (p=0.015), for all subjects, without significant change 12-months (19%; p=0.791) or 18-months (21%; p=0.581) postoperatively. CONCLUSIONS Postoperative improvement in olfaction was reported 6-months after ESS using BSIT scores, with greatest improvements in patients undergoing polypectomy. Overall improvement persisted between 6-month and 18-month following ESS for most patient subgroups, however, dysosmia worsened after initial improvement in patients with asthma and nasal polyps, highlighting the need for further identification of prognostic factors associated with abnormal olfaction in CRS. PMID:27218483

  11. Low SNOT-22 Scores in Chronic Rhinosinusitis: Why do patients seek treatment?

    Science.gov (United States)

    Levy, Joshua M.; Mace, Jess C.; Rudmik, Luke; Soler, Zachary M.; Smith, Timothy L.

    2016-01-01

    Objective Patients with chronic rhinosinusitis (CRS) who experience minimal reductions in quality-of-life (QoL) may present for treatment despite QoL scores comparable to controls without CRS. This study seeks to identify cofactors influencing patients with CRS and low 22-item Sinonasal Outcome Test (SNOT-22) scores to seek care. Study Design Prospective, multi-center, observational cohort. Methods Patients with CRS were enrolled between April 2011 and September 2015. Patients with sinonasal mucocele or unilateral sinus opacification were excluded. Control subjects without CRS were enrolled for comparison. Low-SNOT CRS was defined by a SNOT-22 score<20. Results 774 subjects (“low-SNOT” CRS (n=38); “high-SNOT” CRS (n=641, SNOT-22≥20); controls without CRS (n=95)) were enrolled. Low-SNOT scores were identified in 6% of subjects with CRS. After adjustment, low-SNOT CRS and control groups without CRS report similar baseline average SNOT-22 total scores (p=0.879). Unexpectedly, compared to controls, low-SNOT CRS patients had significantly better average psychological (2.1[2.3] vs. 5.8[6.0]; p=0.030) and sleep dysfunction (2.7[3.4] vs. 6.0[5.2]; p=0.016) scores. 14/38 (37%) low-SNOT patients elected to undergo endoscopic sinus surgery (ESS) with a significantly lower likelihood of reporting a minimal clinically important difference (MCID) when compared to high-SNOT patients (43% vs. 82%; p<0.001) after a mean follow-up of ~15 months. Conclusion Low-SNOT CRS patients represent an outlier population for which measures of QoL fail to identify factors influencing the decision to seek treatment. Low-SNOT CRS patients electing ESS have a decreased likelihood of reporting MCIDs following ESS. Further study is required to identify novel factors associated with treatment seeking behavior in this population. PMID:27377575

  12. Volumetric Computed Tomography Analysis of the Olfactory Cleft in Patients with Chronic Rhinosinusitis

    Science.gov (United States)

    Soler, Zachary M.; Pallanch, John F.; Sansoni, Eugene Ritter; Jones, Cameron S.; Lawrence, Lauren A.; Schlosser, Rodney J.; Mace, Jess C.; Smith, Timothy L.

    2015-01-01

    Background Commonly used computed tomography (CT) staging systems for chronic rhinosinusitis (CRS) focus on the sinuses and do not quantify disease in the olfactory cleft. The goal of the current study was to determine whether precise measurements of olfactory cleft opacification better correlate with olfaction in patients with CRS. Methods Olfaction was assessed using the 40-item Smell Identification Test (SIT-40) before and after sinus surgery in adult patients. Olfactory cleft opacification was quantified precisely using three-dimensional, computerized volumetric analysis, as well as via a semi-quantitative Likert scale estimations at predetermined anatomic sites. Sinus opacification was also quantified using the Lund-Mackay staging system. Results The overall cohort (n=199) included 89 (44.7%) patients with CRS with nasal polyposis (CRSwNP) and 110 (55.3%) with CRS without nasal polyposis (CRSsNP). The olfactory cleft opacified volume correlated with objective olfaction as determined by the SIT-40 (Rs= −0.461; p<0.001). The correlation was significantly stronger in the CRSwNP subgroup (Rs= −0.573; p<0.001), whereas no appreciable correlation was found in the CRSsNP group (Rs= −0.141; p=0.141). Correlations between sinus-specific Lund-Mackay CT scoring and SIT-40 scores were weaker in the CRSwNP (Rs= −0.377; p<0.001) subgroup but stronger in the CRSsNP (Rs= −0.225; p=0.018) group when compared to olfactory cleft correlations. Greater intra-class correlations (ICC) were found between quantitative volumetric measures of olfactory cleft opacification (ICC=0.844; p<0.001) as compared with semi-quantitative Likert grading (ICC=0.627; p<0.001). Conclusions Quantitative measures of olfactory cleft opacification correlate with objective olfaction, with the strongest correlations seen in patients with nasal polyps. PMID:26010298

  13. The impact of bitter taste receptor genetics on culturable bacteria in chronic rhinosinusitis.

    Science.gov (United States)

    Rom, D I; Christensen, J M; Alvarado, R; Sacks, R; Harvey, R J

    2017-03-01

    Extra-oral bitter taste receptors have been associated with innate bacterial defence mechanisms. Genetic variation in T2R38 functionality has been shown to be associated with susceptibility to upper respiratory tract infections and chronic rhinosinusitis (CRS). We sought to independently assess the influence of bitter taste receptor genotype on the presence of culturable bacteria in the sinuses. A cross-sectional analysis of patients with CRS undergoing surgery was performed. Middle meatal nasal swabs were sent for microbiological evaluation at the time of the procedure. Mucosal biopsies were taken and sent for bitter taste receptor genotype analysis. Sequencing of 3 polymorphisms in the TAS2R38 gene was performed to identify genotypes as super-tasters (PAV/PAV), non-tasters (AVI/AVI) or heterozygous expression (PAV/AVI). The presence of culturable organisms and common pathogens were compared with bitter taste receptor genotypes. 25 patients (age 52.4 +/- 18.28 years, 51% female) were assessed. Super-tasters comprised 16% of the group, 24% were non-tasters and 48% had heterozygous expression. A cultured pathogen was grown in 48% of patients; 32% gram-positive, 20% gram-negative, 28% grew Staphylococcus aureus and 12% Pseudomonas aeruginosa. A non-taster genotype was predictive of colonised pathogens. Tissue eosinophilia (more than 10 HPF) was seen in 48%. Even in a small sample of patients with CRS, non-taster T2R38 genotype appears to predict the presence of culturable bacteria colonising the sinus cavity at the time of surgery for their condition. A genetic link to patients more likely to become infected is likely.

  14. The microbiology and the efficacy of antibiotic-based medical treatment of chronic rhinosinusitis in Singapore.

    Science.gov (United States)

    Chin, C W D; Yeak, C L S; Wang, D Y

    2010-12-01

    Medical therapy including appropriate antibiotic treatment is advocated for the management of chronic rhinosinusitis (CRS), with sinus surgery reserved for treatment failures. This study investigates the microbiology of CRS and their response to culture-directed antibiotic treatment. Sinus aspirates of mucopus from 172 consecutive CRS patients, with (n=89) and without (n=83) previous antibiotic treatment, were obtained for bacterial culture at their first visit. Medical treatment which included initial empirical and subsequent culture-directed antibiotics was instituted. Endoscopic sinus surgery (FESS) was performed for patients with persistent CRS and/or complications of CRS. A follow-up of 12 months was scheduled for all patients. One hundred and twenty (69.8%) patients were treated successfully by with antibiotic-based medical therapy. Thirty-eight patients (22.1%) did not respond to medical treatment and eventually underwent FESS. The incidence of CRS with nasal polyps (CRSwNP) was higher in FESS group (n=13, 34.2%) than patients with medical treatment only (n=9, 6.7%). Staphylococcus aureus was the most common pathogen (n=43, 25%) and amongst patients with no prior antibiotic treatment, the incidence was higher in patients with CRSwNP (n=8, 53 %) than CRS without NP (CRSwoNP) (n=20, 27%). The rate of sensitivity of the cultured microbes to amoxicillin with clavulanate and cephalosporins was 78% and 70%, respectively. The microbiology of CRS in Singapore is described. Staphylococcus aureus appears to be the most common bacterial isolates in both CRS with and without nasal polyps. Medical treatment with CRS using culture-directed antibiotics is effective in the majority of patients, especially in patients without nasal polyps.

  15. Transantral, endoscopically guided balloon dilatation of the ostiomeatal complex for chronic rhinosinusitis under local anesthesia.

    Science.gov (United States)

    Stankiewicz, James; Tami, Thomas; Truitt, Theodore; Atkins, James; Liepert, Douglas; Winegar, Bradford

    2009-01-01

    A multicenter study (BREATHE I - Entellus Medical, Inc.) was performed to assess the safety and outcomes of a new, less invasive system that uses direct endoscopic visualization to facilitate balloon dilation of the maxillary sinus ostia and ethmoid infundibulum. General anesthesia was avoided in most subjects to assess feasibility of performing transantral ostial dilatation in an office setting. Subjects with chronic rhinosinusitis of the maxillary sinuses alone or maxillary and anterior ethmoid sinuses underwent baseline evaluation including CT imaging and symptom assessment using the Sino-Nasal Outcome Test (SNOT 20). Subjects underwent transantral balloon dilation and follow-up evaluation at 1 week, 3 months, and 6 months post-procedure. Thirty subjects were treated at three centers. Fifty-five of 58 maxillary ostia were successfully treated for a procedural completion rate of 94.8%. Ninety-seven percent of the procedures were completed under local anesthesia with or without minimal intravenous sedation. There were no device-related serious adverse events or unanticipated adverse device effects. The mean overall SNOT 20 score at baseline was 2.9 +/- 1.0. Mean overall SNOT 20 scores at 1-week, 3-month, and 6-month follow-up were 0.8 +/- 0.8, 0.7 +/- 0.8, and 0.8 +/- 0.9 respectively. Patency at 3-months as confirmed by CT imaging was 95.8%. These results indicate that transantral balloon dilation of the ostiomeatal complex under local anesthesia appears to be a safe technique for managing isolated maxillary or maxillary and anterior ethmoid sinusitis and can potentially be performed safely in an office setting.

  16. Five-year risk of incident disease following a diagnosis of chronic rhinosinusitis.

    Science.gov (United States)

    Hirsch, A G; Yan, X S; Sundaresan, A S; Tan, B K; Schleimer, R P; Kern, R C; Kennedy, T L; Greene, J S; Schwartz, B S

    2015-12-01

    Chronic rhinosinusitis (CRS) has a broad range of comorbidities. Due to a lack of longitudinal studies, it is not known whether these comorbidities cause CRS, are promoted by CRS, or share a systemic disease process with CRS. The objective of this study was to determine the risk of incident disease within 5 years after a new diagnosis of CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). We conducted a case-control study nested within the longitudinal cohort of primary care patients in the Geisinger Clinic using electronic health record data. We evaluated incident disease over 5 years in newly diagnosed CRSwNP and CRSsNP cases compared to controls using multivariable Cox regression models. CRSsNP (n = 3612) cases were at greater risk (HR, 95% confidence interval) than controls for incidence of: upper airway diseases, including adenotonsillitis (3.29, 2.41-4.50); lower aerodigestive tract diseases, including asthma (2.69, 2.14-3.38); epithelial conditions, including atopic dermatitis (2.75, 1.23-6.16); and hypertension (1.38, 1.19-1.61). CRSwNP (n = 241) cases were at greater risk for obesity than controls (1.74, 1.08-2.80), but CRSwNP was not associated with other diseases. The risk of other diseases associated with CRS adds to the burden of an already highly burdensome condition, and suggests either that CRS promotes onset of other diseases or is an indicator of systemic disease processes. Different patterns of association with diseases by CRS phenotype may be due to CRSwNP sample size limitations or reflect a different pattern of disease onset by phenotype. These findings have implications for screening guidelines and care of CRS patients. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Blood Eosinophils and World Trade Center Exposure Predict Surgery in Chronic Rhinosinusitis. A 13.5-Year Longitudinal Study.

    Science.gov (United States)

    Kwon, Sophia; Putman, Barbara; Weakley, Jessica; Hall, Charles B; Zeig-Owens, Rachel; Schwartz, Theresa; Olivieri, Brianne; Singh, Ankura; Huie, Maryann; Morrison, Debra; Webber, Mayris P; Cohen, Hillel W; Kelly, Kerry J; Aldrich, Thomas K; Nolan, Anna; Prezant, David J; Shohet, Michael R; Weiden, Michael D

    2016-08-01

    The World Trade Center (WTC) collapse generated caustic airborne particulates that caused chronic rhinosinusitis in exposed Fire Department of New York firefighters. Surgery was performed when symptoms remained uncontrolled despite medical management. To identify predictors of surgical intervention for chronic rhinosinusitis in firefighters exposed to airborne irritants at the WTC collapse site. We assessed in 8,227 firefighters with WTC exposure between September 11, 2001 (9/11), and September 25, 2001, including WTC-site arrival time, months of rescue and recovery work, and eosinophil concentration measured between 9/11 and March 10, 2003. We assessed the association of serum cytokines and immunoglobulins with eosinophil concentration and surgery for rhinosinusitis in 112 surgical cases and 376 control subjects with serum available from the first 6 months after exposure to the WTC collapse site. Between 9/11 and March 10, 2015, the surgery rate was 0.47 cases per 100 person-years. In the first 18 months post-9/11, surgical patients had higher mean blood eosinophil levels than study cohort patients (219 ± 155 vs. 191 ± 134; P < 0.0001). Increased surgery risk was associated with increasing blood eosinophil counts (hazard ratio [HR], 1.12 per 100 cells/μl; 95% confidence interval [CI], 1.07-1.17; P < 0.001); arriving at the WTC site on 9/11 or September 12, 2001 (HR, 1.43; 95% CI, 1.04-1.99; P = 0.03); and working 6 months or longer at the WTC site (HR, 1.48; 95% CI, 1.14-1.93; P < 0.01). Median blood eosinophil levels for surgical patients were above levels for the cohort in all 18-month intervals March 11, 2000, through March 10, 2015, using 51,163 measurements representing 97,733 person-years of observation. Increasing age, increasing IL-17A, and low IgA in serum from 2001 to 2002 predicted blood eosinophil concentration in surgical patients but not in control subjects (R(2) = 0.26, P < 0.0001; vs. R(2) = 0.008, P = 0

  18. Differentially Regulated Host Proteins Associated with Chronic Rhinosinusitis Are Correlated with the Sinonasal Microbiome

    Directory of Open Access Journals (Sweden)

    Kristi Biswas

    2017-12-01

    Full Text Available The chronic inflammatory nature of chronic rhinosinusitis (CRS makes it a morbid condition for individuals with the disease and one whose pathogenesis is poorly understood. To date, proteomic approaches have been applied successfully in a handful of CRS studies. In this study we use a multifaceted approach, including proteomics (iTRAQ labeling and microbiome (bacterial 16S rRNA gene sequencing analyses of middle meatus swabs, as well as immune cell analysis of the underlying tissue, to investigate the host-microbe interaction in individuals with CRS (n = 10 and healthy controls (n = 9. Of the total 606 proteins identified in this study, seven were significantly (p < 0.05 more abundant and 104 were significantly lower in the CRS cohort compared with healthy controls. The majority of detected proteins (82% of proteins identified were not significantly correlated with disease status. Elevated levels of blood and immune cell proteins in the CRS cohort, together with significantly higher numbers of B-cells and macrophages in the underlying tissue, confirmed the inflammatory status of CRS individuals. Protein PRRC2C and Ras-related protein (RAB14 (two of the seven elevated proteins showed the biggest fold difference between the healthy and CRS groups. Validation of the elevated levels of these two proteins in CRS samples was provided by immunohistochemistry. Members of the bacterial community in the two study cohorts were not associated with PRRC2C, however members of the genus Moraxella did correlate with RAB14 (p < 0.0001, rho = −0.95, which is a protein involved in the development of basement membrane. In addition, significant correlations between certain members of the CRS bacterial community and 33 lower abundant proteins in the CRS cohort were identified. Members of the genera Streptococcus, Haemophilus and Veillonella were strongly correlated with CRS and were significantly associated with a number of proteins with varying functions. The

  19. Limited evidence: higher efficacy of nasal saline irrigation over nasal saline spray in chronic rhinosinusitis: an update and reanalysis of the evidence base

    NARCIS (Netherlands)

    van den Berg, J.W.G.; de Nier, L.M.; Kaper, N.M.; Schilder, A.G.M.; Venekamp, R.P.; Grolman, W.; van der Heijden, G.J.M.G.

    2014-01-01

    OBJECTIVE: To assess the effectiveness of nasal saline irrigation in adult patients with chronic rhinosinusitis. DATA SOURCES: PubMed, EMBASE, the Cochrane Library. REVIEW METHODS: A comprehensive search was performed, and 2 authors independently screened publications. The design of selected studies

  20. Group 2 innate lymphoid cells are elevated and activated in chronic rhinosinusitis with nasal polyps.

    Science.gov (United States)

    Poposki, Julie A; Klingler, Aiko I; Tan, Bruce K; Soroosh, Pejman; Banie, Homayon; Lewis, Gavin; Hulse, Kathryn E; Stevens, Whitney W; Peters, Anju T; Grammer, Leslie C; Schleimer, Robert P; Welch, Kevin C; Smith, Stephanie S; Conley, David B; Raviv, Joseph R; Karras, James G; Akbari, Omid; Kern, Robert C; Kato, Atsushi

    2017-09-01

    Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) is characterized by type 2 inflammation with high levels of Th2 cytokines. Although T helper cytokines are released from T cells, innate lymphoid cells (ILC) are also known to produce high levels of the same cytokines. However, the presence of various types of ILC in CRS is poorly understood. The objective of this study was to fully characterize the presence of all ILC subsets in CRS and to identify phenotypical differences of group 2 ILC (ILC2) in CRSwNP compared to ILC2 from non-type 2 inflamed areas. We investigated the presence of ILC subsets in peripheral blood mononuclear cells (PBMC) from healthy subjects, tonsil tissue, ethmoid tissue from control subjects and patients with non-polypoid CRS (CRSsNP) and CRSwNP, as well as nasal polyp (NP) tissue from CRSwNP by flow cytometry. Sorted ILC2 were cultured in the presence and absence of IL-33 and production of IL-5 and IL-13 was assessed by Luminex. We found that all ILC subsets were present in NP but ILC2 were dominant and significantly elevated compared to PBMC, tonsil, CRSsNP, and normal sinus tissue. We also found that inducible T-cell co-stimulator (ICOS) and side scatter were increased and CD127 was down-regulated in ILC2 from NP compared to blood or tonsil ILC2. Thymic stromal lymphopoietin, IL-7, and IL-33 were able to down-regulate expression of CD127 and increase side scatter in blood ILC2. Furthermore, sorted NP ILC2 but not blood ILC2 spontaneously released type 2 cytokines including IL-5 and IL-13. These results suggest that ILC2 are not only elevated but also activated in CRSwNP in vivo and that ILC2 may play important roles in the type 2 inflammation in CRSwNP. © 2017 The Authors. Immunity, Inflammation and Disease Published by John Wiley & Sons Ltd.

  1. Elevated presence of myeloid dendritic cells in nasal polyps of patients with chronic rhinosinusitis

    Science.gov (United States)

    Poposki, Julie A.; Peterson, Sarah; Welch, Kate; Schleimer, Robert P.; Hulse, Kathryn E.; Peters, Anju T.; Norton, James; Suh, Lydia A.; Carter, Roderick; Harris, Kathleen E.; Grammer, Leslie C.; Tan, Bruce K.; Chandra, Rakesh K.; Conley, David B.; Kern, Robert C.; Kato, Atsushi

    2015-01-01

    Background Although chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by Th2 inflammation, the mechanism underlying the onset and amplification of this inflammation has not been fully elucidated. Dendritic cells (DCs) are major antigen presenting cells, central inducers of adaptive immunity and critical regulators of many inflammatory diseases. However, the presence of DCs in CRS, especially in nasal polyps (NPs), has not been extensively studied. Objective The objective of this study was to characterize DC subsets in CRS. Methods We used real-time PCR to assess the expression of mRNA for markers of myeloid DCs (mDCs; CD1c), plasmacytoid DCs (pDCs; CD303) and Langerhans cells (LCs; CD1a, CD207) in uncinate tissue (UT) from controls and patients with CRS as well as in NP. We assayed the presence of DCs by immunohistochemistry and flow cytometry. Results Compared to UT from control subjects (n=15) and patients with CRS without NP (CRSsNP) (n=16) and CRSwNP (n=17), mRNAs for CD1a and CD1c were significantly elevated in NPs (n=29). In contrast, CD207 mRNA was not elevated in NPs. Immunohistochemistry showed that CD1c+ cells but not CD303+ cells were significantly elevated in NPs compared to control subjects or patients with CRSsNP. Flow cytometric analysis showed that CD1a+ cells in NPs might be a subset of mDC1s, and that CD45+CD19-CD1c+CD11c+CD141-CD303-HLA-DR+ mDC1s and CD45+CD19-CD11c+CD1c-CD141high mDC2s were significantly elevated in NPs compared to UT from controls and CRSsNP, but CD45+CD11c-CD303+HLA-DR+ pDCs were only elevated in NPs compared to control UT. Conclusion & Clinical Relevance Myeloid DCs are elevated in CRSwNP, especially in NPs. Myeloid DCs thus may indirectly contribute to the inflammation observed in CRSwNP. PMID:25469646

  2. Comparative effectiveness of medical and surgical therapy on olfaction in chronic rhinosinusitis: a prospective, multi-institutional study

    Science.gov (United States)

    DeConde, Adam S.; Mace, Jess C.; Alt, Jeremiah A.; Schlosser, Rodney J.; Smith, Timothy L.; Soler, Zachary M.

    2014-01-01

    Background Evidence comparing the impact of medical and surgical management of chronic rhinosinusitis on olfactory function is limited. This study evaluates olfactory outcomes in patients who failed initial medical management and elect either continued medical management or endoscopic sinus surgery (ESS) followed by medical management. Methods Adult subjects were prospectively enrolled into a non-randomized, multi-institutional cohort. Baseline characteristics, quality-of-life and objective clinical findings were collected along with two quality-of-life disease-specific measures, the Rhinosinusitis Disability Index (RSDI) and Sinonasal Outcome Test (SNOT-22). The primary outcome measure was the post-treatment change (≥6 months) in the Brief Smell Identification Test (B-SIT). Bivariate and multivariate analyses compared B-SIT changes by treatment type while controlling for baseline cofactors. Results Subjects (n=280) were enrolled between March, 2011 and May, 2013. Baseline B-SIT scores were comparable between medical and surgical treatment groups (8.8(3.2) vs 9.0(3.2); p=0.703). Subjects with baseline impaired olfaction (n=83; 29.6%) experienced mean B-SIT improvement in both the medical (n=17, 2.3(2.8), p=0.005) and surgical (n=66, 2.1(3.0), p0.050). Conclusion Subjects electing ESS experienced gains in olfaction comparable to subjects electing continued medical management. Further study with larger sample size and more sensitive measures of olfaction are needed to determine differences between treatment groups. PMID:25044658

  3. Diagnostic Utility of Urinary LTE4 in Asthma, Allergic Rhinitis, Chronic Rhinosinusitis, Nasal Polyps, and Aspirin Sensitivity.

    Science.gov (United States)

    Divekar, Rohit; Hagan, John; Rank, Matthew; Park, Miguel; Volcheck, Gerald; O'Brien, Erin; Meeusen, Jeffrey; Kita, Hirohito; Butterfield, Joseph

    2016-01-01

    Urinary leukotriene E4 (LTE4) is a well-validated marker of the cysteinyl leukotriene pathway, and LTE4 elevation has been described in conditions such as asthma, aspirin sensitivity, and chronic rhinosinusitis (CRS). There have been a number of reports investigating the role of spot urine LTE4 to predict aspirin sensitivity; however, variability in urinary LTE4 may affect the accuracy of this approach. Here, we explored the utility of 24-hour urinary LTE4 in 5 clinical diagnoses of allergic rhinitis, asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), CRS without nasal polyps, and aspirin sensitivity. This was a retrospective review of patients who had 24-hour quantification of urinary LTE4 by a clinically validated liquid chromatography tandem mass spectrometry method and their assigned diagnoses after assessment and clinical care. Twenty-four-hour urinary LTE4 elevations were seen in those with asthma and those with CRSwNP but influenced by underlying aspirin sensitivity. Elevation in LTE4 was significant in those with CRSwNP after adjusting for aspirin sensitivity. Allergic rhinitis was not associated with elevated LTE4 excretion. Receiver operator characteristic analysis of 24-hour urinary LTE4 showed that a cutoff value of 166 pg/mg Cr suggested the presence of history of aspirin sensitivity with 89% specificity, whereas a cutoff value of 241 pg/mg Cr discriminated "challenge-confirmed" aspirin-sensitive subjects with 92% specificity. Elevated 24-hour excretion of urinary LTE4 is a reliable and simple test to identify aspirin sensitivity in patients with respiratory diagnoses. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  4. Exhaled and nasal nitric oxide in chronic rhinosinusitis patients with nasal polyps in primary care

    DEFF Research Database (Denmark)

    Frendø, M; Håkansson, K; Schwer, S

    2018-01-01

    were enrolled. Expiratory and nasal NO measurements and thorough pulmonary evaluation were performed. Pulmonary disease was diagnosed by a respiratory physician. RESULTS: Fifty-nine percent of CRSwNP patients with asthma showed elevated expiratory NO; the same was seen in 29% of non-asthmatic CRSw...

  5. Update on Intranasal Medications in Rhinosinusitis.

    Science.gov (United States)

    Snidvongs, Kornkiat; Thanaviratananich, Sanguansak

    2017-07-01

    This review describes beneficial effects and adverse events of various intranasal medications in treating rhinosinusitis. Application of intranasal steroids has been described in treating all subtypes of adult rhinosinusitis, but reports are limited in pediatrics and mostly in acute pediatric subgroups resulted in benefits While saline irrigation is effective for patients with chronic rhinosinusitis without polyps and in pediatric acute rhinosinusitis, there is no evidence yet for saline drips and sprays. Application of intranasal antifungals and nasal irrigation with surfactant brings more harm than benefits. There is no evidence supporting the use of intranasal antibiotics. We also review influence of devices, methods, and patient head position on nasal and paranasal sinus drug delivery.

  6. Quality of Life in Patients with Chronic Rhinosinusitis with Nasal Polyposis Before and After Functional Endoscopic Sinus Surgery: A Study Based on SINO-NASAL OUTCOME TEST

    Directory of Open Access Journals (Sweden)

    Mehrnoosh Musavi Aghdas

    2018-02-01

    Full Text Available Background: Chronic rhinosinusitis is one of the most common diseases in the world. The high prevalence and chronicity of disease increasing burden of disease. Burden of this disease, productivity and the quality of life of patients decreased. The aim of this study was to evaluate the effect of endoscopic sinus surgery on the quality of life of patients with chronic rhinosinusitis with nasal polyposis. Method: This prospective study was performed on 59 patients suffering chronic rhinosinusitis with nasal polyposis referring to ENT clinic of educational hospital of Tabriz University of medical sciences during 2015 to 2017. These patients underwent Endoscopic Sinus Surgery as treatment. For all patients, SINO-NASAL OUTCOME (TEST (SNOT-22 was completed before and twelve months after surgery. Results:  Fifty-nine patients were enrolled in this study. 21 were female (35.6% and 38 were male (64.40%. The mean age of the studied population was 40.88 ± 16.11 years. The mean score of the preoperative score was 59.38 ± 5.84 and the mean score of the postoperative score was 24.01 ± 10.48. The results of the statistical analysis showed that endoscopic surgery reduced The SNOT-22 questionnaire score is significant. (P < 0.000. The results of the test showed that the increase in preoperative score increases the gain after surgery. (Spearman correlation coefficient: 0.419 and P: 0.001 Conclusion: Endoscopic sinus surgery seems to improve the symptoms and quality of Life in patients with chronic rhinosinusitis.

  7. Nasal obstruction has a limited impact on sleep quality and quality of life in patients with chronic rhinosinusitis.

    Science.gov (United States)

    Thomas, Andrew J; Orlandi, Richard R; Ashby, Shaelene; Mace, Jess C; Smith, Timothy L; Alt, Jeremiah A

    2016-09-01

    Nasal obstruction is a cardinal symptom in diagnosing chronic rhinosinusitis (CRS), and decreased sleep quality (SQ) and quality of life (QOL) are commonly reported in CRS. It is, however, unclear what role nasal obstruction severity plays in this decreased SQ and QOL. Using validated instruments, we evaluated the relationship between nasal obstruction severity, SQ, and QOL. Prospective case series. Patients with CRS refractory to standard medical therapy (n = 28) were prospectively enrolled and completed the Nasal Obstruction Symptom Evaluation (NOSE), Pittsburg Sleep Quality Index (PSQI), Rhinosinusitis Disability Index, and the 22-item Sinonasal Outcome Test. CRS disease severity was evaluated with computed tomography and endoscopy. NOSE scores were compared to SQ, QOL, and disease severity measures. Spearman correlations were used to identify significant associations between measures. All patients reported symptomatic nasal obstruction (NOSE score ≥ 30), whereas poor sleep (PSQI ≥ 5) was reported by 82%. The NOSE sleeping subdomain correlated strongly with the PSQI total score, whereas other elements of the NOSE instrument correlated weakly or not at all with this measurement of SQ. Nasal obstruction correlated weakly with disease-specific QOL and had no correlation with the PSQI total. Nasal obstruction appears to have a limited association with CRS-specific QOL and CRS-associated decrease in SQ. Further, the NOSE instrument, because it contains a question about sleep, may have overlap with the PSQI as a measure of SQ. The total NOSE score in CRS patients does not appear to be purely a measure of nasal obstruction. 4 Laryngoscope, 126:1971-1976, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  8. Demography, types, outcome and relationship of surgically treated intracranial suppuration complicating chronic suppurative otitis media and bacterial rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Olufemi Emmanuel Idowu

    2014-01-01

    Full Text Available Introduction: Surgically treated intracranial suppurations (ICS are uncommon, life-threatening neurosurgical emergencies. They can result from complication of chronic suppurative otitis media (CSOM and bacterial rhinosinusitis (BRS. The objective of this study was to know the frequency of BRS and CSOM and relate it to its rare complication of surgically treated ICS while also describing the demography, type and outcome of ICS that resulted from BRS and CSOM. Materials and Methods: All patients that presented to the Otorhinolaryngological department and Neurosurgical unit of the same institution with clinical and radiological features of CSOM, BRS, and ICS were prospectively studied over a 5-year period. Patients were followed up for a minimum of 3 months. Results: Two thousand, two hundred and seventy-nine patients presented during the 5-year study period. Of all these patients, 1511 had CSOM (66.3% and 768 (33.7% presented with features of BRS. Eleven (0.73% had ICS complicating their CSOM while 8 (1.04% cases of surgically treated ICS followed BRS. Bacterial rhinosinusitis was not more likely to lead to ICS (P = 0.4348. The Odds ratio (OR of a child ≤ 18 years of age with CSOM developing ICS was 5.24 (95% Confidence interval 1.13-24.34; P = 0.0345, while it was 7.60 (95% Confidence interval 1.52-37.97; P = 0.0134 for children with BRS. Conclusions: The most common type of ICS complicating CSOM and BRS was brain abscess and subdural empyema, respectively. Children are more prone to develop surgical ICS following CSOM and BRS. The proportion of males that had ICS was higher in both CSOM and BRS patients. Optimal outcome is achieved in patients that presented with GCS of 13 and above.

  9. The effect of smoking on CT score, bacterial colonization and distribution of inflammatory cells in the upper airways of patients with chronic rhinosinusitis.

    Science.gov (United States)

    Uhliarova, Barbora; Adamkov, Marian; Svec, Martin; Calkovska, Andrea

    2014-06-01

    The study was designed to determine whether smoking affects CT score, bacterial colonization of the upper airways and distribution of inflammatory cells in nasal mucosa in patients with chronic rhinosinusitis. Sixty-four patients were enrolled in the prospective study. We characterized differences in CT score, rate of revision surgery, differences in bacterial colonization in the middle nasal meatus and distribution of inflammatory cells in nasal tissue in smoking and non-smoking patients with chronic rhinosinusitis with nasal polyps (CRSwNP), chronic rhinosinusitis without nasal polyps (CRSsNP) and control group. Direct tobacco use was associated with significantly more severe form of the disease according to the preoperative CT investigation of paranasal sinuses using Lund-Mackay scoring system in both CRSwNP (p = 0.035) and CRSsNP (p = 0.023) groups. More intense colonization of upper-respiratory tract by the pathogenic bacteria in smokers compared to non-smokers was found. Non-pathogenic bacterial flora was more often present in non-smokers compared to smokers. Plasma cells and lymphocytes were the most numerous cells in nasal tissue in all three groups. In smokers with presence of pathogenic bacteria in middle nasal meatus there was stronger neutrophil (p = 0.002) and macrophage infiltration (p = 0.044) in CRSsNP group. Tobacco smoke exposure is related to higher Lund-Mackay score, increased colonization by pathogenic bacteria and lower incidence of commensals in middle nasal meatus, but does not influence cell distribution in nasal mucosa in patients with chronic rhinosinusitis.

  10. Does the Timing of Middle Turbinate Resection Influence Quality-of-Life Outcomes for Patients with Chronic Rhinosinusitis?

    Science.gov (United States)

    Scangas, George A; Remenschneider, Aaron K; Bleier, Benjamin S; Holbrook, Eric H; Gray, Stacey T; Metson, Ralph B

    2017-11-01

    Objective To evaluate the impact of bilateral middle turbinate resection (BMTR) on patient-reported quality of life following primary and revision endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Study Design Prospective cohort study. Setting Tertiary care center. Subjects and Methods Patients with CRS who were recruited from 11 otolaryngologic practices completed the Sino-Nasal Outcome Test-22, Chronic Sinusitis Survey, and EuroQol 5-Dimension questionnaires at baseline, as well as 3 and 12 months after ESS. In the primary ESS cohort (n = 406), patients who underwent BMTR (n = 78) at the time of surgery were compared with patients (n = 328) whose middle turbinates were preserved. In the revision ESS cohort (n = 363), a similar comparison was made between patients who did (n = 64) and did not (n = 299) undergo BMTR. Results Sino-Nasal Outcome Test-22, Chronic Sinusitis Survey, and EuroQol 5-Dimension scores showed similar improvements for both the turbinate resection and preservation cohorts at 3 months ( P affect clinical outcomes at any time point. Conclusion Patients who underwent BMTR during primary and revision sinus surgery reported similar benefits in quality-of-life outcomes 1 year after surgery. In select patients undergoing revision sinus surgery, the performance of BMTR results in improved disease-specific quality of life.

  11. Liposomal Nasal Spray versus Guideline-Recommended Steroid Nasal Spray in Patients with Chronic Rhinosinusitis: A Comparison of Tolerability and Quality of Life

    Directory of Open Access Journals (Sweden)

    Anna Eitenmüller

    2014-01-01

    Full Text Available Objective. To investigate the tolerability and impact on quality of life of liposomal nasal spray compared to guideline-recommended steroid-based therapy in patients with chronic rhinosinusitis. Symptom reduction and use of antisymptomatic medication were also examined. Methods. In this monocenter, prospective, controlled, open, and noninterventional study, 60 patients with chronic rhinosinusitis were treated with liposomal nasal spray and 30 patients received steroid-based therapy. The study comprised five visits occurring at intervals of two to four weeks. Efficacy was determined according to the sinusitis symptom score documented daily. The polyp score was recorded at the initial and final visits. Tolerability was determined through the Nasal Spray Evaluation Questionnaire, and quality of life was ascertained with the SNOT-20 Score. Results. Both treatments achieved a significant reduction of sinusitis symptoms (P<0.05 and also rhinoscopic improvement (P<0.05. The majority of patients assessed the treatments as “good” or “very good,” and the quality of life improved significantly (P<0.05. There was no significant difference in symptom reduction, QoL, and endoscopic exams between both treatments. Conclusion. The treatment of chronic rhinosinusitis with liposomal nasal spray results in a similar, significant reduction of symptoms and significant improvement in quality of life as guideline-recommended treatment and is therefore a comparable alternative.

  12. Functional endoscopic sinus surgery improves the quality of life in children suffering from chronic rhinosinusitis with nasal polyps.

    Science.gov (United States)

    Fetta, Melina; Tsilis, Nikolaos S; Segas, John V; Nikolopoulos, Thomas P; Vlastarakos, Petros V

    2017-09-01

    To evaluate the impact of FESS in children with chronic rhinosinusitis with nasal polyps, regarding their overall postoperative quality-of-life (QoL) and constituent QoL domains. Potential differences between cystic fibrosis (CF) sufferers and non-sufferers, or cases with recurrent sinonasal polyposis versus single-operations were also explored. 39 children were studied. The mean patient age was 10.9 years; four children suffered from cystic fibrosis. The children (or parents) completed the Glasgow Benefit Inventory for Children (GCBI) at least six months after their operation. The Mann-Whitney test compared the GCBI scores between non- and CF sufferers, as well as children with and without recurrent polyposis. The median overall QoL score was 98. There were no statistically significant differences between CF sufferers and non-sufferers regarding their overall QoL, or the respective individual QoL domains, apart from their physical postoperative activity (p = 0.04). Twelve children demonstrated recurrent polyposis (30.7%); among them three were cystic fibrosis sufferers. No statistically significant differences were identified in the overall QoL score, or individual GCBI subscale scores between children with recurrent polyposis versus single-operations. Children with recurrent polyposis but not CF performed better regarding their overall QoL (p = 0.021) and medical status (p = 0.015), compared to their CF counterparts. FESS performed for chronic rhinosinusitis with nasal polyps in children is associated with improved postoperative QoL, irrespective of the presence of CF (although the latter needs to be confirmed in larger patient cohorts). The absence of appreciable differences in the overall QoL, or its constituent domains, between single and re-operated children, indicate that the positive effect of FESS outweighed the burden of re-operation. Appropriate preoperative informed consent in cases of recurrent sinonasal polyposis necessitates acknowledging worse

  13. Microparticles in nasal lavage fluids in chronic rhinosinusitis: Potential biomarkers for diagnosis of aspirin-exacerbated respiratory disease.

    Science.gov (United States)

    Takahashi, Toru; Kato, Atsushi; Berdnikovs, Sergejs; Stevens, Whitney W; Suh, Lydia A; Norton, James E; Carter, Roderick G; Harris, Kathleen E; Peters, Anju T; Hulse, Kathryn E; Grammer, Leslie C; Welch, Kevin C; Shintani-Smith, Stephanie; Tan, Bruce K; Conley, David B; Kern, Robert C; Bochner, Bruce S; Schleimer, Robert P

    2017-09-01

    Microparticles (MPs) are submicron-sized shed membrane vesicles released from activated or injured cells and are detectable by flow cytometry. MP levels have been used as biomarkers to evaluate cell injury or activation in patients with pathological conditions. We sought to compare MP types and levels in nasal lavage fluids (NLFs) from controls and patients with chronic rhinosinusitis without nasal polyps (CRSsNP), chronic rhinosinusitis with nasal polyps (CRSwNP), and aspirin-exacerbated respiratory disease (AERD). We collected NLFs from patients with CRSsNP (n = 33), CRSwNP (n = 45), and AERD (n = 31) and control (n = 24) subjects. Standardized flow cytometry methods were used to characterize the following MP types: endothelial MPs, epithelial MPs (epithelial cell adhesion molecule [EpCAM](+)MPs, E-cadherin(+)MPs), platelet MPs (CD31(+)CD41(+)MPs), eosinophil MPs (EGF-like module-containing mucin-like hormone receptor-like 1[EMR1](+)MPs), mast cell MPs (high-affinity IgE receptor [FcεRI](+)c-kit(+)MPs), and basophil MPs (CD203c(+)c-kit(-)MPs). Basophil activation was evaluated by the mean fluorescence intensity of CD203c on basophil MPs. Activated mast cell MPs (CD137(+) FcεRI(+)c-kit(+)MPs) were significantly increased in NLFs of controls compared with NLFs of patients with CRSsNP (2.3-fold; P < .02), CRSwNP (2.3-fold; P < .03), and AERD (7.4-fold; P < .0001). Platelet MPs (3.5-fold; P < .01) and basophil MPs (2.5-fold; P < .05) were increased only in patients with AERD. Mean fluorescence intensity of CD203c on MPs was increased in patients with CRSwNP (P < .002) and AERD (P < .0001), but not in patients with CRSsNP. EpCAM(+)MPs in patients with CRSwNP were no different from control (P = .91) and lower than those in patients with CRSsNP (P < .02) and AERD (P < .002). Based on released MPs, mast cells, platelets, and basophils were more highly activated in patients with AERD than in patients with CRS. Epithelial injury was lower in

  14. Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis - A EUFOREA-ARIA-EPOS-AIRWAYS ICP statement

    DEFF Research Database (Denmark)

    Hellings, P W; Fokkens, W J; Bachert, C

    2017-01-01

    approach for individuals suffering from chronic disabling conditions. Given the emerging data on the impact of patient stratification on treatment outcomes, European and American regulatory bodies support the principles of PM and its potential advantage over current treatment strategies. The aim...... of the current document was to propose a consensus on the position and gradual implementation of the principles of PM within existing adult treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS). At the time of diagnosis, prediction of success of the initiated treatment and patient...

  15. Sinonasal anatomic variants and asthma are associated with faster development of chronic rhinosinusitis in patients with allergic rhinitis.

    Science.gov (United States)

    Sedaghat, Ahmad R; Gray, Stacey T; Chambers, Kyle J; Wilke, Claus O; Caradonna, David S

    2013-09-01

    Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are a major burden to the healthcare system. Although no causal relationship has been established, previous work has demonstrated a strong association of AR with CRS. In this study, we sought to identify risk factors that may influence speed of development of CRS in patients with AR. Retrospective review of all patients diagnosed with AR without CRS presenting to an otolaryngology clinic at a tertiary medical center as part of a multidisciplinary allergy evaluation between March 2004 and November 2011. Medical records were evaluated for clinicodemographic factors including age, gender, smoking history, medical comorbidities, categories of AR based on formal allergy testing, the presence of sinonasal anatomic variants on computed tomography as well as subsequent development of CRS. Faster progression to CRS in patients with AR was associated with comorbid asthma (hazard ratio [HR] = 3.97) as well as sinonasal anatomic variants, such as infraorbital cells (HR = 7.39), and frontal intersinus cells (HR = 68.03), on multivariate survival analysis. A statistically significant but negative interaction between infraorbital cells and frontal intersinus cells suggests that concomitant presence of both leads to a less than additive increase in the rate of CRS progression. Sinonasal anatomical variants, infraorbital cells, and frontal intersinus cells, as well as comorbid asthma are associated with faster development of CRS in patients with AR. The presence of these clinical risk factors identifies patients who should be counseled on compliance with medical therapy for AR. © 2013 ARS-AAOA, LLC.

  16. Smell impairment in chronic rhinosinusitis – evaluation of endoscopic sinus surgery results and review of literature concerning olfactory function predictors.

    Science.gov (United States)

    Szaleniec, Joanna; Wróbel, Agnieszka; Stręk, Paweł; Kowalczyk, Monika; Bylica, Ewa; Przeklasa, Maria; Żyła, Małgorzata; Składzień, Jacek

    2015-01-01

    Endoscopic sinus surgery (ESS) is the treatment of choice for patients with chronic rhinosinusitis (CRS) refractory to medical therapy. ESS successfully reduces most symptoms of CRS, but its effect on olfaction is always uncertain. The aim of this study was to assess the influence of sinus surgery on olfaction and to analyze the predictors of olfactory function before and after ESS in the context of a literature review. The study group comprised of 153 patients with CRS refractory to medical treatment. The patients evaluated their olfactory function before ESS, 3-6 months after ESS (121 individuals) and 12 months after ESS (58 individuals). Statistical analysis concerned the postoperative olfactory improvement as well as the influence of various predictors on the impairment of smell before and after surgery. Olfactory dysfunction was significantly reduced after ESS. The smell impairment before and after surgery depended on different predictors. Patients with severe preoperative olfactory dysfunction and extensive pathological changes in the nose and sinuses, including nasal polyps, reported most pronounced improvement after ESS. However, severely hyposmic subjects with nasal polyposis, asthma or aspirin intolerance as well as older patients reported worse postoperative smell scores.

  17. Contemporary management of chronic rhinosinusitis with nasal polyposis in aspirin exacerbated respiratory disease: an evidence-based review with recommendations

    Science.gov (United States)

    Levy, Joshua M.; Rudmik, Luke; Peters, Anju T.; Wise, Sarah K.; Rotenberg, Brian W.; Smith, Timothy L.

    2016-01-01

    Background Chronic rhinosinusitis (CRS) in aspirin exacerbated respiratory disease (AERD) represents a recalcitrant form of sinonasal inflammation for which a multidisciplinary consensus on patient management has not been reached. Several medical interventions have been investigated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the multidisciplinary management of CRS in AERD. Methods A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria included: adult population>18 years old; CRS based on published diagnostic criteria and a presumptive diagnosis of AERD. We focused on reporting higher-quality studies (level 2 or higher) when available, but reported lower-quality studies if the topic contained insufficient evidence. Treatment recommendations were based on American Academy of Otolaryngology guidelines, with defined grades of evidence and evaluation of research quality and risk/benefits associated with each treatment. Results This review identified and evaluated the literature on 3 treatment strategies for CRS in AERD: dietary salicylate avoidance, leukotriene modification and desensitization with daily aspirin therapy. Conclusion Based on the available evidence, dietary salicylate avoidance and leukotriene modifying drugs are options following appropriate treatment with nasal corticosteroids and saline irrigation. Desensitization with daily aspirin therapy is recommended following revision ESS. PMID:27480830

  18. Rhinosinusitis associated with post-dental extraction chronic oroantral fistula: outcomes of non-surgical management comprising antibiotics and local decongestion therapy.

    Science.gov (United States)

    Mishra, A K; Sinha, V R; Nilakantan, A; Singh, D K

    2016-06-01

    A non-surgical approach for managing rhinosinusitis associated with chronic oroantral fistula resulting from tooth extraction was evaluated. Twenty-six consecutive patients (15 males and 11 females) aged 28-72 years (mean, 49.81 years) were administered local decongestion therapy for 2 weeks and antibiotics for 10 days. Patients showing a reduction in Sino-Nasal Outcome Test 22 scores after two weeks continued to receive local decongestion therapy weekly for up to six weeks, while those not showing any improvement underwent surgical management. At 2 weeks, 17 patients (65.38 per cent) showed an improvement in rhinosinusitis (33.39 per cent mean reduction in Sino-Nasal Outcome Test 22 scores). The primary determinant of response was fistula size. At 6 weeks, sinusitis resolved completely in all 17 patients, and the fistula closed in 16 of these. Final Sino-Nasal Outcome Test 22 and Lund-Mackay scores showed no significant difference between the surgically treated and non-surgically treated groups. Local decongestion therapy along with antibiotics may promote resolution in this subset of rhinosinusitis patients.

  19. European Position Paper on Rhinosinusitis and Nasal Polyps 2012.

    Science.gov (United States)

    Fokkens, Wytske J; Lund, Valerie J; Mullol, Joachim; Bachert, Claus; Alobid, Isam; Baroody, Fuad; Cohen, Noam; Cervin, Anders; Douglas, Richard; Gevaert, Philippe; Georgalas, Christos; Goossens, Herman; Harvey, Richard; Hellings, Peter; Hopkins, Claire; Jones, Nick; Joos, Guy; Kalogjera, Livije; Kern, Bob; Kowalski, Marek; Price, David; Riechelmann, Herbert; Schlosser, Rodney; Senior, Brent; Thomas, Mike; Toskala, Elina; Voegels, Richard; Wang, De Yun; Wormald, Peter John

    2012-03-01

    The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007.The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps and chronic rhinosinusitis with nasal polyps are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed.

  20. Chronic rhinosinusitis with nasal polyps is characterized by B-cell inflammation and EBV-induced protein 2 expression

    Science.gov (United States)

    Hulse, Kathryn E.; Norton, James E.; Suh, Lydia; Zhong, Qiu; Mahdavinia, Mahboobeh; Simon, Patrick; Kern, Robert C.; Conley, David B.; Chandra, Rakesh K.; Tan, Bruce K.; Peters, Anju T.; Grammer, Leslie C.; Harris, Kathleen E.; Carter, Roderick G.; Kato, Atsushi; Schleimer, Robert P.

    2013-01-01

    Background Despite the high prevalence and morbidity of chronic rhinosinusitis (CRS), little is known about the mechanisms that underlie its pathogenesis. Recent studies have suggested that B cells might play an important role in CRS. Objective We sought to thoroughly characterize B lineage cells within sinus tissues of patients with CRS and healthy control subjects and to determine whether levels of EBV-induced protein 2, which is known to play an important role in the development of B-cell responses, were increased in patients with CRS. Methods Cells isolated from sinus tissues of patients with CRS and healthy control subjects were characterized by means of flow cytometry and immunohistochemistry. Local production of antibodies was measured in tissue extracts, nasal lavage fluid, and sera by using multiplex bead arrays and ELISA. Quantitative RT-PCR, ELISA, and Western blotting were used to assess gene and protein expression from tissue extracts. Results Nasal polyps (NPs) from patients with CRS had increased levels of both B cells and plasma cells compared with uncinate tissue from healthy control subjects (P < .05). NPs also contained significantly increased levels of several antibody isotypes compared with normal uncinate tissue (P < .05), but no differences in circulating antibody levels were found. Interestingly, levels of EBV-induced protein 2 were also increased in NPs (P < .05) and were positively correlated with expression of plasma cell markers (CD138 and B lymphocyte–induced maturation protein) in sinus tissue. Conclusion B cells and plasma cells are enriched in NPs, actively produce antibodies locally, and might contribute to chronic inflammation in patients with CRS. Elucidating the mechanisms that underlie this excessive local B-cell response might provide novel insights for the development of improved therapeutic strategies. PMID:23473835

  1. Longitudinal improvement and stability of the SNOT-22 survey in the evaluation of surgical management of chronic rhinosinusitis

    Science.gov (United States)

    DeConde, Adam S.; Mace, Jess C.; Alt, Jeremiah A.; Rudmik, Luke; Soler, Zachary M.; Smith, Timothy L.

    2015-01-01

    Background Patients with chronic rhinosinustis (CRS) have significant quality-of-life (QOL) improvements following endoscopic sinus surgery (ESS). These improvements remain stable and persist between 6-months and 20-months as measured by the Rhinosinusitis Disability Index and the Chronic Sinusitis Survey. There has yet to be an evaluation of the longitudinal stability of the Sinonasal Outcome Test-22 (SNOT-22) after ESS in patients with CRS. Methods Adults with medically recalcitrant CRS who were considered surgical candidates were enrolled in a prospective, multi-center, observational cohort study from February 2011 to February 2013. Baseline evaluation of subjects included assessment of clinical characteristics, measures of CRS-specific disease severity, and QOL evaluation using the SNOT-22. Subjects were then re-evaluated at approximately 6-month, 12-month, and 18-month intervals postoperatively. Data was analyzed using repeated measures ANOVA with Bonferroni corrections for matched pairwise comparisons. Results 110 patients completed baseline evaluations and follow-up for all three postoperative time points. Significant improvement in SNOT-22 scores was seen between baseline and 6-months across both SNOT-22 total and subdomain scores (p<0.001). There was no statistically significant difference between the 6-month, 12-month, and 18-month time points in the total SNOT-22 score or its domains (p≥0.125) for both the entire cohort or subgroups (p≥0.077). Conclusions Postoperative improvement in CRS-specific QOL and symptom severity, as measured by the SNOT-22, suggest stability and durability between 6-months and 18-months. Further study on the longitudinal stability of the SNOT-22 past the 18-month timeframe will help further refine clinical study of CRS and provide further understanding of temporal improvements following ESS. PMID:25511442

  2. Development of asthmatic inflammation in mice following early-life exposure to ambient environmental particulates and chronic allergen challenge

    Directory of Open Access Journals (Sweden)

    Cristan Herbert

    2013-03-01

    Childhood exposure to environmental particulates increases the risk of development of asthma. The underlying mechanisms might include oxidant injury to airway epithelial cells (AEC. We investigated the ability of ambient environmental particulates to contribute to sensitization via the airways, and thus to the pathogenesis of childhood asthma. To do so, we devised a novel model in which weanling BALB/c mice were exposed to both ambient particulate pollutants and ovalbumin for sensitization via the respiratory tract, followed by chronic inhalational challenge with a low mass concentration of the antigen. We also examined whether these particulates caused oxidant injury and activation of AEC in vitro. Furthermore, we assessed the potential benefit of minimizing oxidative stress to AEC through the period of sensitization and challenge by dietary intervention. We found that characteristic features of asthmatic inflammation developed only in animals that received particulates at the same time as respiratory sensitization, and were then chronically challenged with allergen. However, these animals did not develop airway hyper-responsiveness. Ambient particulates induced epithelial injury in vitro, with evidence of oxidative stress and production of both pro-inflammatory cytokines and Th2-promoting cytokines such as IL-33. Treatment of AEC with an antioxidant in vitro inhibited the pro-inflammatory cytokine response to these particulates. Ambient particulates also induced pro-inflammatory cytokine expression following administration to weanling mice. However, early-life dietary supplementation with antioxidants did not prevent the development of an asthmatic inflammatory response in animals that were exposed to particulates, sensitized and challenged. We conclude that injury to airway epithelium by ambient environmental particulates in early life is capable of promoting the development of an asthmatic inflammatory response in sensitized and antigen-challenged mice. These

  3. Evidence for altered levels of IgD in the nasal airway mucosa of patients with chronic rhinosinusitis.

    Science.gov (United States)

    Min, Jin-Young; Nayak, Jayakar V; Hulse, Kathryn E; Stevens, Whitney W; Raju, Paul A; Huang, Julia H; Suh, Lydia A; Van Roey, Griet A; Norton, James E; Carter, Roderick G; Price, Caroline P E; Weibman, Ava R; Rashan, Ali R; Ghosn, Eliver E; Patel, Zara M; Homma, Tetsuya; Conley, David B; Welch, Kevin C; Shintani-Smith, Stephanie; Peters, Anju T; Grammer, Leslie C; Harris, Kathleen E; Kato, Atsushi; Hwang, Peter H; Kern, Robert C; Herzenberg, Leonore A; Schleimer, Robert P; Tan, Bruce K

    2017-12-01

    IgD is an enigmatic antibody isotype best known when coexpressed with IgM on naive B cells. However, increased soluble IgD (sIgD) levels and increased IgD + IgM - B-cell populations have been described in the human upper respiratory mucosa. We assessed whether levels of sIgD and IgD + B cell counts are altered in nasal tissue from patients with chronic rhinosinusitis (CRS). We further characterized IgD + B-cell populations and explored clinical and local inflammatory factors associated with tissue sIgD levels. sIgD levels were measured by means of ELISA in nasal tissues, nasal lavage fluid, sera, and supernatants of dissociated nasal tissues. IgD + cells were identified by using immunofluorescence and flow cytometry. Inflammatory mediator levels in tissues were assessed by using real-time PCR and multiplex immunoassays. Bacterial cultures from the middle meatus were performed. Underlying medical history and medicine use were obtained from medical records. sIgD levels and numbers of IgD + cells were significantly increased in uncinate tissue (UT) of patients with chronic rhinosinusitis without nasal polyps (CRSsNP) compared with that of control subjects (4-fold, P < .05). IgD + cells were densely scattered in the periglandular regions of UT from patients with CRSsNP. We also found that IgD + CD19 + CD38 bright plasmablast numbers were significantly increased in tissues from patients with CRSsNP compared with control tissues (P < .05). Among numerous factors tested, IL-2 levels were increased in UT from patients with CRSsNP and were positively correlated with tissue IgD levels. Additionally, supernatants of IL-2-stimulated dissociated tissue from patients with CRSsNP had significantly increased sIgD levels compared with those in IL-2-stimulated dissociated control tissue ex vivo (P < .05). Tissue from patients with CRS with preoperative antibiotic use or those with pathogenic bacteria showed higher IgD levels compared with tissue from patients without these

  4. Long-term results of functional endoscopic sinus surgery in children with chronic rhinosinusitis with nasal polyps.

    Science.gov (United States)

    Cornet, M E; Georgalas, C; Reinartz, S M; Fokkens, W J

    2013-12-01

    Chronic rhinosinusitis with nasal polyps (CRSwNP) is rare in children and has a major impact on Quality of Life (QoL). Functional endoscopic sinus surgery (FESS) has proven to be an effective treatment, but it is still unclear what long-term outcomes are in children with CRSwNP. The objective of this study was to assess long-term results of FESS in children with CRSwNP. We performed a combined prospective and retrospective study. A QoL questionnaire was send to all children with CRSwNP who received FESS between the year 2000-2010. Almost half of these children also filled in this questionnaire preoperatively. Forty-four Children underwent FESS. From 18 patients, we also prospectively collected preoperative QoL questionnaires. The mean follow-up period was 4.0 years (+- 2.9). The mean age at surgery was 13 years (+-2.9). Of these children, 9 had CF and 10 children asthma. R-SOM scores showed a significant improvement both in general symptoms as well as several different domains when comparing pre- and postoperative questionnaires. Only 5 of 44 patients needed a subsequent intervention. In children with CF this was 3 of 9. This study demonstrates that long-term results of FESS in children with CRSwNP are good. QoL has improved significantly, especially in nasal symptoms, showing that FESS is a good treatment in children with CRSwNP. Furthermore, even children with CF show good results.

  5. Expression and Regulation of Transcription Factor FoxA2 in Chronic Rhinosinusitis With and Without Nasal Polyps.

    Science.gov (United States)

    Luo, Qing; Zhang, Jia; Wang, Hongtian; Chen, Fenghong; Luo, Xi; Miao, Beiping; Wu, Xingmei; Ma, Renqiang; Luo, Xiangqian; Xu, Geng; Shi, Jianbo; Li, Huabin

    2015-09-01

    Chronic rhinosinusitis (CRS) is characterized by the excessive production of mucus. However, the molecular mechanism underlying mucin overproduction in CRS with or without nasal polyps (CRSwNP and CRSsNP, respectively) is poorly understood. This study was conducted to assess the importance of the transcription factor FoxA2 in mucin production and to investigate the targeting of FoxA2 as a potential therapeutic strategy for mucus hypersecretion in CRS patients. We enrolled 15 CRSwNP patients, 15 CRSsNP patients, and 10 normal controls in this study. The expression levels of FoxA2, MUC5AC, and MUC5B in inflamed and healthy nasal tissues were examined via immunohistochemistry and quantitative reverse transcription-polymerase chain reaction, and the levels of several proinflammatory cytokines in nasal secretions were measured via FlowCytomix analysis. In addition, the expression of MUC5AC and FoxA2 was determined in polyp-derived epithelial cells and NCI-H292 cells after in vitro stimulation. FoxA2 was significantly down-regulated, and MUC5AC and MUC5B were significantly up-regulated in both the CRSwNP and CRSsNP patients compared to the controls (PFoxA2 was negatively associated with the IL-6 level in the CRS patients (PFoxA2 expression in vitro (PFoxA2 expression plasmid significantly decreased MUC5AC promoter activity (PFoxA2 suppression and decreased MUC5AC expression in vitro (PFoxA2 may be considered a therapeutic target for the modulation of mucus hypersecretion in CRS patients.

  6. Lack of long-term add-on effect by montelukast in postoperative chronic rhinosinusitis patients with nasal polyps.

    Science.gov (United States)

    Van Gerven, Laura; Langdon, Cristobal; Cordero, Arturo; Cardelús, Sara; Mullol, Joaquim; Alobid, Isam

    2017-11-08

    Eosinophils and mast cells are among the key cells in inflammatory diseases like chronic rhinosinusitis (CRS) and asthma. Leukotriene antagonists have proven to be effective in the treatment of asthma, but data about their efficacy in CRS are scarce, whereas data on montelukast as an add-on treatment to intranasal corticosteroids (INCS) in a postoperative setting are completely lacking. Prospective, randomized, open-label trial. In this trial with long-term follow-up, we evaluated the efficacy of montelukast as an add-on treatment to INCS in postoperative CRS with nasal polyp (CRSwNP) patients. CRSwNP patients (N = 72) undergoing endoscopic sinus surgery were randomized in two arms for the postoperative treatment. One group (N = 36) received INCS in monotherapy, whereas the other group (N = 36) received INCS in association with montelukast for 1 year. The efficacy of montelukast with INCS was evaluated by assessing both subjective (total five-symptom score [T5SS]) and objective (nasal polyp score [NPS], Lund-Mackay [LMK] score, and subjective olfactometry [Barcelona Smell Test 24]) outcome parameters and compared with the gold standard of INCS in monotherapy. After 1 year of surgery, T5SS, NPS, and LMK score were significantly reduced in patients treated with either INCS or INCS plus montelukast, without significant differences between the two treatment arms. Improvement of smell loss by olfactometry was also observed with no differences between arms. Similar findings were observed at 3 and 6 months. These results suggest that the addition of montelukast to INCS should not be recommended in the treatment of postoperative CRSwNP patients. 1b Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Differential effect of omalizumab on pulmonary function in patients with allergic asthma with and without chronic rhinosinusitis.

    Science.gov (United States)

    Clavenna, Matthew J; Turner, Justin H; Samuelson, Madeleine; Tanner, S Bobo; Duncavage, James; Chandra, Rakesh K

    2016-01-01

    Omalizumab, an anti-immunoglobulin E monoclonal antibody, is approved by the U.S. Food and Drug Administration for the management of patients with allergic asthma and with refractory disease, and has also proven beneficial in the management of selected patients with chronic rhinosinusitis (CRS). The common airway model indicates that patients with both allergic asthma and CRS may be more challenging to manage clinically. This is the first study to evaluate the response of omalizumab in patients with asthma and CRS versus those with asthma alone. To compare pulmonary function test (PFT) responses in omalizumab-treated patients with asthma with CRS with omalizumab-treated patients with asthma without CRS. This was a retrospective case-control study at a tertiary university clinic. Between 2007 and 2014, a total of 259 patients with allergic asthma had been prescribed omalizumab for asthma. Outcome measures were absolute, and the percentage changes in PFT results were compared with the baseline. Overall, 81 patients had serial PFT results available for evaluation, among whom 59 (73%) had CRS. Average treatment duration was 27.2, 27.7, and 25.8 months for the entire sample, for patients with asthma and CRS, and for patients with asthma and without CRS, respectively. Overall, PFT metrics improved across all parameters (forced expiratory volume in 1 second, forced vital capacity, forced expiratory volume in 1 second to forced vital capacity ratio, and forced expiratory flow 25-75%). Significant improvement (p omalizumab manifested some improvement in PFT scores. CRS may add to the overall symptom burden experienced by patients with asthma, especially in those with increasing severity, but comorbid CRS did not adversely impact the therapeutic potential of omalizumab. In fact, the benefit of omalizumab was more likely to be observed in patients with asthma and with CRS than in patients with asthma and without CRS.

  8. A prospective analysis evaluating tissue biopsy location and its clinical relevance in chronic rhinosinusitis with nasal polyps.

    Science.gov (United States)

    Weibman, Ava R; Huang, Julia He; Stevens, Whitney W; Suh, Lydia A; Price, Caroline P E; Lidder, Alcina K; Conley, David B; Welch, Kevin C; Shintani-Smith, Stephanie; Peters, Anju T; Grammer, Leslie C; Kato, Atsushi; Kern, Robert C; Schleimer, Robert P; Tan, Bruce K

    2017-11-01

    Chronic rhinosinusitis with nasal polyps (CRSwNP) has a high propensity for recurrence. Studies suggest that eosinophilia influences disease severity and surgical outcomes, but the selection of sinonasal site for measuring eosinophilia has not been examined. The aim of this study was to investigate how region-specific tissue eosinophilia affects radiographic severity, comorbidity prevalence, and polyp recurrence risk following sinus surgery. Eosinophil cationic protein (ECP) levels in uncinate tissue (UT) and nasal polyp (NP) homogenates from 116 CRSwNP patients were measured using enzyme-linked immunosorbent assay (ELISA). Clinical history, radiographic severity, and time to polyp recurrence were obtained from electronic health records. The correlations between baseline Lund-Mackay scores and comorbidities were compared between UT and NP ECP levels. Cox regression and Kaplan-Meier analysis were then performed to assess whether UT or NP ECP better predicted recurrence. Censoring occurred at 4 years or at last follow-up if there was no endoscopic diagnosis of recurrent polyps. Lund-Mackay scores were significantly correlated with UT and NP ECP (r = 0.46 and 0.26 respectively, p < 0.05). UT but not NP ECP was significantly higher in patients with asthma (p < 0.01) and aspirin-exacerbated respiratory disease (AERD) (p < 0.05). Polyp recurrence risk was only significantly higher for patients with eosinophilic UT tissue (hazard ratio [HR] = 2.84, p = 0.025). When measured in NP, eosinophilia did not predict recurrence. Although ECP in NP was higher than in UT tissue, eosinophilia in UT tissue was a more clinically coherent biomarker of baseline radiographic severity, comorbid asthma and AERD, and prospective polyp recurrence risk than NP eosinophilia. © 2017 ARS-AAOA, LLC.

  9. Polymorphisms in RYBP and AOAH genes are associated with chronic rhinosinusitis in a Chinese population: a replication study.

    Directory of Open Access Journals (Sweden)

    Yuan Zhang

    Full Text Available BACKGROUND: The development of CRS is believed to be the result of combined interactions between the genetic background of the affected subject and environmental factors. OBJECTIVES: To replicate and extend our recent findings from genetic association studies in chronic rhinosinusitis (CRS performed in a Canadian Caucasian population in a Chinese population. METHODS: In a case-control replication study, DNA samples were obtained from CRS with (n  = 306; CRSwNP and without (n = 332; CRSsNP nasal polyps, and controls (n = 315 in a Chinese population. A total of forty-nine single nucleotide polymorphisms (SNPs selected from previous identified SNPs associated with CRS in Canadian population, and SNPs from the CHB HapMap dataset were individually genotyped. RESULTS: We identified two SNPs respectively in RYBP (rs4532099, p = 2.15E-06, OR = 2.59 and AOAH (rs4504543, p = 0.0001152, OR = 0.58 significantly associated with whole CRS cohort. Subgroup analysis for the presence of nasal polyps (CRSwNP and CRSsNP displayed significant association in CRSwNP cohorts regarding to one SNP in RYBP (P = 3.24(E-006, OR = 2.76. Evidence of association in the CRSsNP groups in terms of 2 SNPs (AOAH_rs4504543 and RYBP_rs4532099 was detected as well. Stratifying analysis by gender demonstrated that none of the selected SNPs were associated with CRSwNP as well as CRSsNP. Meanwhile 3 SNPs (IL1A_rs17561, P = 0.005778; IL1A_rs1800587, P = 0.009561; IRAK4_rs4251513, P = 0.03837 were associated with serum total IgE level. CONCLUSIONS: These genes are biologically plausible, with roles in regulation of transcription (RYBP and inflammatory response (AOAH. The present data suggests the potential common genetic basis in the development of CRS in Chinese and Caucasian population.

  10. Health Utility Outcomes in Patients Undergoing Medical Management for Chronic Rhinosinusitis – A Prospective Multi-Institutional Study

    Science.gov (United States)

    Luk, Lauren J.; Steele, Toby O.; Mace, Jess C.; Soler, Zachary M.; Rudmik, Luke; Smith, Timothy L.

    2015-01-01

    Background A health utility value represents an individual’s preference for living in a specific health state and is used in cost-utility analyses. This study investigates the impact of continuing medical therapy on health utility outcomes in patients with chronic rhinosinusitis (CRS). Methods The Medical Outcomes Study Short Form-6D (SF-6D) was administered to patients prospectively enrolled in a longitudinal study examining treatment outcomes for CRS. Patients were prescribed robust, initial medical therapy and then elected to continue with medical therapy (n=40) or undergo endoscopic sinus surgery (ESS), followed by medical therapy (n=152). Patients observed through treatment crossover to ESS were also evaluated (n=20). Health utility values (SF-6D) were generated at baseline, 6-months, and 12-months follow-up for both cohorts and evaluated using repeated measures ANOVA. Results Treatment crossover patients were found to have a significantly higher prevalence of previous sinus surgery compared to medical management (χ2=6.91; p=0.009) and surgical intervention (χ2=8.11; p=0.004) subgroups. Mean baseline utility value for the medical therapy cohort was significantly better compared to the ESS cohort (0.76[0.12] versus 0.70[0.15]; p=0.023). Significant improvement in health utility was reported in the ESS cohort (F(2)=37.69; p<0.001), while values remained stable, without significant improvement, in both the medical therapy cohort (F(2)=0.03; p=0.967) and treatment crossover cohort (F(2)=2.36; p=0.115). Conclusions Patients electing continued medical management report better baseline health utility compared to patients electing ESS. Patients electing ESS demonstrate significant improvement in health utility while those electing continued medical management demonstrate stable health utility over 12 months. PMID:26140502

  11. Vitamin D3 as a Novel Regulator of Basic Fibroblast Growth Factor in Chronic Rhinosinusitis with Nasal Polyposis

    Science.gov (United States)

    Sansoni, E. Ritter; Sautter, Nathan B.; Mace, Jess C.; Smith, Timothy L.; Yawn, James R.; Lawrence, Lauren A.; Schlosser, Rodney J.; Soler, Zachary M.; Mulligan, Jennifer K.

    2015-01-01

    Background The immunopathogenesis of chronic rhinosinusitis (CRS) is largely unknown, but it is thought that different inflammatory profiles are responsible for the different CRS subtypes. 25-hydroxyvitamin-D (25-VD3) has been shown to alter inflammatory mediators in other disease processes and 25VD3 deficiency is associated with CRS with nasal polyps (CRSwNP), but it is unknown if 25VD3 levels impacts local inflammation in CRS. This study investigated the correlation between plasma 25-VD3 and sinonasal mucus MCP-1, RANTES and bFGF levels in patients with CRS. Methods Study subjects undergoing endoscopic sinus surgery (ESS) for CRS were prospectively enrolled from January 2012-August 2014. Control subjects included patients undergoing ESS for non-inflammatory pathology. Blood and sinonasal mucus were collected at the time of ESS. Plasma 25-VD3 was measured by ELISA and mucus levels of MCP-1, RANTES, and bFGF by cytometric bead array (CBA). Results A total of 57 patients were enrolled and categorized as CRS without nasal polyps (CRSsNP) (n=31), CRSwNP (n=14) and controls (n=12). No significant correlation was found between MCP-1 and 25-VD3. There was a significant negative correlation between 25-VD3 and RANTES (r= −0.612; p=0.026) and bFGF (r= −0.578; p=0.039) in CRSwNP patients; however, there was no significant correlation in CRSsNP patients. Conclusion This data suggests that 25-VD3 may play a role in regulation of RANTES and bFGF expression in CRSwNP. This may occur through regulation of nasal polyp fibroblasts or other immune cells. Further investigation is warranted to better elucidate the role of RANTES, bFGF and 25-VD3 in CRSwNP. PMID:25561293

  12. Correlation of T2R38 taste phenotype and in vitro biofilm formation from nonpolypoid chronic rhinosinusitis patients.

    Science.gov (United States)

    Adappa, Nithin D; Truesdale, Carl M; Workman, Alan D; Doghramji, Laurel; Mansfield, Corrine; Kennedy, David W; Palmer, James N; Cowart, Beverly J; Cohen, Noam A

    2016-08-01

    Sinonasal biofilms have been demonstrated in specimens collected from chronic rhinosinusitis (CRS) patients. Mounting evidence suggests that biofilms contribute to therapeutically recalcitrant CRS. Recently, the bitter taste receptor T2R38 has been implicated in the regulation of the sinonasal mucosal innate immune response. TAS2R38 gene polymorphisms affect receptor functionality and contribute to variations seen in sinonasal innate defense as well as taste perception reflected in gustatory sensitivity to the bitter compound phenylthiocarbamide (PTC). In a population of CRS patients with active infection or inflammation, we sought to determine if a correlation between T2R38 phenotype and in vitro biofilm formation existed. Endoscopically guided sinonasal swabs were obtained prospectively from CRS (±polyp) patients with evidence of persistent inflammation or mucopurulence. In vitro biofilm formation was assessed with a modified Calgary Biofilm Detection Assay. Patients' phenotypic (functional) expression of the bitter taste receptor T2R38 was evaluated with a taste test including the compound PTC. Linear regression was used to determine the level of significance between mean in vitro biofilm formation levels and mean PTC taste test intensity ratings across CRS patients. Sinonasal swabs were obtained from 59 patients, with 42 of the 59 samples demonstrating in vitro biofilm formation. Analysis revealed an inverse linear association between in vitro biofilm formation and PTC taste intensity ratings (p = 0.019) for all patients. This association was exclusively driven by nonpolypoid CRS patients (p = 0.0026). In vitro biofilm formation from sinonasal clinical isolates is inversely correlated with PTC taste sensitivity in nonpolypoid CRS patients. © 2016 ARS-AAOA, LLC.

  13. Comparison of Sinonasal Symptoms in Patients with Nasal Septal Deviation and Patients with Chronic Rhinosinusitis

    OpenAIRE

    Naeimi, Mohammad; Garkaz, Maria; Naeimi, Mohammad Reza

    2013-01-01

    Introduction: Disorders of the nose and paranasal sinuses are among the most common chronic illnesses. Although considerable progress has been made in the medical and surgical control of these diseases, a large number of questions relating to the diagnosis, evaluation, and treatment of these conditions remain unanswered. The aim of the present study was to evaluate differences in the frequency of symptoms and disease severity in patients with nasal septal deviation (NSD) compared with chronic...

  14. Potential Involvement of the Epidermal Growth Factor Receptor Ligand Epiregulin and Matrix Metalloproteinase-1 in Pathogenesis of Chronic Rhinosinusitis.

    Science.gov (United States)

    Homma, Tetsuya; Kato, Atsushi; Sakashita, Masafumi; Takabayashi, Tetsuji; Norton, James E; Suh, Lydia A; Carter, Roderick G; Harris, Kathleen E; Peters, Anju T; Grammer, Leslie C; Min, Jin-Young; Shintani-Smith, Stephanie; Tan, Bruce K; Welch, Kevin; Conley, David B; Kern, Robert C; Schleimer, Robert P

    2017-09-01

    Chronic rhinosinusitis (CRS) is a heterogeneous chronic inflammatory disease of the nose and paranasal sinuses that presents without or with nasal polyps (CRSwNP). Notable features of CRSwNP are the frequent presence of type 2 allergic inflammation and high prevalence of Staphylococcus aureus (SA) colonization. As inflammation persists, sinus tissue undergoes epithelial damage and repair along with polyp growth, despite active medical management. Because one feature of damaged tissue is enhancement of growth factor signaling, we evaluated the presence of epidermal growth factor receptor (EGFR) ligands and matrix metalloproteinases (MMPs) in CRS. The objectives of this study were to analyze the expression of EGFR ligands and MMPs in patients with CRS and to investigate the possible role of SA on epithelial activation. Sinonasal tissues were collected during surgery from control subjects and patients with CRS. Tissues were processed as described previously for analysis of mRNA (RT-PCR) and proteins (ELISA) for the majority of EGFR ligands within the tissue extracts. CRS tissue was used for evaluation of the distribution of epiregulin (EREG), an EGFR ligand, and MMP-1 by immunohistochemistry. In parallel studies, expression of these genes and proteins was analyzed in cultured primary airway epithelial cells. Elevated expression of EREG and MMP-1 mRNA and protein was observed in uncinate and polyp tissue from patients with CRSwNP. Immunohistochemistry study of clinical samples revealed that airway epithelial cells expressed both of these proteins. Cultured primary human airway epithelial cells expressed MMP-1, and MMP-1 was further induced by stimulation with EREG or heat-killed SA (HKSA). The induction of MMP-1 by HKSA was blocked by an antibody against EREG, suggesting that endogenous EREG induces MMP-1 after stimulation with HKSA. EREG and MMP-1 were found to be elevated in nasal polyp and uncinate tissues in patients with CRSwNP. Elevated expression of EREG and MMP

  15. Sinonasal T-cell expression of cytotoxic mediators granzyme B and perforin is reduced in patients with chronic rhinosinusitis.

    Science.gov (United States)

    Smith, Sarah E; Schlosser, Rodney J; Yawn, James R; Mattos, Jose L; Soler, Zachary M; Mulligan, Jennifer K

    2017-11-01

    CD8+ T cells and natural killer (NK) cells are cytotoxic cells that use granzyme B (GrB) and perforin. Defective cytotoxic function is known to play a role in dysregulated immune response as seen in chronic sinusitis, also referred to as chronic rhinosinusitis (CRS). However, to our knowledge, in the United States, neither GrB or perforin expression has been reported in patients with CRS. The aim of this study was to investigate sinonasal cytotoxic cells, their mediators, and cell-specific distribution of these mediators in patients with CRS with nasal polyp (CRSwNP) and in patients with CRS without nasal polyp (CRSsNP). Blood and sinus tissue samples were taken from patients with CRSsNP (n = 8) and CRSwNP (n = 8) at the time of surgery. Control subjects (n = 8) underwent surgery for cerebrospinal fluid leak repair or to remove non-hormone-secreting pituitary tumors. The cells were analyzed via flow cytometry by using CD8 expression to identify cytotoxic T cells and CD56 expression to identify NK cells. Intracellular GrB and perforin expression were analyzed with flow cytometry. We observed no significant differences in plasma or peripheral blood immune cell numbers or specific levels of GrB or perforin among the groups. In the sinonasal mucosa of the patients with CRSsNP and the patients with CRSwNP, there was a significant decrease in GrB and perforin levels (p < 0.05) despite similar or increased numbers of cytotoxic cells when compared with the controls. The overall decrease in GrB and perforin in the sinonasal mucosa of the patients with CRSsNP and the patients with CRSwNP was due to decreased T cell production. There was no difference in total NK cell count or expression of perforin or GrB among all the groups. Total levels of sinonasal GrB and perforin were decreased in the sinonasal mucosa of both the patients with CRSwNP and the patients with CRSsNP compared with the controls, whereas sinonasal CD8+ T cells, (but not NK cells,), intracellular stores of Gr

  16. The role of point-of-care CT in the management of chronic rhinosinusitis: a case-control study.

    Science.gov (United States)

    Conley, David; Pearlman, Aaron; Zhou, Kali; Chandra, Rakesh; Kern, Robert

    2011-08-01

    Point-of-care computed tomography (POC-CT) has become more feasible since the introduction of smaller imaging devices that deliver lower radiation doses. As the availability of this modality continues to increase, its impact on diagnostic and therapeutic algorithms in patients with chronic rhinosinusitis (CRS) must be evaluated. We conducted a study of 40 consecutively presenting new patients who (1) met the symptom criteria for CRS but whose endoscopy results were negative (i.e., no pus, polyps, or edema), (2) had not undergone any previous CT scanning or sinus surgery, and (3) had undergone POC-CT during their initial evaluation. A comparison group was made up of 40 patients from the pre-POC-CT era whose initial treatment had been based on the history alone; these patients underwent CT after their medical therapy had been completed. In the pre-POC-CT group, follow-up CT showed evidence of inflammatory disease in 24 patients (60%), 13 of whom (54.2%) had received an antibiotic at their initial visit, including 2 who had received an oral steroid, as well; among the 16 patients whose follow-up CT was negative, only 2 (12.5%) had received an antibiotic, neither of whom received an oral steroid. In the POC-CT group, 27 of 40 patients (67.5%) had positive findings at the initial visit, and 14 of them (51.9%) received an antibiotic and an oral steroid; none of the 13 patients in whom POC-CT was negative was prescribed either agent. Thus, the incidence of scan positivity and antibiotic use was similar in the two cohorts. Also, patients who met the symptomatic definition of CRS but who were lacking in objective endoscopic findings were more likely to have received an oral steroid when POC-CT was part of the initial assessment; these patients were also less likely to be lost to follow-up. Ongoing prospective studies will better characterize the magnitude of these effects on long-term outcomes, antibiotic resistance, healthcare costs, and overall quality of care.

  17. Chronic invasive fungal rhinosinusitis by Paecilomyces variotii: A rare case report

    Directory of Open Access Journals (Sweden)

    T Swami

    2016-01-01

    Full Text Available Fungal infection of the paranasal sinuses is an increasingly recognised entity, both in normal and immunocompromised individuals. The recent increase in mycotic nasal and paranasal infections is due to both improved diagnostic research and an increase in the conditions that favour fungal infection. Aspergillus, Candida, and Mucor species are the most common causative agents of fungal sinusitis, but infection with lesser known species have been reported across the world infrequently. This article reviews and presents a case report of chronic fungal sinusitis in an immunocompetent adult male infected with Paecilomyces variotii which is opportunistic soil saprophyte, uncommon to humans.

  18. Macroscopic findings during endoscopic sinus surgery for chronic rhinosinusitis in children.

    Science.gov (United States)

    Chmielik, Lechoslaw Pawel; Raczkowska-Labuda, Karolina; Zawadzka-Glos, Lidia

    2015-09-01

    Endeavor to intraoperative macroscopic evaluation of changes in children with CRSs. Analysis of the type and incidence of pathological changes observed macroscopically during FESS was undertaken as well as an parallel attempt to correlate the level of inflammation markers with severity of disease. Retrospective analysis of case records of 153 patients of the Department of Pediatric Otolaryngology, Medical University of Warsaw, hospitalized between 2010 and 2013. During that time 106 patients with a diagnosis of chronic maxillary sinusitis required surgical intervention. 102 children (avg-aged 11.5 years) were qualified to functional endoscopic surgery. The youngest patient was 3 years old and the oldest 18. 26 patients presented the polypoid lesions of sinuses or nasals. At 19 confirmed the coexistence of sinus polyps with nasal polyps. 76 patients had oedematous-inflammatory lesions and 26 polypoid. Among the group of listed above 26 children, 19 had either sinuses or nasal polyps. 15% children with polyps were diagnosed with cystic fibrosis and 8.0% with asthma. A common deviation in the results of morphology in children with CRSs is higher level of monocytes. Inflammation markers within the population of FESS qualified children were low. (1) Oedematous-inflammatory lesions are frequently intraoperatively identified. (2) The CRSs without polyps is the common type of chronic sinusitis in children. (3) Nasal polyps often coexist with sinus polyps. (4) If nasal polyps are found in pediatric population then diagnosis of CF, allergy and GERD should be considered. (5) Markers of inflammation in CRSs are low. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Allergic Aspergillus Rhinosinusitis

    Science.gov (United States)

    Chakrabarti, Arunaloke; Kaur, Harsimran

    2016-01-01

    Allergic fungal rhinosinusitis (AFRS) is a unique variety of chronic polypoid rhinosinusitis usually in atopic individuals, characterized by presence of eosinophilic mucin and fungal hyphae in paranasal sinuses without invasion into surrounding mucosa. It has emerged as an important disease involving a large population across the world with geographic variation in incidence and epidemiology. The disease is surrounded by controversies regarding its definition and etiopathogenesis. A working group on “Fungal Sinusitis” under the International Society for Human and Animal Mycology (ISHAM) addressed some of those issues, but many questions remain unanswered. The descriptions of “eosinophilic fungal rhinosinusitis” (EFRS), “eosinophilic mucin rhinosinusitis” (EMRS) and mucosal invasion by hyphae in few patients have increased the problem to delineate the disease. Various hypotheses exist for etiopathogenesis of AFRS with considerable overlap, though recent extensive studies have made certain in depth understanding. The diagnosis of AFRS is a multi-disciplinary approach including the imaging, histopathology, mycology and immunological investigations. Though there is no uniform management protocol for AFRS, surgical clearing of the sinuses with steroid therapy are commonly practiced. The role of antifungal agents, leukotriene antagonists and immunomodulators is still questionable. The present review covers the controversies, recent advances in pathogenesis, diagnosis, and management of AFRS. PMID:29376948

  20. Allergic Aspergillus Rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Arunaloke Chakrabarti

    2016-12-01

    Full Text Available Allergic fungal rhinosinusitis (AFRS is a unique variety of chronic polypoid rhinosinusitis usually in atopic individuals, characterized by presence of eosinophilic mucin and fungal hyphae in paranasal sinuses without invasion into surrounding mucosa. It has emerged as an important disease involving a large population across the world with geographic variation in incidence and epidemiology. The disease is surrounded by controversies regarding its definition and etiopathogenesis. A working group on “Fungal Sinusitis” under the International Society for Human and Animal Mycology (ISHAM addressed some of those issues, but many questions remain unanswered. The descriptions of “eosinophilic fungal rhinosinusitis” (EFRS, “eosinophilic mucin rhinosinusitis” (EMRS and mucosal invasion by hyphae in few patients have increased the problem to delineate the disease. Various hypotheses exist for etiopathogenesis of AFRS with considerable overlap, though recent extensive studies have made certain in depth understanding. The diagnosis of AFRS is a multi-disciplinary approach including the imaging, histopathology, mycology and immunological investigations. Though there is no uniform management protocol for AFRS, surgical clearing of the sinuses with steroid therapy are commonly practiced. The role of antifungal agents, leukotriene antagonists and immunomodulators is still questionable. The present review covers the controversies, recent advances in pathogenesis, diagnosis, and management of AFRS.

  1. The Potential for Topical Probiotic Treatment of Chronic Rhinosinusitis, a Personal Perspective

    Directory of Open Access Journals (Sweden)

    Anders U. Cervin

    2018-01-01

    Full Text Available This review describes the rationale for topical probiotic intervention, the obstacles we are facing and a strategy for future research in the use of probiotics to modify CRS symptoms and disease expression. Recent advances in molecular microbiology has revealed a plethora of microbial DNA in the nasal cavity and sinuses of healthy subjects as well as in chronic sinusitis (CRS patients. An infection is today rather seen as an imbalance between the commensal microbiome and the bacterial pathogens, resulting in a reduction in commensal bacterial diversity, combined with an increase in the growth of microbes eliciting an inflammatory response. This will in turn lead to the clinical symptoms of sinusitis. Probiotics (microorganisms that confer a health benefit can be used either as a form of living antibiotics treatment, or as an immune-modulatory intervention. Topical probiotics, which is the focus of this review, have shown efficacy in a limited number of trials in otitis media and tonsillitis, but to date not in CRS. Although bacterial interference capacity against pathogens can be determined in in vitro experiments, it may not translate to a health benefit. This limits the role of laboratory research in identifying probiotic strains with a clinical benefit. To gain more clinical experience without further delay, I recommend future research to focus on empirical clinical trials in well-defined CRS patient populations and study the underlying mechanisms in more detail once a clinical benefit has been established.

  2. Allergic fungal rhinosinusitis infiltrating anterior skull base and clivus

    NARCIS (Netherlands)

    Meccariello, Giuseppe; Deganello, Alberto; Mannelli, Giuditta; Bianco, Giacomo; Ammannati, Franco; Georgalas, Christos; Gallo, Oreste

    2013-01-01

    Bone erosion and skull base invasion are often suggestive of a malignant mass in paranasal and nasal cavities. Nevertheless, forms of chronic rhinosinusitis, such as allergic fungal rhinosinusitis (AFRS), could mimic malignant features. Here, we report AFRS patient with orbital, anterior cranial

  3. [Informed Treatment Consent and Refusal in Advanced Endonasal Surgery: The Ethical Dilemma of Olfaction Sacrifice in Surgery for Chronic Rhinosinusitis with Polyposis].

    Science.gov (United States)

    Subtil, João; Araújo, João Pedro; Saraiva, José; Santos, Alberto; Vera-Cruz, Paulo; Paço, João; Pais, Diogo

    2015-01-01

    Olfaction is frequently affected in chronic rhino-sinusitis with polyposis and has been recognised to have important impact on quality of life. Surgical resolution on cases of maximal medical therapy failure is an option to relieve symptoms, with debates as to how extensive surgery should be. A more radical approach will achieve better disease control with less relapse, but can also compromise olfaction. This decision about a more radical surgical approach should be shared with the patient. Thorough informed consent regarding disease control and hyposmia should be taken. Literature review and consultation with a board of experts. We propose some elements to be included in the informed consent discussion, in order to broadly address the surgical limitations regarding anosmia as a frequent complaint, as well as the different options and their associated consequences. Radical surgery decision making should be shared with the patient and the informed consent should be as thorough as possible regarding disease control and hyposmia resolution.

  4. Limited evidence: higher efficacy of nasal saline irrigation over nasal saline spray in chronic rhinosinusitis--an update and reanalysis of the evidence base.

    Science.gov (United States)

    van den Berg, Jelle W G; de Nier, Linden M; Kaper, Nina M; Schilder, Anne G M; Venekamp, Roderick P; Grolman, Wilko; van der Heijden, Geert J M G

    2014-01-01

    To assess the effectiveness of nasal saline irrigation in adult patients with chronic rhinosinusitis. PubMed, EMBASE, the Cochrane Library. A comprehensive search was performed, and 2 authors independently screened publications. The design of selected studies was assessed on directness of evidence and risk of bias. Of 1596 publications, 1 open-label randomized trial with high directness of evidence and moderate risk of bias was included. In this study, 127 patients were randomly allocated to isotonic nasal saline irrigation or isotonic nasal saline spray, as added to their usual medication. The mean 20-Item Sinonasal Outcome Test (SNOT-20) scores of those treated with nasal irrigation improved more than those allocated to nasal spray. While the authors consider an improvement of 16 or more to be clinically meaningful, the changes from baseline in mean SNOT-20 scores of those treated with irrigation (and the differences with those treated with nasal spray) at 2, 4, and 8 weeks were 12.2 (difference 5.5, [95% confidence interval -0.04 to 11.0]), 16.2 (difference 8.8 [3.2 to 14.4]), and 15.0 (difference 6.5 [0.4 to 12.6]), respectively. Side effects of posttreatment nasal dripping were common but minor and did not lead to discontinuation of treatment. It should be explained to adult patients with chronic rhinosinusitis that there is limited information on the relative effect of nasal saline irrigation and nasal saline spray on subjective symptom improvement, since there is only 1 trial available with a moderate risk of bias showing limited benefit of irrigation over spray.

  5. A prospective randomized cohort study evaluating 3 weeks vs 6 weeks of oral antibiotic treatment in the setting of "maximal medical therapy" for chronic rhinosinusitis.

    Science.gov (United States)

    Sreenath, Satyan B; Taylor, Robert J; Miller, Justin D; Ambrose, Emily C; Rawal, Rounak B; Ebert, Charles S; Senior, Brent A; Zanation, Adam M

    2015-09-01

    Surprisingly, little literature exists evaluating the optimal duration of antibiotic treatment in "maximal medical therapy" for chronic rhinosinusitis (CRS). As such, we investigated whether 3 weeks vs 6 weeks of antibiotic therapy resulted in significant differences in clinical response. A prospective, randomized cohort study was performed with patients assigned to 3-week or 6-week cohorts. Our primary outcome was failure of "maximal medical therapy" and surgical recommendation. Secondary outcomes included changes in pretherapy and posttherapy scores for the Rhinosinusitis Disability Index (RSDI), Chronic Sinusitis Survey (CSS), and computed tomography (CT)-based Lund-Mackay (LM) evaluation. Analyses were substratified based on presence of nasal polyps. Forty patients were randomized to the 3-week or 6-week treatment cohorts, with near-complete clinical follow-up achieved. No significant difference was found between the proportion of patients who failed medical therapy and were deemed surgical candidates between the 2 cohorts (71% vs 68%, p = 1.000). No significant difference was found in the change of RSDI or CSS scores in the 3 vs 6 weeks of treatment groups (mean ± standard error of the mean [SEM]; RSDI: 9.62 ± 4.14 vs 1.53 ± 4.01, p = 0.868; CSS: 5.75 ± 4.36 vs 9.65 ± 5.34, p = 0.573). Last, no significant difference was found in the change of LM scores (3.35 ± 1.11 vs 1.53 ± 0.81, p = 0.829). Based on this data, there is little difference in clinical outcomes between 3 weeks vs 6 weeks of antibiotic treatment as part of "maximal medical therapy" for CRS. Increased duration of antibiotic treatment theoretically may increase risk from side effects and creates higher healthcare costs. © 2015 ARS-AAOA, LLC.

  6. Microbiologia do meato médio na rinossinusite crônica Microbiology of middle meatus in chronic rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Elisabeth Araujo

    2007-08-01

    Full Text Available Este foi um estudo prospectivo que visou identificar a microbiologia do meato médio em pacientes com rinossinusite crônica (RSC e compará-la com a de indivíduos sadios. MATERIAL E MÉTODOS: Foram incluídos 134 pacientes RSC e 50 voluntários sadios, que constituíram o grupo controle. As amostras foram coletadas endoscopicamente e submetidas a exames pelo método de Gram com contagem leucocitária e culturas para aeróbios, anaeróbios e fungos. RESULTADOS: Nos pacientes com RSC foram cultivados 220 microorganismos, dentre os quais os mais freqüentes foram o Staphylococcus aureus, presente em 31% das amostras, e o Staphylococcus coagulase-negativo (SCN em 23%. Gram-negativos ou facultativos foram isolados em 37% das amostras, anaeróbios em 12%, e fungos em 14%. Ao exame bacterioscópico evidenciou-se alguns ou numerosos leucócitos em 74% das amostras com culturas positivas. Nos indivíduos sadios o SCN foi isolado em 40% das amostras e o Staphylococcus aureus em 18%. Em 12% dos indivíduos a cultura para fungos foi positiva, e o exame direto negativo. Todas as culturas anaeróbias foram estéreis. Quanto à contagem leucocitária todos apresentaram nenhum ou raros leucócitos. CONCLUSÃO: Os grupos apresentaram resultados semelhantes quanto à microbiologia, entretanto, diferiram em relação à contagem leucocitária, o que auxilia na diferenciação um microorganismo infectante de um colonizante.This was a prospective study which assessed endoscopically collected middle meatus secretions in patients with chronic rhinosinusitis (CRS and compared those findings with microbiological data of healthy individuals. METHODS: Middle meatus samples were collected from 134 CRS patients. In the laboratory, samples were Gram stained for microscopic examination with white blood cels (WBCs count and also send for aerobic, anaerobic and fungal cultures. Fifty volunteers served as control. RESULTS: In CRS patients a total of 220 microorganisms were

  7. Chapter 8: Invasive fungal rhinosinusitis.

    Science.gov (United States)

    Duggal, Praveen; Wise, Sarah K

    2013-01-01

    Invasive fungal rhinosinusitis (IFRS) is a disease of the paranasal sinuses and nasal cavity that typically affects immunocompromised patients in the acute fulminant form. Early symptoms can often mimic rhinosinusitis, while late symptoms can cause significant morbidity and mortality. Swelling and mucosal thickening can quickly progress to pale or necrotic tissue in the nasal cavity and sinuses, and the disease can rapidly spread and invade the palate, orbit, cavernous sinus, cranial nerves, skull base, carotid artery, and brain. IFRS can be life threatening if left undiagnosed or untreated. While the acute fulminant form of IFRS is the most rapidly progressive and destructive, granulomatous and chronic forms also exist. Diagnosis of IFRS often mandates imaging studies in conjunction with clinical, endoscopic, and histopathological examination. Treatment of IFRS consists of reversing the underlying immunosuppression, antifungal therapy, and aggressive surgical debridement. With early diagnosis and treatment, IFRS can be treated and increase patient survival.

  8. Chapter 8: Invasive fungal rhinosinusitis.

    Science.gov (United States)

    Duggal, Praveen; Wise, Sarah K

    2013-05-01

    Invasive fungal rhinosinusitis (IFRS) is a disease of the paranasal sinuses and nasal cavity that typically affects immunocompromised patients in the acute fulminant form. Early symptoms can often mimic rhinosinusitis, while late symptoms can cause significant morbidity and mortality. Swelling and mucosal thickening can quickly progress to pale or necrotic tissue in the nasal cavity and sinuses, and the disease can rapidly spread and invade the palate, orbit, cavernous sinus, cranial nerves, skull base, carotid artery, and brain. IFRS can be life threatening if left undiagnosed or untreated. While the acute fulminant form of IFRS is the most rapidly progressive and destructive, granulomatous and chronic forms also exist. Diagnosis of IFRS often mandates imaging studies in conjunction with clinical, endoscopic, and histopathological examination. Treatment of IFRS consists of reversing the underlying immunosuppression, antifungal therapy, and aggressive surgical debridement. With early diagnosis and treatment, IFRS can be treated and increase patient survival.

  9. Rinossinusite fúngica em pacientes com infecção nasossinusal crônica Fungal rhinosinusitis in patients with chronic sinusal disease

    Directory of Open Access Journals (Sweden)

    Celso Dall'Igna

    2005-12-01

    Full Text Available OBJETIVO: Estudar a rinossinusite fúngica em pacientes com infecção nasossinusal crônica. Nas últimas décadas houve aumento das infecções fúngicas, e a rinossinusite fúngica (RSF tem sido mais freqüentemente diagnosticada. O conhecimento da flora fúngica, da sua prevalência e da apresentação sintomática em pacientes portadores de rinossinusite crônica (RSC permitirá um melhor entendimento da doença, fato importante para a realização do diagnóstico, estabelecimento do tratamento e formulação do prognóstico. FORMA DE ESTUDO: clínico retrospectivo com coorte transversal. MATERIAL E MÉTODO: 62 pacientes com diagnóstico de RSF foram selecionados entre 890 portadores de RSC submetidos à cirurgia endoscópica. Avaliou-se anamnese, exame otorrinolaringológico com videoendoscopia nasal, TC dos seios da face e exames microbiológicos e histopatológico. RESULTADOS: A prevalência de RSF foi de 6,7% em portadores de RSC submetidos à cirurgia endoscópica dos seios paranasais, e o tipo de fungo mais encontrado foi do gênero Aspergillus. Bola fúngica foi encontrada em mais da metade dos casos, e RSFA, em mais de um terço dos pacientes. CONCLUSÕES: A evolução sintomática após a cirurgia endoscópica foi mais favorável nos portadores de bola fúngica, que necessitaram menor número de reintervenções.AIM: Fungal rhinosinusitis in patients with chronic sinusal disease study. In the past decades, there has been an increase in fungal infections, and fungal rhinosinusitis (FRS has been diagnosed more frequently. Knowing the fungal flora, its prevalence and symptomatic presentation in patients with chronic rhinosinusitis (CRS will allow a better understanding of this disease, permitting a correct diagnosis, and treatment and formulating its prognosis. STUDY DESIGN: clinical retrospective with transversal cohort. MATERIAL AND METHOD: 62 patients diagnosed with FRS were selected among 890 cases of CRS undergoing endoscopic

  10. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists.

    Science.gov (United States)

    Fokkens, Wytske J; Lund, Valerie J; Mullol, Joachim; Bachert, Claus; Alobid, Isam; Baroody, Fuad; Cohen, Noam; Cervin, Anders; Douglas, Richard; Gevaert, Philippe; Georgalas, Christos; Goossens, Herman; Harvey, Richard; Hellings, Peter; Hopkins, Claire; Jones, Nick; Joos, Guy; Kalogjera, Livije; Kern, Bob; Kowalski, Marek; Price, David; Riechelmann, Herbert; Schlosser, Rodney; Senior, Brent; Thomas, Mike; Toskala, Elina; Voegels, Richard; Wang, De Yun; Wormald, Peter John

    2012-03-01

    The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007. The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed. This executive summary for otorhinolaryngologists focuses on the most important changes and issues for otorhinolaryngologists. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

  11. Impact of chronic rhinosinusitis on work productivity through one-year follow-up after balloon dilation of the ethmoid infundibulum.

    Science.gov (United States)

    Stankiewicz, James; Tami, Thomas; Truitt, Theodore; Atkins, James; Winegar, Bradford; Cink, Paul; Schaeffer, B Todd; Raviv, Joseph; Henderson, Diana; Duncavage, James; Hagaman, David

    2011-01-01

    Although multiple clinical trials have demonstrated that balloon dilation of sinus ostia in patients diagnosed with chronic rhinosinusitis (CRS) results in sustained symptomatic improvement, less data are available to measure the effects of sinusitis on worker productivity. The objective of our research was to analyze work and activity impairment before and after transantral, endoscopically-guided balloon dilation of the maxillary sinus ostia and ethmoid infundibulum. Subjects diagnosed with CRS and computed tomography (CT) evidence of disease in the maxillary sinuses alone, or maxillary and anterior ethmoid sinuses, completed the Work Productivity and Activity Impairment (WPAI) questionnaire and the Work Limitation Questionnaire (WLQ) before treatment and at 3, 6, and 12 months postprocedure. A total of 56 subjects were enrolled and 53 completed the 1-year follow-up. The lost productivity composite score computed from the WLQ improved by 73% (9.0 to 2.4; p productivity at work as measured by the WPAI improved by approximately 76% (38.3 to 9.2; p problems impose a substantial burden on work productivity and physical/mental activity levels. Treatment of CRS by dilating the maxillary sinus ostium and ethmoid infundibulum can significantly improve quality of life (QOL) and work productivity. Copyright © 2011 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.

  12. Superoxide dismutase reduces the inflammatory response to Aspergillus and Alternaria in human sinonasal epithelial cells derived from patients with chronic rhinosinusitis.

    Science.gov (United States)

    Lawrence, Lauren A; Mulligan, Jennifer K; Roach, Catherine; Pasquini, Whitney N; Soler, Zachary M; Banglawala, Sarfaraz M; Karnezis, Tom T; Gudis, David A; Schlosser, Rodney J

    2015-01-01

    Aspergillus fumigatus and Alternaria alternata are ubiquitous environmental fungal allergens that can exacerbate airway inflammation and contribute to the disease process in patients with chronic rhinosinusitis (CRS). These antigens have been shown to induce human sinonasal epithelial cells (HSNECs) to promote a proinflammatory response, but what is unclear is a means by which to reduce these effects. Inhaled pathogens can induce HSNECs to produce reactive oxygen species (ROS) that trigger cytokine production. This study aimed to determine whether the free radical scavenger superoxide dismutase (SOD) could reduce HSNEC-derived inflammation, as measured by interleukin (IL)-6 and IL-8 production, in response to Aspergillus or Alternaria exposure. Sinus tissue explants were collected at the time of surgery from control patients (n = 7) and patients with CRS with nasal polyps (CRSwNP) (n = 9). HSNECs were cultured from the explants and treated with Aspergillus, Alternaria, and SOD for 24 hours. Cell supernatants and lysates were collected, and IL-6 and IL-8 concentrations were measured using enzyme-linked immunosorbent assay. In control and CRSwNP HSNECs, Aspergillus and Alternaria both increased cytokine production (p Alternaria exposure and IL-8 after Aspergillus exposure (p Alternaria, SOD treatment decreases the fungal antigen-induced inflammatory response. The ability to attenuate inflammation induced by common fungal allergens with SOD treatment could provide a novel therapeutic or preventative approach for patients with CRS or other allergic inflammatory airway diseases.

  13. Contemporary management of chronic rhinosinusitis with nasal polyposis in aspirin-exacerbated respiratory disease: an evidence-based review with recommendations.

    Science.gov (United States)

    Levy, Joshua M; Rudmik, Luke; Peters, Anju T; Wise, Sarah K; Rotenberg, Brian W; Smith, Timothy L

    2016-12-01

    Chronic rhinosinusitis (CRS) in aspirin-exacerbated respiratory disease (AERD) represents a recalcitrant form of sinonasal inflammation for which a multidisciplinary consensus on patient management has not been reached. Several medical interventions have been investigated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the multidisciplinary management of CRS in AERD. A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria included: adult population >18 years old; CRS based on published diagnostic criteria, and a presumptive diagnosis of AERD. We focused on reporting higher-quality studies (level 2 or higher) when available, but reported lower-quality studies if the topic contained insufficient evidence. Treatment recommendations were based on American Academy of Otolaryngology (AAO) guidelines, with defined grades of evidence and evaluation of research quality and risk/benefits associated with each treatment. This review identified and evaluated the literature on 3 treatment strategies for CRS in AERD: dietary salicylate avoidance, leukotriene modification, and desensitization with daily aspirin therapy. Based on the available evidence, dietary salicylate avoidance and leukotriene-modifying drugs are options following appropriate treatment with nasal corticosteroids and saline irrigation. Desensitization with daily aspirin therapy is recommended following revision endoscopic sinus surgery (ESS). © 2016 ARS-AAOA, LLC.

  14. Eight weeks of omeprazole 20 mg significantly reduces both laryngopharyngeal reflux and comorbid chronic rhinosinusitis signs and symptoms: Randomised, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Anzić, S A; Turkalj, M; Župan, A; Labor, M; Plavec, D; Baudoin, T

    2018-04-01

    Gastroesophageal reflux recommended treatment (dose and duration) with proton-pump inhibitor (PPI) compared to placebo significantly reduces the signs and symptoms of laryngopharyngeal reflux (LPR) and comorbid chronic rhinosinusitis (CRS). Double-blind randomised placebo-controlled trial. Eight weeks of treatment with omeprazole 20 mg once daily (OD). Sixty patients (28 women, aged 19-87 years) with diagnosed LPR and comorbid CRS. Significant reduction in signs and symptoms (reflux symptom index (RSI) score as subjective, and reflux finding score (RFS) as objective measure) of LPR after 8 weeks of treatment with omeprazole 20 mg OD when compared to placebo. Secondary objectives were significant reduction in signs and symptoms of comorbid CRS after 8 weeks of treatment with omeprazole 20 mg OD when compared to placebo and the association of the severity of signs and symptoms of LPR with the ones of CRS. RSI and RFS decreased significantly more in the active treatment group after 8 weeks compared to placebo (P < .001 for both). CRS and endoscopy scoring decreased both significantly more in the active group after 8 weeks compared to placebo (P < .001 for both). CRS scoring significantly correlated with RSI (R = 0.312, P = .015) but not with RFS (R = 0.199, P = .127). The results of our trial suggest that omeprazole 20 mg OD for 8 weeks was effective in reducing signs and symptoms of both LPR and CRS, although in most patients still present at the end of the trial. © 2017 John Wiley & Sons Ltd.

  15. Rhinosinusitis: A retrospective analysis of clinical pattern and ...

    African Journals Online (AJOL)

    Chronic maxillary sinusitis is a common condition in otolaryngology practice from various regions in Nigeria.[9-15] Ogunleye et al. reported 93% cases of chronic sinusitis in. Ibadan, south western Nigeria, while Sogebi et al. reported 75.6% cases of chronic rhinosinusitis in their study.[10,11] A comparative study in the.

  16. Dead Sea salt irrigations vs saline irrigations with nasal steroids for symptomatic treatment of chronic rhinosinusitis: a randomized, prospective double-blind study.

    Science.gov (United States)

    Friedman, Michael; Hamilton, Craig; Samuelson, Christian G; Maley, Alexander; Wilson, Meghan N; Venkatesan, T K; Joseph, Ninos J

    2012-01-01

    Intranasal steroids are 1 of the most frequently prescribed medications for the treatment of chronic rhinosinusitis (CRS), and saline irrigations are commonly used as an adjunct to medical therapy. We aimed to compare the efficacy of Dead Sea salt (DSS) irrigations and DSS nasal spray vs saline irrigations and topical nasal steroid spray in the treatment of symptoms of CRS. A total of 145 symptomatic adult patients without acute infection were initially enrolled and 114 completed the study. Patients completed a Sino-Nasal Outcomes Test 20 (SNOT-20) survey (primary outcome metric) and underwent endonasal examination, acoustic rhinometry, and smell testing (secondary outcome metrics). Patients were randomized to 2 groups. The experimental group (n = 59) self-administered hypertonic DSS spray and DSS irrigation; the control group (n = 55) self-administered fluticasone spray and hypertonic saline irrigation and spray. Patients and staff were blinded to group assignment. Outcomes were reassessed at 4 weeks. The 2 groups were homogeneous with respect to pretreatment primary and secondary outcome metrics. Dropout rates were 30% in the DSS group and 36.6% in the control group. Both groups showed significant improvement in mean SNOT-20 scores following treatment; however, the degree of improvement was not significantly different between groups (p = 0.082). There were no significant changes in secondary outcome metrics between the 2 groups. For patients with CRS, treatment with DSS irrigations and sprays appears as effective for symptom reduction as a combination of hypertonic saline irrigations and sprays and a topical steroid spray. Copyright © 2011 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.

  17. Corticosteroid nasal irrigations are more effective than simple sprays in a randomized double-blinded placebo-controlled trial for chronic rhinosinusitis after sinus surgery.

    Science.gov (United States)

    Harvey, Richard J; Snidvongs, Kornkiat; Kalish, Larry H; Oakley, Gretchen M; Sacks, Raymond

    2018-04-01

    Persistent mucosal inflammation in patients with chronic rhinosinusitis (CRS) often results in ongoing symptoms, recurrence of polypoid mucosa, infective exacerbations, and further systemic medication despite surgical intervention. Debate exists as to the most effective topical therapy in CRS. The objective was to determine if corticosteroid delivered via a nasal irrigation or via a simple nasal spray would be more effective in controlling the symptoms and signs of CRS. A double-blind placebo-controlled randomized trial over 12 months was performed between 3 tertiary rhinologic clinics. After sinus surgery, all patients performed a nasal irrigation followed by a nasal spray once a day for 12 months. Groups were defined by corticosteroid (2 mg mometasone) delivered by either spray or irrigation. The primary outcomes were patient-reported symptoms: visual analogue score (VAS) and 22-item Sino-Nasal Outcome Test (SNOT-22), a global rating of sinonasal function. Secondary outcomes were also recorded from radiology (Lund-Mackay score [LMS]) and endoscopic (Modified Lund-Kennedy score [mLKS]) assessments. A total of 44 patients were randomized (age 50.3 ± 13.0 years; 40.9% female). Overall, patients improved significantly from either intervention. However, the corticosteroid nasal irrigation group had greater improvement in nasal blockage (-69.91 ± 29.37 vs -36.12 ± 42.94; p = 0.029), a greater improvement on LMS (-12.07 ± 4.43 vs -7.39 ± 6.94; p = 0.031) and less inflammation on mLKS at 12 months (7.33 ± 11.55 vs 21.78 ± 23.37; p = 0.018). One-year posttreatment blockage, drainage, fever, and total VAS scores were all lower in the corticosteroid irrigation group. In the setting of diffuse or patchy CRS disease, the use of corticosteroid delivered by nasal irrigation is superior to simple nasal spray in postsurgical patients. © 2018 ARS-AAOA, LLC.

  18. Computed tomography imaging practice patterns in adult chronic rhinosinusitis: survey of the American Academy of Otolaryngology-Head and Neck Surgery and American Rhinologic Society membership.

    Science.gov (United States)

    Batra, Pete S; Setzen, Michael; Li, Yan; Han, Joseph K; Setzen, Gavin

    2015-06-01

    The objective of this study was to assess the current practice patterns of computed tomography (CT) imaging for diagnosis and management of adult chronic rhinosinusitis (CRS). A 29-item, electronic, Web-based physician survey was disseminated to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and American Rhinologic Society (ARS) membership from November 2012 to January 2013. A total of 331 otolaryngologists completed the survey. Seventy-five percent of respondents did not obtain confirmatory CT imaging prior to initiating medical therapy for CRS. A typical diagnostic scan was considered to be a 3-mm coronal CT with or without 3-mm axial images for 50.6% of participants. On average, the respondents obtained 1 (58.8%) or 2 (36.6%) CT scans prior to proceeding with sinus surgery. CT scanning was most commonly performed in a hospital radiology department (76.4%), followed by a free-standing imaging center (44.5%). An in-office CT scanner was owned by 24.5% of the respondents, mostly commonly a cone beam CT (74.0%) scanner. Most respondents (87.1%) did not experience problems with carriers denying ability to image or reimbursing for scans. Overall, 68.4% of the respondents were unaware of the dosage of radiation delivered by the scanner used for CT acquisition. This survey provides a snapshot of the current utility of CT imaging in the management paradigm for CRS. Given that most are unaware of the delivered radiation dose, this clearly represents an important area of improvement in the knowledge gap. © 2015 ARS-AAOA, LLC.

  19. A randomised, double blind, placebo-controlled, multi-centric parallel arm trial to assess the effects of homoeopathic medicines on chronic rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Raj K Manchanda

    2014-01-01

    Full Text Available Background: Chronic rhinosinusitis (CRS is one of the most common illnesses interfering with patient′s quality of life and work. Observational studies conducted by the Council indicate positive outcome. This protocol has been developed to ascertain the usefulness of homoeopathic intervention in comparison with control group in a randomised control setting. Objectives: Primary objective is to evaluate the changes in TSS (Total Symptoms Score and SNOT-22 (Sino-nasal Outcome Test-22 within the two groups of the study (Homoeopathy + Placebo. Secondary objective is to evaluate changes in SNOT-22 at end of the trial, changes in Lund and Mackay staging of CT scan, rhinoscopy grading, absolute eosinophil count, global assessment by investigator and patient, and number of acute exacerbations of CRS (for frequency, duration and intensity as per TSS scale compared to placebo. Methods/Design: This is a randomised double blind, placebo-controlled, multi-centric parallel arm trial of 6 months (three months treatment and three months observation period with 14 days run-in period. The primary outcome is a composite of the changes in the TSS and SNOT-22 over 3 months from baseline with area under the curve and changes over 3 months in the Sinus Nasal Outcome Test 22 (SNOT-22 from baseline. Prescription shall be made as per the homoeopathic principles. Efficacy data will be analysed in the intention-to-treat population. Discussion: This trial will help to evaluate the efficacy of homoeopathic individualised treatment using LM-potencies versus placebo in patients suffering from CRS as per the homoeopathic dictum.

  20. Effects of mobile phone WeChat services improve adherence to corticosteroid nasal spray treatment for chronic rhinosinusitis after functional endoscopic sinus surgery: a 3-month follow-up study.

    Science.gov (United States)

    Feng, Shaoyan; Liang, Zibin; Zhang, Rongkai; Liao, Wei; Chen, Yuan; Fan, Yunping; Li, Huabin

    2017-03-01

    The objective of the study is to investigate the impact of receiving daily WeChat services on one's cell phone on adherence to corticosteroid nasal spray treatment in chronic rhinosinusitis (CRS) patients after functional endoscopic sinus surgery (FESS). This study was a two-arm, randomized, follow-up investigation. Patients with chronic rhinosinusitis with/without nasal polyps following bilateral FESS were randomised to receive, or to not receive, daily WeChat service on their cell phone to take corticosteroid nasal spray treatment. A prescription of budesonide aqueous nasal spray 128 µg bid was given to all the subjects. Then they returned to the clinic after 30, 60, 90 days. The primary study outcome was adherence to nasal spray treatment, whereas secondary outcomes were change in endoscopic findings and SinoNasal Outcome Test-20 (SNOT-20). On the whole, there was a significant inter-group difference in the change of adherence rate (F = 90.88, p = 0.000). The WeChat group had much higher adherence rate than the control group during the follow-up. In terms of postoperative endoscopic scores and SNOT-20, except granulation score, no significant differences were observed between the two randomization groups. WeChat services are already after a short period of observation associated with improved adherence to corticosteroid nasal spray treatment in CRS patients after FESS.

  1. Differences in the Sino-Nasal Outcome Test 22 and visual analog scale symptom scores in chronic rhinosinusitis with and without nasal polyps.

    Science.gov (United States)

    Gregurić, Tomislav; Trkulja, Vladimir; Baudoin, Tomislav; Grgić, Marko; Šmigovec, Igor; Kalogjera, Livije

    2016-01-01

    Chronic rhinosinusitis (CRS) with and without polyps has a high impact on health-related quality of life (HRQL), but the difference in HRQL and symptom presentation between two clinical phenotypes of CRS has not been specifically evaluated before now. To evaluate patterns of symptoms and HRQL disease-specific domains affected in patients with CRS by comparing differences between two clinical phenotypes, adjusted for demographics, major risk factors, comorbidities, current medical treatment, and previous surgery. A group of 251 patients with CRS completed the visual analog scale (VAS) symptom severity score and the Sino-Nasal Outcome Test 22 (SNOT-22) questionnaire. Data sets were analyzed by using principal component analysis (PCA) to identify a set of symptom components, together with the items excluded from PCA, which were then analyzed for differences between patients with CRS with nasal polyps (CRSwNP) and patients with CRS without nasal polyps (CRSsNP). PCA of SNOT-22 items identified six components, three referred to CRS-specific symptoms termed "nasal"; "extranasal, rhinologic"; and "olfactory/cough"; and three referred to HRQL impairment termed "sleep disturbance," "functional disturbance," and "emotional disturbance." Nasal obstruction, ear pain, ear fullness, and fatigue were excluded from PCA and treated as separate outcomes. Patients with CRSwNP had significantly worse nasal symptoms, olfactory/cough symptoms, and nasal obstruction. Patients with CRSsNP scored significantly worse with regard to fatigue and to sleep and functional disturbances. The PCA results for VAS scores identified three symptom components: pain, nasal symptoms, and pharyngeal symptoms. Patients with CRSwNP had significantly worse VAS nasal symptoms but less pronounced VAS pain symptoms than patients with CRSsNP. The total SNOT-22 score between the groups was not significantly different. With controlling of covariates that may influence the severity of the disease, this study showed

  2. Age-Related Increased Prevalence of Asthma and Nasal Polyps in Chronic Rhinosinusitis and Its Association with Altered IL-6 Trans-Signaling

    Science.gov (United States)

    Kim, Dae Woo; Lee, Sun H.; Kolliputi, Narasaiah; Hong, Seung J.; Suh, Lydia; Norton, James; Hulse, Kathryn E.; Seshadri, Sudarshan; Conley, David B.; Kern, Robert C.; Tan, Bruce K.; Peters, Anju; Grammer, Leslie C.; Schleimer, Robert P.

    2015-01-01

    We report that S100 proteins were reduced in patients with chronic rhinosinusitis (CRS). S100A8/9, which is important in epithelial barrier function, was particularly decreased in elderly patients with CRS. Epithelial expression of S100A8/9 is partly regulated by the IL-6 trans-signaling pathway. The goal of this study was to investigate whether or not age-related reduction of S100A8/9 in CRS is associated with blunting of IL-6 trans-signaling. The levels of IL-6, soluble IL-6 receptor (sIL-6R), soluble gp130 (sgp130), and S100A8/9 from control subjects (n = 10), and patients with CRS without nasal polyps (n = 13) and those with CRS with nasal polyps (CRSwNP) (n = 14), were measured by ELISA. Age-related differences in the level of each protein were investigated. Normal human bronchial epithelial cells were cultured in air–liquid interface and stimulated with IL-6/sIL-6R and tumor necrosis factor (TNF)-α with or without the addition of sgp130, a natural inhibitor of IL-6 trans-signaling. There was a significant age-related decline in S100A8/9 and an increase in sgp130 in nasal tissue samples from patients with CRSwNP, although there was no age-related difference in IL-6/sIL-6R production. Additionally, expression of the S100A8/9 gene and protein was increased significantly by IL-6/sIL-6R plus TNF-α in normal human bronchial epithelial cells. This increase was blocked by sgp130. These results suggest that increased sgp130 in older patients may inhibit IL-6 trans-signaling, impair barrier function, and decrease S1008/9 production in elderly patients with CRSwNP. Restoration of barrier function by targeting sgp130 may be a novel treatment strategy. PMID:26266960

  3. Management and Outcome of Rhinosinusitis in Nigeria

    Directory of Open Access Journals (Sweden)

    Olushola Abdulrahman Afolabi FWACS

    2017-01-01

    Full Text Available Objective The aim of this study is to present the management and outcome of treatment of rhinosinusitis in Nigeria. Study Design A retrospective review of the case notes of patients with rhinosinusitis between January 2009 and December 2014. Setting Study at the University of Ilorin Teaching Hospital, Nigeria, using retrieved case notes after ethical approval was received. Subjects and Methods The information retrieved included sociodemographic data, clinical presentation, duration, endoscopic examination, and other clinical management protocols with follow-up. All information was entered into SPSS version 20 and analyzed descriptively, and results are presented in tables and figure. Results A total of 5618 patients were seen in the ear, nose, and throat clinic over the 6-year period. Of the patients, 445 had rhinosinusitis, and only 410 had complete data for analysis. Patient age ranged from 2 to 75 years (mean ± SD, 31.8 ± 1.2 years. The male to female ratio was 1.2:1. The duration of symptoms varied from 3 days to 10 years, with 78.7% having symptoms between 3 and 120 months. About 82.4% had nasal discharge, 51.3% had sneezing, 78.9% had alternating nasal obstruction, and 49.3% had nasal itch. Of the patients, 61.4% had a predisposition, of which 30.9% were allergic, 23.3% were infective, and 7.2% were vasomotor. Ethmoidal-maxillary sinuses were commonly affected radiologically. About 63% of patients had medical treatment, and only 28.7% had surgical intervention, of which 37% were scheduled for surgical treatment and 7.3% refused. Improved symptoms were noticed in 72.6% of patients, and 1.4% reported no improvement. Conclusion Rhinosinusitis is still common, affecting active males economically with more chronic cases and more allergic predisposition. Early medical management is still effective, and endoscopic sinus surgery is now a better surgical option with better outcome in 72.6%.

  4. Is fruit and vegetable intake associated with asthma or chronic rhino-sinusitis in European adults? Results from the Global Allergy and Asthma Network of Excellence (GA2LEN) Survey

    DEFF Research Database (Denmark)

    Garcia-Larsen, Vanessa; Arthur, Rhonda; Potts, James F.

    2017-01-01

    was negatively associated with intake of dried fruits (β-coefficient -2.34; 95% confidence interval [CI] -4.09, -0.59), whilst CRS was statistically negatively associated with total intake of fruits (OR 0.73; 95% CI 0.55, 0.97). Conversely, a positive association was observed between asthma score and alliums......Background: Fruits and vegetables are rich in compounds with proposed antioxidant, anti-allergic and anti-inflammatory properties, which could contribute to reduce the prevalence of asthma and allergic diseases. Objective: We investigated the association between asthma, and chronic rhino......-sinusitis (CRS) with intake of fruits and vegetables in European adults. Methods: A stratified random sample was drawn from the Global Allergy and Asthma Network of Excellence (GA2LEN) screening survey, in which 55,000 adults aged 15-75 answered a questionnaire on respiratory symptoms. Asthma score (derived from...

  5. CITRIC-ACID COUGH THRESHOLD AND AIRWAY RESPONSIVENESS IN ASTHMATIC-PATIENTS AND SMOKERS WITH CHRONIC AIR-FLOW OBSTRUCTION

    NARCIS (Netherlands)

    AUFFARTH, B; DEMONCHY, JGR; VANDERMARK, TW; POSTMA, DS; KOETER, GH

    The relation between citric acid cough threshold and airway hyperresponsiveness was investigated in 11 non-smoking patients with allergic asthma (mean FEV1 94% predicted) and 25 non-atopic smokers with chronic airflow obstruction (mean FEV1 65% predicted). Cough threshold was determined on two

  6. Dental Erosion and Dentin Hypersensitivity among Adult Asthmatics and Non-asthmatics Hospital-based: A Preliminary Study.

    Science.gov (United States)

    Farag, Zahra Hassan Abdelaziz; Awooda, Elhadi Mohieldin

    2016-01-01

    Asthma is a chronic inflammatory condition affecting the airways leading to spasm and swelling of the airways. The medications taken for the treatment of asthma can result in dental erosion and dentin hypersensitivity. The aims of this study were to investigate the severity of dental erosion amongst adult asthmatics according to: gender, type and duration of medication taken and to compare dental erosion and dentin hypersensitivity between asthmatics and non-asthmatics. Comparative, cross-sectional hospital based study among 40 asthmatics (M=15 & F=25) and 40 non-asthmatics (M=18 & F=22) in the age range of 18-60 year selected purposefully from Al-Shaab Teaching Hospital in Khartoum city. The Basic Erosive Wear Index was used for dental erosion assessment. Dentine hypersensitivity was determined by giving ice cold water and rated using the Visual Analogue Scale. Chi-square and Student's t-test were used for statistical analysis with P value ≤.05. There was an association between severity of dental erosion and presence of asthma (P=0.03), where asthmatics had a higher degree of erosion (moderate and severe) and non-asthmatics a lower degree. No significant association was found between dental erosion and gender, type and duration of medication among asthmatics group. A statistically significant difference was revealed in the degree of dentin hypersensitivity (P=0.00) among asthmatics (35.13%) and non-asthmatics (14.13%). Asthmatic patients had a higher degree of dental erosion and dentin hypersensitivity compared to non-asthmatics. Among asthmatic patients there was no association between severity of dental erosion and gender, type and duration medication was taken for.

  7. European Position Paper on Rhinosinusitis and Nasal Polyps 2012: Updates and highlights on diagnosis and treatment of rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Ren-wu CHEN

    2013-02-01

    Full Text Available Rhinosinusitis is one of the most common chronic inflammatory diseases worldwide. It has been associated with many diseases, including allergic and non-allergic rhinitis, asthma, nasal polyps, aspirin sensitivity, cystic fibrosis, immotile cilia syndrome, immunodeficiency, airway infection, otitis media and dental diseases. Due to the complexity in clinical manifestation and classification of rhinosinusitis, and their associated etiology and pathophysiology, evidence based consensus on diagnosis and treatment is important in order to enhance the effectiveness of available treatment and the quality of life of the patients. Since patients with rhinosinusitis may consult a wide range of clinicians, including otolaryngologists, allergists, pulmonologists and paediatricians, clinical guidelines or consensus with the evidence based diagnostic and treatment scheme for rhinosinusitis for different specialists are very important. The first European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS was published in 2005 by the European Academy of Allergology and Clinical Immunology in the Journal of “Rhinology”, and the updated versions were published in 2007 and 2012 in the same journal. EP3OS 2007 had been endorsed by many international medical societies, including WHO (e.g., InterAirway document, and the full document was translated into more than 15 languages, and its contents have been widely endorsed, as some chapters were significantly enriched, as extensive up-to-date information on epidemiology, predisposing factors, pediatric aspects and randomized double-blinded placebo-controlled studies in the treatment of rhinosinusitis were added, and it encourages further clinical and basic research in this field in the future.

  8. Serum Zinc Level in Asthmatic and Non-Asthmatic School Children

    Directory of Open Access Journals (Sweden)

    Atqah AbdulWahab

    2018-03-01

    Full Text Available Asthma is one of the most common chronic disorders among children. Zinc (Zn is an essential dietary antioxidant and may have a special role in assisting the airways of asthmatic subjects. The primary objective of this study was to measure serum Zn levels among asthmatic school children and to compare this to the serum Zn level in non-asthmatic children. The secondary objective was to investigate the relationship between Zn levels and the degree of asthma control. A cross-sectional study following forty asthmatic children and forty matched non-asthmatic children of both genders was conducted. Weight, height, body mass index (BMI, BMI Z-scores, serum Zn, hemoglobin, total protein, and albumin concentrations were measured in both groups. Serum immunoglobulin E (IgE levels, the forced expiratory volume in 1 second (FEV1, and dosage of inhaled steroids were measured in asthmatic school children. The results show the mean Zn level among asthmatic children was 12.78 ± 1.8 μmol/L. Hypozincemia was detected in four asthmatic children. Asthma and control groups were matched in age, gender, and BMI Z score (p > 0.05. No significant difference was observed in Zn levels, hemoglobin, albumin, and total protein between both groups (p > 0.05. Among asthmatics, Zn levels were not significantly associated with the degree of asthma control (well controlled, mean Zn = 12.9 ± 1.5, partially controlled, mean Zn = 11.9 ± 1.6, and uncontrolled, mean Zn = 3.62 ± 2.2 (p = 0.053. The Zn level was not correlated with the FEV1 Z score. There was no significant association between Zn level and the dosage of inhaled steroids or IgE concentrations (p > 0.05. The findings show that Zn may not play a major role in the degree of asthma control. Larger studies are needed to confirm these results.

  9. Can asthmatic subjects dive?

    Directory of Open Access Journals (Sweden)

    Yochai Adir

    2016-06-01

    Full Text Available Recreational diving with self-contained underwater breathing apparatus (scuba has grown in popularity. Asthma is a common disease with a similar prevalence in divers as in the general population. Due to theoretical concern about an increased risk for pulmonary barotrauma and decompression sickness in asthmatic divers, in the past the approach to asthmatic diver candidates was very conservative, with scuba disallowed. However, experience in the field and data in the current literature do not support this dogmatic approach. In this review the theoretical risk factors of diving with asthma, the epidemiological data and the recommended approach to the asthmatic diver candidate will be described.

  10. IMMUNOTHERAPY EFFICIENCY IN RHINOSINUSITIS PATIENTS

    Directory of Open Access Journals (Sweden)

    I. V. Stagnieva

    2015-01-01

    Full Text Available Latent rhinosinusitis proceeds without facial pain symptoms. Immune deficiency plays a leading role in pathogenesis of the disease latency. Substance P seems to be a universal mediator of painful irritation and inflammation. The objective of our study was to determine effectiveness of therapies in patients with latent rhinosinusitis, in terms of substance P levels.We treated 148 patients with rhinosinusitis, being free of local pains. All the patients underwent clinical and laboratory examination, including immune profile assessment, measurements of serum cytokines IL-1β, IL-4, IL-6, IL-8, IL-10, TNFα, IFNγ, and substance P. To correct a secondary immunodeficiency, the standard treatment of rhinosinusitis in a subgroup of the patients was accomplished by immunomodulatory drugs from the first day of therapy. The latter drugs were avoided for the rest of study group. Efficacy of treatment was evaluated by clinical signs and laboratory parameters on day 7 of the medication. Pre-treatment levels of substance P were determined in all the patients with latent clinical course and lack of pain symptoms. Low substance P levels (< 100 pg /ml were considered as indications for immunomodulatory therapy, due to immune deficiency confirmed by the cytokine imbalance. Choice of a specific drug was dependent on immunopathogenesis, i.e., for catarrhal rhinosinusitis and deficiency of cellular immunity, we administered IFN-ES-lipint; in cases of purulent rhinosinusitis, Likopid was applied. The patients treated with immunomodulatory drugs showed improvement of immune indexes by the 7th day of treatment, along with return of substance P levels to control values typical to healthy persons. Among patients with low substance P levels and immune deficiency (without immunomodulatory treatment, the immune parameters and substance P levels did not exhibit any sufficient changes over time.Low contents of substance P (SP ≤ 100 pg /ml in blood serum in pain

  11. Fungal rhinosinusitis with atypical presentation – a report of two cases

    Directory of Open Access Journals (Sweden)

    Rafael da Costa Monsanto

    2015-05-01

    Full Text Available Rhinosinusitis affects approximately 20% of the population, and the chronic rhinosinusitis represents over 90% of all cases of rhinosinusitis. The correct diagnosis is important for proper treatment and to predict its evolution. This study presents two cases of atypical frontal sinus disease, which the follow-up revealed a diagnosis of fungal rhinosinusitis. The present study aims to describe the cases of two patients with atypical lesions on the left frontal sinus; the treatment options, surgical approach, results, diagnosis and follow-up are further discussed. A significant increase in the reported cases of fungal rhinosinusitis has been seen in the last two decades, justified by the use of broad-spectrum antibiotics and steroids, as well as the increased number of immunocompromised individuals. This study reports the cases of two patients with a type of fungal rhinosinusitis named "fungal ball", characterized by a tangle of hyphae in the sinuses without tissue invasion. The treatment included surgical removal of the fungal infectious process with aeration of the affected sinus, and the procedure was successfully performed in our patients.

  12. Pathogenesis of chronic rhinosinusitis in patients affected by β-thalassemia major and sickle cell anaemia post allogenic bone marrow transplant.

    Science.gov (United States)

    Martino, F; Di Mauro, R; Paciaroni, K; Gaziev, J; Alfieri, C; Greco, L; Floris, R; Di Girolamo, S; Di Girolamo, M

    2018-03-01

    Sickle cell anemia (SCA) and β -thalassemia major are well-recognized beta-globin gene disorders of red blood cells associated to mortality and morbidity included bone morbidities due to ineffective erythropoiesis and bone marrow expansion, which affect every part of the skeleton. While there are an abundance of described disease manifestations of the head and neck, the manner of paranasal sinuses involvement and its relations to β-thalassemia and SCA process was not studied yet. Therefore, the aim of this study was to investigate a possible increased risk of rhinosinusitis and the real pathogenetic mechanism of it, comparing these two hematological diseases using msCT, gold standard for paranasal sinuses evaluation. A retrospective analysis of 90 patients affected by β-thalassemia major or SCA (respectively 59 and 31) underwent allogeneic bone marrow transplantation (BMT), and 44 control subjects was performed. Both patient categories and control group have been subjected to hematological and radiological evaluation using 64-multidetector-row CT scanner without contrast injection. Statistical analysis reveals that patients of the two study groups exhibit a significantly increased risk of sinusitis in comparison with the normal controls (RR: 3.55 for β-thalassemic pediatric subjects; RR: 3.35 for SCA pediatric subjects). A significant difference (p < 0,5) was found between the β -thalassemic patients on the one side, and SCA and control group on the other side, with regard to the evaluation of the typical anatomic alteration of maxillary sinus: β-thalassemic children had significant increase in the bone thickness of anterior and lateral sinus walls and significant reduction in volume and density compared to SCA patients and control group, with normal conditions of these parameters. In these hematological patients, there is an increased incidence of sinonasal infections due their therapy-induced immunosuppression post transplantation. In

  13. FcɛR1α gene polymorphism shows association with high IgE and anti-FcɛR1α in Chronic Rhinosinusitis with Nasal Polyposis.

    Science.gov (United States)

    Dar, Sajad A; Rai, Gargi; Ansari, Mohammad A; Akhter, Naseem; Gupta, Neelima; Sharma, Sonal; Haque, Shafiul; Ramachandran, Vishnampettai G; Wahid, Mohd; Rudramurthy, Shivprakash M; Chakrabarti, Arunaloke; Das, Shukla

    2017-12-15

    Despite large number of investigations, the etiology of chronic rhinosinusitis (CRS) remains unclear. Several factors are likely involved in its onset. The genetic susceptibility of IgE-responsiveness likely caused by polymorphism(s) in high affinity receptor for IgE (FcɛR1α) gene can help in understanding the pathophysiology of CRS with nasal polyposis (CRSwNP). A population-based case-control association analysis was conducted to assess the risk of CRSwNP conferred by single nucleotide polymorphisms (SNPs) in FcɛR1α gene in a North Indian cohort. Two promoter and three exonic regions of FcɛR1α gene were amplified and sequenced to investigate five SNPs: rs2427827, rs2251746, rs2298804, rs2298805, and rs2269718. BLAST analysis and subsequent multiple alignments, with known sequences available in the NCBI database, were performed. Total serum IgE and FcɛR1α antibody levels were estimated. Patient IgE level of 461.22 ± 436.43 in comparison to 83.62 ± 58.043 IU/mL in controls (P IgE level CRSwNP patients. Nonetheless, we found no SNP associated with low serum IgE level patients. SNP (rs2427827) in the FcɛR1α gene region and high IgE levels may confer susceptibility to CRSwNP in north Indian population. However, further studies including larger sample size, gene-gene, and gene-environment interactions are required for its elucidation. © 2017 Wiley Periodicals, Inc.

  14. Phenotype and Functional Features of Human Telomerase Reverse Transcriptase Immortalized Human Airway Smooth Muscle Cells from Asthmatic and Non-Asthmatic Donors

    NARCIS (Netherlands)

    Burgess, J. K.; Ketheson, A.; Faiz, A.; Rempel, K. A. Limbert; Oliver, B. G.; Ward, J. P. T.; Halayko, A. J.

    2018-01-01

    Asthma is an obstructive respiratory disease characterised by chronic inflammation with airway hyperresponsiveness. In asthmatic airways, there is an increase in airway smooth muscle (ASM) cell bulk, which differs from non-asthmatic ASM in characteristics. This study aimed to assess the usefulness

  15. Predictors of olfactory dysfunction in rhinosinusitis using the brief smell identification test.

    Science.gov (United States)

    Alt, Jeremiah A; Mace, Jess C; Buniel, Maria C F; Soler, Zachary M; Smith, Timothy L

    2014-07-01

    Associations between olfactory function to quality-of-life (QOL) and disease severity in patients with rhinosinusitis is poorly understood. We sought to evaluate and compare olfactory function between subgroups of patients with rhinosinusitis using the Brief Smell Identification Test (B-SIT). Cross-sectional evaluation of a multicenter cohort. Patients with recurrent acute sinusitis and chronic rhinosinusitis with and without nasal polyposis were prospectively enrolled from three academic tertiary care sites. Each subject completed the B-SIT, in addition to measures of disease-specific QOL. Patient demographics, comorbidities, and clinical measures of disease severity were compared between patients with normal (BSIT≥9) and abnormal (BSIT<9) olfaction scores. Regression modeling was used to identify potential risk factors associated with olfactory impairment. Patients with rhinosinusitis (n=445) were found to suffer olfactory dysfunction as measured by the B-SIT (28.3%). Subgroups of rhinosinusitis differed in the degree of olfactory dysfunction reported. Worse disease severity, measured by computed tomography and nasal endoscopy, correlated to worse olfaction. Olfactory scores did not consistently correlate with the Rhinosinusitis Disability Index or Sinonasal Outcome Test scores. Regression models demonstrated nasal polyposis was the strongest predictor of olfactory dysfunction. Recalcitrant disease and aspirin intolerance were strongly predictive of worse olfactory function. Olfactory dysfunction is a complex, multifactorial process found to be differentially expressed within subgroups of rhinosinusitis. Olfaction was associated with disease severity as measured by imaging and endoscopy, with only weak associations to disease-specific QOL measures. 2b. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  16. Post-septal orbital complications of acute bacterial rhinosinusitis: Endoscopic anatomical considerations

    Directory of Open Access Journals (Sweden)

    Ahmed A. Ibrahim

    2015-11-01

    The study was carried out on 240 patients suffering from acute rhino-sinusitis with 90 patients suffering from orbital post-septal complicating acute rhino-sinusitis. Eighty-five cases underwent orbital decompression, except 5 cases with orbital cellulitis; they were improved on medical treatment. Visual monitoring by the ophthalmological team on regular basis was performed, until clinical and radiological improvement of the condition. This study proves that there may be a relationship between anatomic variation and orbital infections complicating acute sinusitis or acute on top of chronic sinusitis.

  17. Inflammatory Biomarkers During Bacterial Acute Rhinosinusitis.

    Science.gov (United States)

    Autio, Timo J; Koskenkorva, Timo; Koivunen, Petri; Alho, Olli-Pekka

    2018-02-21

    Diagnosis of bacterial acute rhinosinusitis is difficult. Several attempts have been made to clarify the diagnostic criteria. Inflammatory biomarkers are easily obtainable variables that could shed light on both the pathophysiology and diagnosis of bacterial acute rhinosinusitis. The purpose of this review article is to assess literature concerning the course of inflammatory biomarkers during acute rhinosinusitis and the use of inflammatory biomarkers in diagnosing bacterial acute rhinosinusitis. We included C-reactive protein, erythrocyte sedimentation rate, white blood cell counts, procalcitonin, and nasal nitric oxide in this review and found that especially elevated C-reactive protein and erythrocyte sedimentation rate are related to a higher probability of a bacterial cause of acute rhinosinusitis. Still, normal levels of these two biomarkers are quite common as well, or the levels can be heightened even during viral respiratory infection without suspicion of bacterial involvement. Elevated levels of C-reactive protein or erythrocyte sedimentation rate support diagnosis of bacterial acute rhinosinusitis, but due to a lack of sensitivity, they should not be used to screen patients for bacterial acute rhinosinusitis.

  18. An assessment of asthmatic patients at four Western Cape ...

    African Journals Online (AJOL)

    Objectives. To identify the profile of asthmatic patients visiting community pharmacies and to assess the appropriateness of their current asthma therapy. Design. Patients were identified as either chronic, newly diagnosed or undiagnosed. Asthma status was assessed from their current symptom and medication profiles and ...

  19. Diagnóstico de rinossinusite crônica em pacientes com fibrose cística: correlação entre anamnese, nasofibroscopia e tomografia computadorizada Diagnosis of chronic rhinosinusitis in patients with cystic fibrosis: correlation between anamnesis, nasal endoscopy and computed tomography

    Directory of Open Access Journals (Sweden)

    Letícia Boari

    2005-12-01

    cística.The sinonasal involvement is one of the most common manifestations in cystic fibrosis. Data show a high incidence of chronic rhinosinusitis in these patients. Although it has been found radiographic opacification of the sinus in more than 90% of cases, few are symptomatic. So that, it is difficult to recognize nasossinusal disease in patients with cystic fibrosis. Questionnaire, nasal endoscopy and CT-scan are very important methods in this approach. AIM: To evaluate the diagnosis of chronic rhinosinusitis in patients with cystic fibrosis by anamnesis, nasal endoscopy and CT-scan and compare those results. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Evaluation of 34 patients - older than 6 years and with a confirmed diagnoses of cystic fibrosis - by anamnesis (questionnaire, nasal endoscopy (score Lund-Kennedy and CT-scan (score Lund-Mackay. RESULTS: chronic rhinosinusitis was confirmed in: 20,58% of cases by the questionnaire, 73,52% of the cases by the nasal endoscopy and in 93,54% of the cases by the CT-scan. The results showed significant differences. The correlation between nasal endoscopy score (Lund-Kennedy score and CT-scan score (Lund-Mackay score was statistically significant. CONCLUSION: The diagnosis of chronic rhinosinusitis was statistically different between the three methods. It was higher in imaging analysis and lower in questionnaire. The nasal endoscopy is an excellent method to evaluate nasossinusal disease in cystic fibrosis.

  20. Acute bacterial rhinosinusitis in adults: part I. Evaluation | Scheid ...

    African Journals Online (AJOL)

    Acute rhinosinusitis is one of the most common conditions that physicians treat in ambulatory practice. Although often caused by viruses, it sometimes is caused by bacteria, a condition that is called acute bacterial rhinosinusitis. The signs and symptoms of acute bacterial rhinosinusitis and prolonged viral upper respiratory ...

  1. Steroid Phobia among Parents of Asthmatic Children: Myths and Truth.

    Science.gov (United States)

    Zedan, Magdy M; Ezz El Regal, Mohammed; A Osman, Engy; E Fouda, Ashraf

    2010-09-01

    Asthma is one of the most common chronic diseases of childhood. Inhaled corticosteroids (ICS) are the recommended controller drug for asthma treatment. The aim of our study was to determine concerns and fears of parents of children with asthma towards the use of ICS. One hundred parents of asthmatic children were interviewed using structural questionnaire. Airway inflammation was reported by only 6% of interviewed parents, whereas airway narrowing was addressed by 34%. Interesting data, 71% of parents were concerned with the role of steroids in asthma treatment, but more than half (53%) of them addressed fears from side effects. Apparent gaps were found in knowledge of parents of asthmatic children about ICS as controller asthma medication. So, physician and health providers should explain to asthmatic parents that airway inflammation is the core for asthma management. This may remove fears about ICS and thus improve adherence to treatment.

  2. Microbiologia dos seios maxilar e etmoidal em pacientes com rinossinusite crônica submetidos à cirurgia funcional endoscópica dos seios paranasais Microbiology of the maxillary and ethmoid sinuses in patients with chronic rhinosinusitis submitted to functional endoscopic sinus surgery

    Directory of Open Access Journals (Sweden)

    Josiane Faria de Aguiar Nigro

    2006-04-01

    Full Text Available Estudos da microbiologia da rinossinusite crônica mostram a presença de microorganismos aeróbicos, anaeróbicos, fungos e vírus e sua incidência varia de acordo com cada estudo. Estes estudos nos guiam para a escolha do antimicrobiano mais adequado para eliminar o processo infeccioso, ajudando a restaurar a mucosa nasossinusal. FORMA DE ESTUDO: Clínico prospectivo. OBJETIVO: O objetivo deste trabalho foi estudar a microbiologia dos seios maxilar e/ou etmoidal de pacientes com rinossinusite crônica e com indicação de cirurgia funcional endoscópica dos seios paranasais. MATERIAIS E MÉTODOS: Durante a cirurgia coletamos, em 41 pacientes, secreção e/ou fragmento de mucosa dos seios maxilar e/ou etmoidal para realização de bacterioscopia, pesquisa direta de fungos, cultura para microorganismos aeróbios, anaeróbios e fungos. RESULTADOS: Identificou-se a presença de microorganismos aeróbios em 21 pacientes (51,2%, anaeróbios em 16 (39% e fungos em 1 (2,4%. Na população estudada, apenas em 12 (29,2% o microorganismo isolado foi considerado patogênico quando analisado junto à contagem semiquantitativa de leucócitos. O Staphylococcus coagulase-negativo e o Staphylococcus aureus foram os microorganismos mais freqüentes, em 5 (12,1% e em 4 pacientes (9,75% respectivamente. CONCLUSÃO: Este estudo revela que o Staphylococcus coagulase-negative e o Staphylococcus aureus foram os microorganismos mais freqüentes isolados nos pacientes com rinossinusite crônica.Chronic rhinosinusitis microbiology studies show the presence of aerobe and anaerobe microorganisms, fungus and virus and their incidence vary according to each study. These studies guide us on choosing the most adequate antimicrobial agent to eliminate the infectious process, thus, helping in restoring rhinosinusal mucosa. STUDY DESIGN: Clinical prospective. AIM: This work aimed at studying the microbiology of the maxillary and/or ethmoid sinuses of patients with chronic

  3. Impaired mucociliary clearance in allergic rhinitis patients is related to a predisposition to rhinosinusitis.

    Science.gov (United States)

    Vlastos, Ioannis; Athanasopoulos, Ioannis; Mastronikolis, Nicholas S; Panogeorgou, Theodora; Margaritis, Vassilios; Naxakis, Stefanos; Goumas, Panos D

    2009-04-01

    Although mucociliary clearance has been shown to be impaired in patients with allergic rhinitis and chronic rhinosinusitis, its exact role in relation to a predisposition to rhinosinusitis is unknown. To investigate this possible association, we conducted a prospective study of 125 patients with allergic rhinitis. Of this group, 23 patients were classified as being sinusitis-prone based on their history of antibiotic consumption for the treatment of rhinosinusitis; the remaining 102 patients were deemed to be not sinusitis-prone. The saccharine test was used to evaluate mucociliary clearance in all patients. Several variables-age, sex, smoking habits, rhinitis severity, and medication history-were examined. We found that the sinusitis-prone patients had a significantly greater mucociliary clearance time than did those who were not prone (median: 15 and 12 min, respectively; p = 0.02). No other statistically significant differences were seen between the 2 groups with respect to any other variables that might have affected mucociliary clearance. We conclude that impaired mucociliary clearance in allergic rhinitis patients is associated with a predisposition to rhinosinusitis.

  4. Dengue 2 virus enhancement in asthmatic and non asthmatic individual

    Directory of Open Access Journals (Sweden)

    Maria G. Guzman

    1992-12-01

    Full Text Available During the 1981 dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS Cuban epidemic, bronchial asthma (BA was frequently found as a personal or family antecedent in dengue hemorragic fever patients. Considering that antibody dependent enhancement (ADE plays an important role in the etiopathogenic mechanism of DHF/DSS, we decide to study the Dengue 2 virus (D2V capability of replication in peripheral blood leukocytes (PBL from asthmatic patients and healthy persons. In 90% of asthmatic patients and 53.8% of control group it was obtained PBL with a significant D2V enhancing activity (X² p < 0.01. Power enhancement was higher in asthmatic group. This is the first in vitro study relating BA and the dengue 2 virus immuno enhancement. The results obtained support the role of BA as a risk factor for DHF/DSS as already described on epidemiological data.

  5. Phenotype and Functional Features of Human Telomerase Reverse Transcriptase Immortalized Human Airway Smooth Muscle Cells from Asthmatic and Non-Asthmatic Donors.

    Science.gov (United States)

    Burgess, J K; Ketheson, A; Faiz, A; Limbert Rempel, K A; Oliver, B G; Ward, J P T; Halayko, A J

    2018-01-16

    Asthma is an obstructive respiratory disease characterised by chronic inflammation with airway hyperresponsiveness. In asthmatic airways, there is an increase in airway smooth muscle (ASM) cell bulk, which differs from non-asthmatic ASM in characteristics. This study aimed to assess the usefulness of hTERT immortalisation of human ASM cells as a research tool. Specifically we compared proliferative capacity, inflammatory mediator release and extracellular matrix (ECM) production in hTERT immortalised and parent primary ASM cells from asthmatic and non-asthmatic donors. Our studies revealed no significant differences in proliferation, IL-6 and eotaxin-1 production, or CTGF synthesis between donor-matched parent and hTERT immortalised ASM cell lines. However, deposition of ECM proteins fibronectin and fibulin-1 was significantly lower in immortalised ASM cells compared to corresponding primary cells. Notably, previously reported differences in proliferation and inflammatory mediator release between asthmatic and non-asthmatic ASM cells were retained, but excessive ECM protein deposition in asthmatic ASM cells was lost in hTERT ASM cells. This study shows that hTERT immortalised ASM cells mirror primary ASM cells in proliferation and inflammatory profile characteristics. Moreover, we demonstrate both strengths and weaknesses of this immortalised cell model as a representation of primary ASM cells for future asthma pathophysiological research.

  6. Telemonitorização domiciliária de insuficientes respiratórios crónicos graves e de doentes asmáticos Home telemonitoring of severe chronic respiratory insufficient and asthmatic patients

    Directory of Open Access Journals (Sweden)

    Manuela Zamith

    2009-05-01

    at the hospital Pulido Valente and Espirito Santo and 21 asthmatics (A were followed at the latter hospital. The use and acceptance of this device was evaluated through questionnaires soliciting patients’ and health professionals opinions. Patients with CRI followed in Lisbon were also asked about hospital admissions and quality of life compared with a nine month period before the monitoring programme. CRI patients found learning to use the system more difficult; the majority (80% reported problems with the equipment, qualified as rare/occasional in 62% of the cases. For 31 CRI patients followed in Lisbon, the use of the system was classified as correct in 12 patients, incorrect in 7 and reasonable in 12 patients. The first group had a reducded number and duration of hospital admissions and also improved quality of life. With this remote monitoring system 80% of CRI patients reported they were more/much more supported and 33 patients (75% would use this system in the future. 81% of asthmatic patients would also like to maintain this type of monitoring. The service was considered useful by the researchers. We concluded that home telemonitoring was a positive contribution to the management of chronic patients and raised awareness of it should be considered in the future.

  7. Streptococcus pneumoniae Drugs Resistance in Acute Rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Chong Jie Hao

    2016-03-01

    Full Text Available Background: Acute rhinosinusitis that usually caused by Streptococcus pneumoniae becomes the reason why patients seek for medical care. Drugs resistance in Streptococcus pneumoniae is increasing worldwide. This study was conducted to determine drugs resistance of Streptococcus pneumonia from acute rhinosinusitis in Dr. Hasan Sadikin General Hospital. Methods: A descriptive laboratory study was conducted in June–October 2014 at the Laboratory of Microbiology Faculty of Medicine Universitas Padjadjaran. The sample was taken using nasopharyngeal swabbing from 100 acute rhinosinusitis patients in Dr. Hasan Sadikin General Hospital and planted on tryptic soy agar containing 5% sheep blood and 5 μg/ml of gentamicin sulphate and then incubated in 5% CO2 incubator at 37°C for 24 hours. The identification of Streptococcus pneumonia was performed by optochin test. The susceptibility test against Streptococcus pneumoniae was done using disk diffusion method.The antibiotic disks were trimethoprim-sulfamethoxazole, oxacillin, levofloxacin, azithromycin, and doxycycline. Results: Out of 100 samples, 8 of them were tested positive for Streptococcus pneumoniae. Three of Streptococcus pneumoniae isolates died with unknown reason after it were stored at -80 .The drugs resistance test showed the resistance of Streptococcus pneumonia to oxacillin, azithromycin and trimethoprim were 6, whereas levofloxacin and doxycycline are 4. Conclusions: Streptococcus pneumonia drugs resistance in acute rhinosinusitis shows the resistance of Streptococcus pneumoniae to oxacillin, azithromycin and trimethoprim are 6, whereas the resistance to levofloxacin and doxycycline are 4.

  8. Rinossinusite crônica em pacientes infectados pelo vírus da imunodeficiência humana: avaliação clínica e radiológica Chronic rhinosinusitis in HIV-infected patients: radiological and clinical evaluation

    Directory of Open Access Journals (Sweden)

    Ivan Dieb Miziara

    2005-10-01

    Full Text Available O advento dos inibidores de protease, aumentando a sobrevida dos pacientes infectados com HIV aumentou a procura destes pacientes por médicos otorrinolaringologistas, já que 40% a 70% deles podem apresentar alguma alteração otorrinolaringológica. OBJETIVIVOS: Objetivamos, nesse estudo, comparar os achados radiológicos e sintomatologia nasossinusal entre pacientes infectados com HIV e pacientes com AIDS, com rinossinusite crônica. A literatura sobre o assunto é revisada e discutida. FORMA DE ESTUDO: clínico prospectivo com coorte transversal. CASUÍSTICA E MÉTODOS: Prospectivamente, 39 pacientes em uso de drogas antiretrovirais foram divididos em 2 grupos: pacientes com diagnóstico de AIDS (grupo I e aqueles apenas infectados pelo HIV (grupo II. Estes grupos foram comparados clinicamente, quanto à contagem de células CD4+ e avaliação tomográfica dos seios paranasais. RESULTADOS: Os pacientes dos grupos I e II apresentaram média de células CD4+ de 118 cél/10-9l e 377 cél/10-9l, respectivamente. Na comparação dos achados tomográficos pelo sistema de Lund e Mackay, o grupo I apresentou escore médio de 12 e o grupo II apresentou média de escore de 5,63 (pThe advent of protease inhibitors, which enhances the survival rate of HIV-infected individuals, leads patients to search for otorhinolaryngologists, as 40-70% of them may present some sort of otorhinolaryngological disorder. AIM: We aimed at comparing the CT scan findings and the nasosinusal complaints of HIV-infected and AIDS patients with clinical diagnosis of chronic rhinosinusitis. The literature on the subject is revised and discussed. STUDY DESIGN: clinical prospective with transversal cohort. MATERIAL AND METHODS: Prospectively, 39 patients with chronic rhinosinusitis, in use of antiretroviral therapy, were included in the present study and divided into two groups: patients with diagnosis of AIDS (group I and those infected by HIV (group II. Clinical and laboratorial

  9. Eosinophil fungal rhinosinusitis caused by Fusarium infection secondary to odontogenic maxillary sinus disease: when collaboration between otolaryngologist and allergologist leads to the correct diagnosis and therapy.

    Science.gov (United States)

    Gamba, P; Lombardi, C

    2017-05-01

    Rhinitis and sinusitis usually coexist and are concurrent in most individuals; thus, the correct terminology is now "rhinosinusitis". On the basis of numerous causative factors, often co-existing in the same patient, the diagnosis of rhinosinusitis is also made by a wide variety of practitioners (allergologists, otolaryngologists, pulmonologists, primary care physicians, paediatricians, and many others). Approximately 5-15% of the population suffers from chronic rhinosinusitis, and in 10-12% of them, it is of dental origin. The treatment of odontogenic maxillary sinus disease is directed to the management of the rhinosinusitis and of the odontogenic source. The widespread use of dental implants and reconstructive procedures for dental implant placement has led to new types of complication, as in this case report, due to chronic eosinophilic rhinosinusitis secondary to Fusarium infection in the maxillary sinus. The patient was initially evaluated by the allergologist, and subsequently successfully treated by the otolaryngologist with Functional Endoscopic Sinus Surgery. The advantages of endoscopic sinus surgery include more accurate visualization, no external incision, reduced soft tissue dissection, and reduced hospital stay. Chronic maxillary sinusitis of dental origin is a common disease that requires treatment of the sinusitis as well as of the odontogenic source.

  10. Post-irradiation otitis media, rhinosinusitis, and their interrelationship in nasopharyngeal carcinoma patients treated by IMRT.

    Science.gov (United States)

    Hsin, Chung-Han; Tseng, Hsien-Chun; Lin, Huang-Pin; Chen, Tsai-Hsin

    2016-02-01

    This study aimed to investigate the occurrences of post-irradiation chronic suppurative otitis media (CSOM), otitis media with effusion (OME), chronic rhinosinusitis (CRS), and their interrelationship in nasopharyngeal carcinoma (NPC) patients treated by intensity-modulated radiotherapy (IMRT). A retrospective review of medical records and magnetic resonance imaging for NPC patients across a 5-year follow-up was conducted. Rhinosinusitis was diagnosed and staged by Lund-Mackay system. A total of 102 patients were enrolled in the study. On the 5th year following IMRT, 8 patients (7.8 %), 30 patients (29.4 %), and 17 patients (16.7 %) suffered from IMRT-induced CSOM, post-irradiation OME, and CRS, respectively. Analysis by logistic regression showed a lack of association between the occurrence of post-irradiation OME and CRS (P = 0.06). These observations indicated that the modern radiotherapy technique exhibits capability in decreasing the incidences of CSOM and CRS comparing to the data of traditional radiotherapy. But post-irradiation OME was still encountered in more than one-quarter of long-term survivors of NPC. Of note, rhinosinusitis in NPC survivors does not predispose to the development of post-irradiation OME, suggesting nasal irrigation might be unnecessary for the management of OME following radiotherapy.

  11. Respiratory functions in asthmatic and normal women during different phases of menstrual cycle

    International Nuclear Information System (INIS)

    Arora, D.B.; Sandhu, P.K.; Dhillon, S.; Arora, A.

    2015-01-01

    Menstrual cycle is an integral part of life of women. There is widespread agreement that changes in the levels of oestrogen and progesterone associated with menstrual cycle also affect different systems of the body besides reproductive system. Levels of oestrogen and progesterone are maximum in the secretory phase and minimum just before the menstruation .Bronchial asthma is one of the commonest chronic respiratory diseases. Premenstrual worsening of asthma symptoms has been reported to affect 33-40% of asthmatic women. This exacerbation of asthma symptoms has been correlated with the oestrogen and progesterone levels. The association between menstrual cycle and lung functions in normal females has also been recognised. The pathophysiology of this process is still not proved. The purpose of our study was to confirm the probable effects of the female hormones on lung functions in normal and asthmatic women in different phases of menstrual cycle and to compare them. Methods: The study was done on 40 normal and 40 asthmatic females in the age group of 15-45 years. Pulmonary function tests were done in three phases of menstrual cycle i.e. follicular, secretory and menstrual in all the subjects. Results: The mean value of lung functions, i.e., FVC, FEV, PEFR, FEF25-75%, FEF 200-1200 were significantly lower in asthmatic females than normal ones (p<0.01) in all three phases. The lung functions of both asthmatic and non-asthmatic females in secretory phase were significantly higher than in menstrual phase (p<0.005). The PFTs in menstrual phase were even lower than the follicular phase (p<0.04). Conclusion: Respiratory parameters of both asthmatic and non-asthmatic women in reproductive age group show significant variation in different phases of menstrual cycle. The smooth muscle relaxant effect of progesterone and probably oestrogen might have contributed to it. The lung function parameters in asthmatics were of lower value compared to normal women. (author)

  12. Evaluation of Right Ventricular Function by Tissue Doppler Echocardiography in Asthmatic Children

    Directory of Open Access Journals (Sweden)

    Mehdi Ghaderian

    2016-11-01

    Full Text Available BackgroundAsthma is the most chronic inflammatory disorder of the airways in children and asthmatic patients can experience cardiac dysfunction, pulmonary hypertension and finally cor pulmonale later in life. We aimed to investigate Right Ventricular (RV functions in asthmatic children by conventional and tissue Doppler echocardiography (TDE.Materials and Methods Pulmonary function tests, conventional and TDE examinations were performed on 42 asthmatic and 42 age- and gender matched healthy controls subjects (n=42.Results Compared with healthy children the RV wall was statistically thicker among asthmatic patients (P= 0.01. Conventional echocardiography had not significant difference between cases and controls, but TDE had significant difference between these two groups. Peak E’ velocity, A’ velocity, E’/A’ ratio and S’ in lateral and medial sites of tricuspid annulus valve, were significantly differ from control group in our patients (P

  13. Allergic Fungal Rhinosinusitis - Outcomes of Multimodality Treatment

    OpenAIRE

    Baisakhi Bakat; Subhendu Chowdhury; Amitabha Roy Chowdhury; Soumitra Ghosh; Barin Kumar Roychaudhuri

    2013-01-01

    Abstract Objective : To evaluate the treatment outcomes of multimodality therapy for allergic fungal rhinosinusitis. Study Design: Prospective Observational Study. Materials&methods : This study was carried out in the department of ENT & Head neck Surgery, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata from January 2010 to July 2011. During this study period of one & half years, 20 subjects having Allergic Fungal Sinusitis were selected fr...

  14. European Position Paper on Rhinosinusitis and Nasal Polyps 2012

    NARCIS (Netherlands)

    Fokkens, Wytske J.; Lund, Valerie J.; Mullol, Joachim; Bachert, Claus; Alobid, Isam; Baroody, Fuad; Cohen, Noam; Cervin, Anders; Douglas, Richard; Gevaert, Philippe; Georgalas, Christos; Goossens, Herman; Harvey, Richard; Hellings, Peter; Hopkins, Claire; Jones, Nick; Joos, Guy; Kalogjera, Livije; Kern, Bob; Kowalski, Marek; Price, David; Riechelmann, Herbert; Schlosser, Rodney; Senior, Brent; Thomas, Mike; Toskala, Elina; Voegels, Richard; Wang, De Yun; Wormald, Peter John

    2012-01-01

    The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007.The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of

  15. European position paper on rhinosinusitis and nasal polyps 2007

    NARCIS (Netherlands)

    Fokkens, Wytske; Lund, Valerie; Mullol, Joaquirn

    2007-01-01

    Rhinosinusitis is a significant and increasing health problem which results in a large financial burden on society. This evidence based position paper describes what is known about rhinosinusitis and nasal polyps, offers evidence based recommendations on diagnosis and treatment, and considers how we

  16. Rhinosinusitis in HIV-infected children undergoing antiretroviral therapy.

    Science.gov (United States)

    Pinheiro Neto, Carlos Diógenes; Weber, Raimar; Araújo-Filho, Bernardo Cunha; Miziara, Ivan Dieb

    2009-01-01

    The association of protease inhibitors (PI) to antiretroviral therapy has generated sensible changes in morbidity and mortality of HIV-infected patients. Aims at evaluating the impact of this association on the prevalence of rhinosinusitis (RS) and CD4+ lymphocyte count in HIV-infected children. Retrospective cross-sectional study of the medical charts of 471 HIV-infected children. In 1996, protease inhibitors were approved for use as an association drug in antiretroviral therapy. Children were divided into two groups: one which did not receive PI and another which received PI after 1996. The prevalence of RS and CD4+ lymphocyte counts were compared between these groups. 14.4% of HIV-infected children had RS. Chronic RS was more prevalent the its acute counterpart. Children under 6 years old who were taking protease inhibitors presented with a significant higher prevalence of acute RS. The association of PI with the antiretroviral regimen was associated to higher mean CD4+ lymphocyte count and lower prevalence of chronic RS. The use of protease inhibitors was associated to higher mean CD4+ lymphocyte count. Children under 6 years of age in antiretroviral therapy associated with PI presented a lower likelihood of developing chronic RS.

  17. Phenomenology, pathogenesis, diagnosis and treatment of aspirin-sensitive rhinosinusitis.

    Science.gov (United States)

    Schapowal, A G; Simon, H U; Schmitz-Schumann, M

    1995-01-01

    Aspirin-sensitive rhinosinusitis is a non-allergic, non-infectious perennial eosinophilic rhinitis starting in middle age and rarely seen in children. It may also been seen in atopic patients who have developed a mixed type rhinitis with recurrent airway infections. There is an intolerance to aspirin and most other NSAID. An intolerance to tartrazine, food additives, alcohol, narcotics and local anaesthetics can follow. Most aspirin-sensitive patients develop nasal polyps. Untreated, it can lead to asthma. The frequency of aspirin intolerance is 6.18% in patients with perennial rhinitis and 14.68% in patients with nasal polyps. Immunologic studies of the blood and the nasal polyps show a hyperreactive immune system with an activation of the eosinophil granulocytes due to a TH1-lymphocyte-activation. In atopic subjects with a mixed type rhinitis, we found a TH2- and B-lymphocyte-activation as well. Inhibition of eosinophil apoptosis might be a second remarkable change in the immune system of aspirin-sensitive patients. A key pathogenic event for aspirin sensitivity is the change of the leukotriene pathway for arachidonic acid metabolism releasing high amounts of leukotrienes LTC4, LTD4 and LTE4, effective chemoattractants and activators of inflammatory cells. For the diagnosis of aspirin intolerance, nasal, bronchial and oral challenge are available. The sensitivity of nasal challenge with lysine-aspirin for the diagnosis of aspirin-sensitive rhinitis is 0.93, the specificity 0.97. It is the safest test in aspirin-sensitive asthmatics causing bronchial side effects only in 0.45%. Therapy of aspirin-sensitive rhinosinusitis includes avoidance of aspirin and NSAID. A general down regulation of the immune response with glucocorticosteroids is an effective means. We prefer a maintenance dose of budesonid 400 micrograms a day. Systemic steroids for a reversibility test or in exacerbation due to viral infection are given in a dose of 50 mg a day for one week. If steroids

  18. Clinical characteristics of childhood asthmatics in Johannesburg

    African Journals Online (AJOL)

    Objectives. To describe the clinical features of Caucasian childhood asthmatics in Johannesburg in order to compare these with a similar population of black asthmatic children resident in Soweto_. Design. In a prospective study, a history was obtained by means of an investigator-administered questionnaire. Main outcome ...

  19. Change of mean platelet volume values in asthmatic children as an inflammatory marker.

    Science.gov (United States)

    Tuncel, T; Uysal, P; Hocaoglu, A B; Erge, D O; Karaman, O; Uzuner, N

    2012-01-01

    Asthma is the most common chronic disease of childhood in industrialised countries. T helper-2 (Th-2) cells, mast cells and eosinophils have a role in inflammation of asthma. Recently it was shown that platelets also play a role in asthma. Mean platelet volume shows platelet size and reflects platelet activation. The aim of this retrospective study is to evaluate levels of mean platelet volume in asthmatic patients during asymptomatic periods and exacerbations compared with healthy controls. The study consisted of 100 asthmatic patients (male/female: 55/45, mean age: 8.2±3.3) and 49 age and sex matched healthy children as a control group. Mean platelet volume values of asthmatic patients during asymptomatic period were 7.7±0.8fL while mean platelet volume values in asthmatics during exacerbation were 7.8±0.9fL. Comparison of mean platelet volume values of asthmatic patients and healthy controls both in acute asthmatic attack and asymptomatic period showed no difference (p>0.05). Comparison of mean platelet volume values at asthmatic attack and asymptomatic period also had no difference (p>0.05). The presence of atopy, infection, eosinophilia, elevated immunoglobulin E, and severity of acute asthmatic attack did not influence mean platelet volume values. The results of our study suggest that mean platelet volume values may not be used as a marker in bronchial asthma, although prospective studies with larger number of patients are needed to evaluate the role of mean platelet volume in asthma. Copyright © 2011 SEICAP. Published by Elsevier Espana. All rights reserved.

  20. 1,8-Cineol Reduces Mucus-Production in a Novel Human Ex Vivo Model of Late Rhinosinusitis

    OpenAIRE

    Sudhoff, Holger; Klenke, Christin; Greiner, Johannes F. W.; Müller, Janine; Brotzmann, Viktoria; Ebmeyer, Jörg; Kaltschmidt, Barbara; Kaltschmidt, Christian

    2015-01-01

    Inflammatory diseases of the respiratory system such as rhinosinusitis, chronic obstructive pulmonary disease, or bronchial asthma are strongly associated with overproduction and hypersecretion of mucus lining the epithelial airway surface. 1,8-cineol, the active ingredient of the pharmaceutical drug Soledum, is commonly applied for treating such inflammatory airway diseases. However, its potential effects on mucus overproduction still remain unclear.In the present study, we successfully esta...

  1. DRUG THERAPY IN ASTHMATIC CHILDREN: SURVEY IN MASHHAD

    Directory of Open Access Journals (Sweden)

    M.H Karimi

    2000-03-01

    Full Text Available Introduction. For future health planning of our country, the type and amount of drugs used for treatment of chronic diseases should be known. Therefore, in the present study the treatment regimen of asthmatic children in the city of Mashhad was studied. Methods. To study the different types of drugs in the treatment regimen of asthmatic children in the city of Mashhad, we evaluated the treatment regimen of 366 primary school children with asthma disease. Starting, maximum and duration of action of three different bronchodilators (salbutamol inhaler, salbutamol syrup, and theophylline syrup were compared. Findings. The results of the first part of this study showed that only 31.6 percent of asthmatic children had history of treatment and only 10.6 percent had current medication. In addition, most of the treated children (38.8 percent had only bronchodilator (salbutamol syrup in their treatment regimen. The effect of salbutamol inhaler on lung function tests starts in 5 min, salbutamol syrup in 15 min and theophylline syrup at 30 min after administration. The maximum response to salbutamol inhaler, salbutamol syrup, and theophylline syrup occurred 15 min, 4 hr and 3 hr after administration, respectively. The reduction of response to salbutamol inhaler occurs after 3 hr, but there was no any reduction in response to salbutamol and theophylline syrup during study period. Conclusion. The prevalence of asthma among children in the city of Mashhad is relatively high, but most of asthmatic children are not treated. Although the oral bronchodilator in mild asthma is effective, salbutamol inhaler is needed for emergency use.

  2. Fungal Microbiota in Chronic Airway Inflammatory Disease and Emerging Relationships with the Host Immune Response

    Directory of Open Access Journals (Sweden)

    Irene Zhang

    2017-12-01

    Full Text Available The respiratory tract is a complex system that is inhabited by niche-specific communities of microbes including bacteria, fungi, and viruses. These complex microbial assemblages are in constant contact with the mucosal immune system and play a critical role in airway health and immune homeostasis. Changes in the composition and diversity of airway microbiota are frequently observed in patients with chronic inflammatory diseases including chronic rhinosinusitis (CRS, cystic fibrosis, allergy, and asthma. While the bacterial microbiome of the upper and lower airways has been the focus of many recent studies, the contribution of fungal microbiota to inflammation is an emerging research interest. Within the context of allergic airway disease, fungal products are important allergens and fungi are potent inducers of inflammation. In addition, murine models have provided experimental evidence that fungal microbiota in peripheral organs, notably the gastrointestinal (GI tract, influence pulmonary health. In this review, we explore the role of the respiratory and GI microbial communities in chronic airway inflammatory disease development with a specific focus on fungal microbiome interactions with the airway immune system and fungal-bacterial interactions that likely contribute to inflammatory disease. These findings are discussed in the context of clinical and immunological features of fungal-mediated disease in CRS, allergy, and asthmatic patients. While this field is still nascent, emerging evidence suggests that dysbiotic fungal and bacterial microbiota interact to drive or exacerbate chronic airway inflammatory disease.

  3. Pharmacokinetics of nebulized and oral procaterol in asthmatic and non-asthmatic subjects in relation to doping analysis

    DEFF Research Database (Denmark)

    Krogh, Nanna; Backer, Vibeke; Rzeppa, Sebastian

    2016-01-01

    The purpose of the present study was to investigate pharmacokinetics of procaterol in asthmatics and non-asthmatics after nebulized and oral administration in relation to doping. Ten asthmatic and ten non-asthmatic subjects underwent two pharmacokinetic trials. At first trial, 4 μg procaterol was...

  4. Increasing ventilation as an intervention in homes of asthmatic children

    DEFF Research Database (Denmark)

    Hogaard, Nina Viskum; Rubak, Sune Leisgaard Mørck; Halken, Susanne

    2016-01-01

    In children asthma is the most frequent chronic disease and house dust mite (HDM) allergy the most frequent cause of allergic asthma. Indoors most of the time, children are exposed to many indoor air pollutants that may act as asthma triggers. Reducing this exposure may improve asthma control...... in children. We conducted a double-blind, placebo-controlled intervention study with 46 asthmatic, house dust mite allergic children. The aim was to investigate the association between indoor air quality in homes and severity of asthma, in particular the effect of increased ventilation rate and expected lower...

  5. Streptococcus viridans has a leading role in rhinosinusitis complications.

    Science.gov (United States)

    Hwang, Siew Yoong; Tan, Kun Kiaang

    2007-05-01

    We sought to determine whether the bacteria in complicated rhinosinusitis were the typical acute rhinosinusitis triad of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. We also compared the difference in yield between infection sites and blood cultures. We performed a retrospective review of all patients who had required surgical intervention for rhinosinusitis complications over 7 years at a tertiary care pediatric hospital. There were a total of 28 patients during the review period. Twenty-five organisms were isolated from 21 patients, of which Streptococcus viridans formed 44% of the isolates (11 of the 25). The typical triad of bacteria only formed 20% of the isolates (5 of the 25), and none of these bacteria were found in the group with intracranial complications. Infection site cultures had a superior yield compared to blood cultures (p viridans is the leading cause of rhinosinusitis complications. It is not merely a commensal organism of the upper respiratory tract.

  6. (ENA-78/CXCL5) in asthmatic children

    African Journals Online (AJOL)

    EL-HAKIM

    CXCL5) in asthmatic children: relation to eosinophil activation. INTRODUCTION. Airway inflammation is a characteristic feature of bronchial asthma. It contributes significantly to many features of this disease, including airflow obstruction, bronchial ...

  7. A Study on the Frequency of Fungal Rhinosinusitis and to Determine the Sensitivity of the Isolates to Antifungal Drugs in Shiraz, Iran 2012-2013

    Directory of Open Access Journals (Sweden)

    Parisa Badiei

    2015-06-01

    Full Text Available Abstract Background: Fungal spores are present in large amounts in the nature which may cause diseases in the susceptible individuals. Fungal rhinosinusitis has been increased during recent decades. This study aims to investigate fungal rhinosinusitis in the patients with chronic needing endoscopic sinus surgery aims and to determine the sensitivity of the isolates to rhin sinusitis antifungal agents. Materials and Methods: In cross sectional study, specimens were obtained in sterile plates containing normal saline. from the suspected cases of chronic rhinosinusitis who had undergone endoscopic sinus surgery. Microscopic experiments and Cultures were done in Sabouraud Dextrose Agar medium. Minimum inhibitory concentration (MIC of the growth of fungi for seven antifungal agents against the isolates was determined using E-Test. Results: In total, specimens from 102 immunocompetent patients were examined. Nine positive specimens were presented, consisting of 3 for Aspergillus fumigatus, 3 for Penicillium, 2 for Aspergillus flavus and 1 for Alternaria. The mean age of the patients was 38 years, with 59 males and 43 females. The isolates were most sensitive to the voriconazole and amphotericin B. Conclusion: Since the prevalence of fungal rhinosinusitis is low, unfortunately, the clinicians are not attentive enough to the condition, and they initiate antifungal therapy if the patients are not responsive to antibiotics. Early diagnosis and suitable treatment can help more efficient management of patients.

  8. Anti-inflammatory effects of embelin in A549 cells and human asthmatic airway epithelial tissues.

    Science.gov (United States)

    Lee, In-Seung; Cho, Dong-Hyuk; Kim, Ki-Suk; Kim, Kang-Hoon; Park, Jiyoung; Kim, Yumi; Jung, Ji Hoon; Kim, Kwanil; Jung, Hee-Jae; Jang, Hyeung-Jin

    2018-02-01

    Allergic asthma is the most common type in asthma, which is defined as a chronic inflammatory disease of the lung. In this study, we investigated whether embelin (Emb), the major component of Ardisia japonica BL. (AJB), exhibits anti-inflammatory effects on allergic asthma via inhibition of NF-κB activity using A549 cells and asthmatic airway epithelial tissues. Inflammation was induced in A549 cells, a human airway epithelial cell line, by IL-1β (10 ng/ml) treatment for 4 h. The effects of Emb on NF-κB activity and COX-2 protein expression in inflamed airway epithelial cells and human asthmatic airway epithelial tissues were analyzed via western blot. The secretion levels of NF-κB-mediated cytokines/chemokines, including IL-4, 6, 9, 13, TNF-α and eotaxin, were measured by a multiplex assay. Emb significantly blocked NF-κB activity in IL-1β-treated A549 cells and human asthmatic airway epithelial tissues. COX-2 expression was also reduced in both IL-1β-treated A549 cells and asthmatic tissues Emb application. Emb significantly reduced the secretion of IL-4, IL-6 and eotaxin in human asthmatic airway epithelial tissues by inhibiting activity of NF-κB. The results of this study suggest that Emb may be used as an anti-inflammatory agent via inhibition of NF-κB and related cytokines.

  9. [Management of Rhinosinusitis in Primary Care].

    Science.gov (United States)

    Gabaldón, N Gómez; Arnaiz, C Manzanares; Cánovas, L Noguero; Armas, J Juan

    2018-02-13

    Acute rhinosinusitis is an important health problem. Even though its frequency is not well documented in our country?, the economic burden it bears is not insignificant as it notably alters the quality of life of affected patients. Its diagnosis is generally clinical in nature, with further studies reserved only for the differential diagnoses of complications or tumour-like processes. The most frequent causes are viral infections, although Streptococcus pneumoniae and Haemophilus influenzae are the most commonly isolated bacterial agents. Although complications are uncommon nowadays, they can be serious when they occur, and commonly include orbital infections, closely followed in frequency by intracranial and bone infections. Treatment should consist of symptomatic measures, like saline rinses and antibiotics in cases of bacterial origin. Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Expression of activated Fc gamma RII discriminates between multiple granulocyte-priming phenotypes in peripheral blood of allergic asthmatic subjects.

    Science.gov (United States)

    Kanters, Deon; ten Hove, Willem; Luijk, Bart; van Aalst, Corneli; Schweizer, René C; Lammers, Jan-Willem J; Leufkens, Hubert G M; Raaijmakers, Jan A M; Bracke, Madelon; Koenderman, Leo

    2007-11-01

    Allergic asthma is associated with chronic airway and systemic immune responses. Systemic responses include priming of peripheral blood eosinophils, which is enhanced after allergen challenge. In a subpopulation of asthmatic subjects, neutrophils are associated with bronchial inflammation. We sought to monitor systemic granulocyte priming in allergic asthmatic subjects as a consequence of chronic and acute inflammatory signals initiated by allergen challenge. Blood was taken at baseline and 6 to 24 hours after allergen challenge in asthmatic subjects with and without late asthmatic responses. Systemic granulocyte priming was studied by using expression of cellular markers, such as alpha-chain of Mac-1 (alpha m)/CD11b, L-selectin/CD62L, and an activation epitope present on Fc gamma RII/CD32 recognized by monoclonal phage antibody A17. Eosinophils of asthmatic subjects have a primed phenotype identified by cell-surface markers. Neutrophils of these patients were subtly primed, which was only identified after activation with N-formyl-methionyl-leucyl-phenylalanine. After allergen challenge, an acute increase in eosinophil priming characterized by enhanced expression of activated Fc gamma RII was found in patients experiencing a late asthmatic response and not in patients with a single early asthmatic response. In contrast, expression of alpha m/CD11b and L-selectin on granulocytes was not different between control and asthmatic subjects and was not affected by allergen challenge. Interestingly, expression of both adhesion molecules was positively correlated, and alpha m expression on eosinophils and neutrophils correlated positively with bronchial hyperresponsiveness. Different phases, phenotypes, or both of allergic asthma are associated with distinct priming profiles of inflammatory cells in peripheral blood. Insight in differences of systemic innate responses will lead to better definition of asthma subtypes and to better designs of new therapeutic options.

  11. Fragranced consumer products: effects on asthmatics.

    Science.gov (United States)

    Steinemann, Anne

    2018-01-01

    Fragranced consumer products, such as cleaning supplies, air fresheners, and personal care products, can emit a range of air pollutants and trigger adverse health effects. This study investigates the prevalence and types of effects of fragranced products on asthmatics in the American population. Using a nationally representative sample ( n  = 1137), data were collected with an on-line survey of adults in the USA, of which 26.8% responded as being medically diagnosed with asthma or an asthma-like condition. Results indicate that 64.3% of asthmatics report one or more types of adverse health effects from fragranced products, including respiratory problems (43.3%), migraine headaches (28.2%), and asthma attacks (27.9%). Overall, asthmatics were more likely to experience adverse health effects from fragranced products than non-asthmatics (prevalence odds ratio [POR] 5.76; 95% confidence interval [CI] 4.34-7.64). In particular, 41.0% of asthmatics report health problems from air fresheners or deodorizers, 28.9% from scented laundry products coming from a dryer vent, 42.3% from being in a room cleaned with scented products, and 46.2% from being near someone wearing a fragranced product. Of these effects, 62.8% would be considered disabling under the definition of the Americans with Disabilities Act. Yet 99.3% of asthmatics are exposed to fragranced products at least once a week. Also, 36.7% cannot use a public restroom if it has an air freshener or deodorizer, and 39.7% would enter a business but then leave as quickly as possible due to air fresheners or some fragranced product. Further, 35.4% of asthmatics have lost workdays or a job, in the past year, due to fragranced product exposure in the workplace. More than twice as many asthmatics would prefer that workplaces, health care facilities and health care professionals, hotels, and airplanes were fragrance-free rather than fragranced. Results from this study point to relatively simple and cost-effective ways to

  12. 1,8-Cineol Reduces Mucus-Production in a Novel Human Ex Vivo Model of Late Rhinosinusitis.

    Directory of Open Access Journals (Sweden)

    Holger Sudhoff

    Full Text Available Inflammatory diseases of the respiratory system such as rhinosinusitis, chronic obstructive pulmonary disease, or bronchial asthma are strongly associated with overproduction and hypersecretion of mucus lining the epithelial airway surface. 1,8-cineol, the active ingredient of the pharmaceutical drug Soledum, is commonly applied for treating such inflammatory airway diseases. However, its potential effects on mucus overproduction still remain unclear.In the present study, we successfully established ex vivo cultures of human nasal turbinate slices to investigate the effects of 1,8-cineol on mucus hypersecretion in experimentally induced rhinosinusitis. The presence of acetyl-α-tubulin-positive cilia confirmed the integrity of the ex vivo cultured epithelium. Mucin-filled goblet cells were also detectable in nasal slice cultures, as revealed by Alcian Blue and Periodic acid-Schiff stainings. Treatment of nasal slice cultures with lipopolysaccharides mimicking bacterial infection as observed during late rhinosinusitis led to a significantly increased number of mucin-filled goblet cells. Notably, the number of mucin-filled goblet cells was found to be significantly decreased after co-treatment with 1,8-cineol. On a molecular level, real time PCR-analysis further showed 1,8-cineol to significantly reduce the expression levels of the mucin genes MUC2 and MUC19 in close association with significantly attenuated NF-κB-activity. In conclusion, we demonstrate for the first time a 1,8-cineol-dependent reduction of mucin-filled goblet cells and MUC2-gene expression associated with an attenuated NF-κB-activity in human nasal slice cultures. Our findings suggest that these effects partially account for the clinical benefits of 1,8-cineol-based therapy during rhinosinusitis. Therefore, topical application of 1,8-cineol may offer a novel therapeutic approach to reduce bacteria-induced mucus hypersecretion.

  13. 1,8-Cineol Reduces Mucus-Production in a Novel Human Ex Vivo Model of Late Rhinosinusitis.

    Science.gov (United States)

    Sudhoff, Holger; Klenke, Christin; Greiner, Johannes F W; Müller, Janine; Brotzmann, Viktoria; Ebmeyer, Jörg; Kaltschmidt, Barbara; Kaltschmidt, Christian

    2015-01-01

    Inflammatory diseases of the respiratory system such as rhinosinusitis, chronic obstructive pulmonary disease, or bronchial asthma are strongly associated with overproduction and hypersecretion of mucus lining the epithelial airway surface. 1,8-cineol, the active ingredient of the pharmaceutical drug Soledum, is commonly applied for treating such inflammatory airway diseases. However, its potential effects on mucus overproduction still remain unclear.In the present study, we successfully established ex vivo cultures of human nasal turbinate slices to investigate the effects of 1,8-cineol on mucus hypersecretion in experimentally induced rhinosinusitis. The presence of acetyl-α-tubulin-positive cilia confirmed the integrity of the ex vivo cultured epithelium. Mucin-filled goblet cells were also detectable in nasal slice cultures, as revealed by Alcian Blue and Periodic acid-Schiff stainings. Treatment of nasal slice cultures with lipopolysaccharides mimicking bacterial infection as observed during late rhinosinusitis led to a significantly increased number of mucin-filled goblet cells. Notably, the number of mucin-filled goblet cells was found to be significantly decreased after co-treatment with 1,8-cineol. On a molecular level, real time PCR-analysis further showed 1,8-cineol to significantly reduce the expression levels of the mucin genes MUC2 and MUC19 in close association with significantly attenuated NF-κB-activity. In conclusion, we demonstrate for the first time a 1,8-cineol-dependent reduction of mucin-filled goblet cells and MUC2-gene expression associated with an attenuated NF-κB-activity in human nasal slice cultures. Our findings suggest that these effects partially account for the clinical benefits of 1,8-cineol-based therapy during rhinosinusitis. Therefore, topical application of 1,8-cineol may offer a novel therapeutic approach to reduce bacteria-induced mucus hypersecretion.

  14. Psychological problems in Turkish asthmatic children and their families.

    Science.gov (United States)

    Akçakaya, N; Aydogan, M; Hassanzadeh, A; Camcioglu, Y; Cokugraş, H

    2003-01-01

    Asthma is a chronic respiratory disorder characterized by recurrent episodes of impaired breathing. The disease causes psychological problems due to hospitalization, long-term medication use, and restricted social life. The aim of this study was to investigate the relationship between the severity and duration of asthma and psychological problems in asthmatic children, as well as the probability of maternal anxiety. Thirty-seven children with mild asthma, 55 with moderate asthma and eight with severe asthma were compared with 50 healthy children. The severity of asthma was evaluated using the Pearlman-Bierman classification. Psychological adjustment was measured using the Achenback child Behavior checklist and Spielberger's scale. Emotional factors and family dynamics were found to be triggering factors for disease attacks in 16% of children with mild asthma, 38% of those with moderate asthma and 63% of those with severe asthma (p anxiety score between the disease severity groups (p > 0.05). The mean depression score was significantly higher in children with moderate and severe asthma than in those with mild asthma (p anxiety. Both asthmatic children and their mothers are negatively affected by the disease.

  15. [The asthmatic patient and his/her family dynamics].

    Science.gov (United States)

    Vázquez Nava, Francisco; Santos Díaz, Aidee del Pilar; Martínez Burnes, Julio; Caballero Rico, Frida; Morales González, Francisco; Prado Lobato, Simón Carlos

    2003-01-01

    Asthma is a chronic disorder of the airways that modify behavior response of persons and affect family function. To determine if there is a disorder of the familial dynamics in asthmatic patients of Tamaulipas. An observational, comparative, open and cross-sectional study was performed to determine: family categorization, family function and evaluation of conjugal subsystem. We included 300 persons who were 30 to 50 years old, male and female: 100 subjects with asthma diagnosis, 100 with diabetes type 2 and 100 healthy people. The asthmatic subjects' age average was of 45.67 years, complete nuclear family was documented in 15% of sick persons, women were the family head in 50% of the cases, we appreciated great family dysfunction in relation to: adaptability function (50%), participation (63%), family grow-up (61%) and feeling manifestations (64%). In 53% of the conjugal couple cases of the patients, do not carry out her family functions like: communication 59%, share out functions 59%, sexual satisfaction 60%, and making decision 59%. It is only feasible to treat these patients when there is an active participation of the family members.

  16. Metabolic syndrome in asthmatic patients of hazara division

    International Nuclear Information System (INIS)

    Ahmed, N.; Kazim, S.M.; Gillani, S.Y.

    2017-01-01

    Bronchial asthma is a common disease and most asthmatics are obese. Both asthma and obesity are showing parallel trends in their increasing prevalence. Obesity is also the main component of metabolic syndrome and several studies have shown metabolic syndrome to be associated with bronchial asthma. The present study was, therefore, designed to determine the frequency of metabolic syndrome among patients with chronic asthma in our setup. Methods: This cross-sectional study was conducted in Department of Medicine, Ayub Teaching Hospital, Abbottabad from May to November, 2014. One hundred and fifty-four asthmatic patients were enrolled in this study. Samples for blood glucose, triglycerides and HDL Cholesterol were taken after an overnight fast. Sitting blood pressure was measured with mercury sphygmomanometer after 10 minutes of rest. Waist circumference was measured at the level of the midpoint between the high point of the iliac crest and the last rib. Results: Out of 154 patients, 80 were males and 74 were females. Metabolic syndrome was diagnosed in 46 (29.87 percent) patients. When metabolic syndrome was stratified according to age, sex and duration of asthma, the results were found to be insignificant (p-0.89, 0.30 and 0.85). Conclusion: This study showed that metabolic syndrome was present in almost one third of study population. (author)

  17. The parenting attitudes and the stress of mothers predict the asthmatic severity of their children: a prospective study.

    Science.gov (United States)

    Nagano, Jun; Kakuta, Chikage; Motomura, Chikako; Odajima, Hiroshi; Sudo, Nobuyuki; Nishima, Sankei; Kubo, Chiharu

    2010-10-07

    To examine relationships between a mother's stress-related conditions and parenting attitudes and their children's asthmatic status. 274 mothers of an asthmatic child 2 to 12 years old completed a questionnaire including questions about their chronic stress/coping behaviors (the "Stress Inventory"), parenting attitudes (the "Ta-ken Diagnostic Test for Parent-Child Relationship, Parent Form"), and their children's disease status. One year later, a follow-up questionnaire was mailed to the mothers that included questions on the child's disease status. 223 mothers (81%) responded to the follow-up survey. After controlling for non-psychosocial factors including disease severity at baseline, multiple linear regression analysis followed by multiple logistic regression analysis found chronic irritation/anger and emotional suppression to be aggravating factors for children aged types of parental stress/coping behaviors and parenting styles may differently predict their children's asthmatic status, and such associations may change as children grow.

  18. Intranasal inverted tooth: A rare cause of a persistent rhinosinusitis

    Directory of Open Access Journals (Sweden)

    José Wilson Noleto

    2013-01-01

    Full Text Available The aim of this study was to report a case of two supernumerary teeth in the nasal cavity in a 22-year-old woman who presented pain, rhinorrhea, and inflammation of the nasal mucosa (rhinosinusitis. The computed tomograph scan showed two radiopaque images that were diagnosed as supernumerary nasal teeth. One was unerupted in the floor and the other inverted, and erupted on the floor on the left side of the nasal cavity. They were removed under general anesthesia, one through the palatine approach, and the other directly through the nasal cavity. The patient was followed for a year and there was no sign of recurrence of rhinosinusitis.

  19. Exercise induced bronchospasm in asthmatic and non-asthmatic obese children.

    Science.gov (United States)

    del Río-Navarro, B; Cisneros-Rivero, M; Berber-Eslava, A; Espínola-Reyna, G; Sienra-Monge, J

    2000-01-01

    to investigate the spirometric response to the exercise challenge in asthmatic and non-asthmatic obese children. it was a prospective, longitudinal, open label clinical trial with four groups of children from 8 to 16 years. The group 1 had 15 asthmatic non-obese children. The group 2 had 15 asthmatic obese children. The group 3 had 15 non-asthmatic obese children. The group 4 had 13 control healthy children. Spirometry measures were realized at baseline, and after exercise at 2, 5, 10, 15, 20, 25, 30 and 60 minutes. Exercise challenge was performed on a walking band at 6 km/h speed and a slope of 10 degrees with a duration of 6 to 8 minutes. Data were are analyzed by repeated measures ANOVA. the mean age was 11.8 +/- 2.1, and the mean height was 150.2 +/- 11.3 cm, the mean weight was 46.3 +/- 17.15 in the group 1, 59.4 +/- 11.9 in the group 2, 67.8 +/- 20.6 in the group 3, and 44.2 +/- 9.7 in the group 4. The mean values of forced expiratory volume in one second (FEV1) for each group are shown on table II. the non-asthmatic obese children had a significant decrease in FEV1, meanwhile the asthmatic obese children had a deeper decrease in FEV1 than the asthmatic non-obese children. Obesity ay be a conditioning factor for bronchial hyperreactivity to the exercise.

  20. Review of fungus-induced asthmatic reactions

    NARCIS (Netherlands)

    Kauffman, H. F.; TOMEE, J. F.; van der Werf, T. S.; de Monchy, J. G.; Koëter, G. K.

    Fungus-induced obstructive airway disease in atopic individuals can be differentiated into two categories: first, uncomplicated asthmatic reactions due to high but transient exposure to fungal spores (fungal asthma), resulting in a T-H2-type response with immunoglobulin E-mediated reactions and

  1. Respiratory function in children of asthmatic mothers

    Directory of Open Access Journals (Sweden)

    Marco A. Valadares

    2013-03-01

    Conclusions: The frequency of spirometry alterations in children of asthmatic mothers was high; the restrictive pattern was more often observed that the obstructive. There was a higher incidence of obstructive test results in those who presented clinical symptoms of asthma, with a higher frequency of clinical diagnosis of asthma than that found in the literature.

  2. Bronchial hyperresponsiveness and anti-asthmatic therapy

    NARCIS (Netherlands)

    Kraan, Jan

    1990-01-01

    Many asthmatic patients experience shortness of breath or wheezing, when exposed to cold air, or irritants like baking fumes, exhaust gases or cigarette smoke. This clinical phenomenon has been called bronchial hypemsponsiveness (BHR), which is defined as an exaggerated broncho-obstructive response

  3. Invasive fungal rhinosinusitis in adult patients: Our experience in diagnosis and management.

    Science.gov (United States)

    Pagella, Fabio; De Bernardi, Francesca; Dalla Gasperina, Daniela; Pusateri, Alessandro; Matti, Elina; Avato, Irene; Cavanna, Caterina; Zappasodi, Patrizia; Bignami, Maurizio; Bernardini, Elena; Grossi, Paolo Antonio; Castelnuovo, Paolo

    2016-04-01

    This paper describes our experience in the management of acute and chronic invasive fungal rhinosinusitis (IFRS) in adults. Medical files of all patients aged >18 years treated in our institutions for IFRS from 2002 to 2013 were retrospectively reviewed. A total of 18 cases (10 acute and 8 chronic) were recorded. In acute form, haematological malignancies represented the principal comorbidity (100%), while in chronic form this was diabetes mellitus (87.5%). All patients received systemic antifungal agents. Endoscopic sinus surgery was performed in 16/18 patients (88.9%). Among patients with an acute IFRS, 4/10 died of fungal infection (40%), on the other side 2/8 patients with chronic IFRS died of the evolution of the mycosis (25%). Acute and chronic IFRS are different entities: in acute form, prognosis is poor, so therapy should be promptly performed, although host immune status and evolution of the haematological disease are key factors for the outcome. In chronic form, a wide surgical excision of the disease is recommended in order to obtain a complete removal of fungal infection. In both forms, early clinical findings are non-specific and ambiguous, so diagnosis depends on a high index of suspicion, taking into account predisposing factors. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  4. Oral health and risk of pneumonia in asthmatic pacients with inhaled treatment.

    Science.gov (United States)

    Rodríguez, Francesc; Duran, Analía; Muñoz, Zulema; Palomera, Elisabet; Serra-Prat, Mateu; Boixeda, Ramón; Vicente, Vanesa; Almirall, Jordi

    2017-09-22

    Asthma is a chronic disease requiring inhaled treatment and in addition it is a risk factor (RF) of pneumonia. In the oropharyngeal cavity there are numerous species of bacteria that could be dragged to the bronco-alveolar level. to decide whether oral health is a community acquired pneumonia (CAP) RF in asthmatic patients who are taking inhaled treatment, and determining whether the frequency of use of inhalation devices and the type of inhaled drug are CAP RF. Case-control study in asthmatic population with inhaled treatment. We recruited 126 asthmatic patients diagnosed with pneumonia by clinical and radiological criteria (cases) and 252 asthmatics not diagnosed with pneumonia during the last year (controls), matched by age. The main factor of study was the General Oral Health Assessment Index (GOHAI) score. Bivariated analysis showed a statistically significant association of CAP with a GOHAI score≤57 points (poor oral health) (OR 1.69), anticholinergic treatment (OR 2.41), 6 or more inhalations (3.23), chamber use (OR 1.62), FEV 1 (OR 0.98), altered functionality (OR 2.08) and psychiatric disorders or depression (OR 0.41). The multivariated analysis shows an independent association of performing 6 or more inhalations per day (OR 2.74) and functional impairment (OR 1.67). The results suggest that poor oral health may be a CAP RF. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  5. Undifferentiated bronchial fibroblasts derived from asthmatic patients display higher elastic modulus than their non-asthmatic counterparts.

    Science.gov (United States)

    Sarna, Michal; Wojcik, Katarzyna A; Hermanowicz, Pawel; Wnuk, Dawid; Burda, Kvetoslava; Sanak, Marek; Czyż, Jarosław; Michalik, Marta

    2015-01-01

    During asthma development, differentiation of epithelial cells and fibroblasts towards the contractile phenotype is associated with bronchial wall remodeling and airway constriction. Pathological fibroblast-to-myofibroblast transition (FMT) can be triggered by local inflammation of bronchial walls. Recently, we have demonstrated that human bronchial fibroblasts (HBFs) derived from asthmatic patients display some inherent features which facilitate their FMT in vitro. In spite of intensive research efforts, these properties remain unknown. Importantly, the role of undifferentiated HBFs in the asthmatic process was systematically omitted. Specifically, biomechanical properties of undifferentiated HBFs have not been considered in either FMT or airway remodeling in vivo. Here, we combine atomic force spectroscopy with fluorescence microscopy to compare mechanical properties and actin cytoskeleton architecture of HBFs derived from asthmatic patients and non-asthmatic donors. Our results demonstrate that asthmatic HBFs form thick and aligned 'ventral' stress fibers accompanied by enlarged focal adhesions. The differences in cytoskeleton architecture between asthmatic and non-asthmatic cells correlate with higher elastic modulus of asthmatic HBFs and their increased predilection to TGF-β-induced FMT. Due to the obvious links between cytoskeleton architecture and mechanical equilibrium, our observations indicate that HBFs derived from asthmatic bronchi can develop considerably higher static tension than non-asthmatic HBFs. This previously unexplored property of asthmatic HBFs may be potentially important for their myofibroblastic differentiation and bronchial wall remodeling during asthma development.

  6. Case Report Rhinosinusitis; A Potential hazard of Nasogastric tube ...

    African Journals Online (AJOL)

    The nasogastric tube has been used frequently for enteral feeding and as an intranasal oxygen catheter. This practice is however associated with complications. We present a case of rhinosinusitis and sepsis in a diabetic patient following the insertion of a nasogastric tube. Physicians should be aware of sinusitis as a ...

  7. Orbital Complications of Rhinosinusitis | Sijuwola | Annals of Ibadan ...

    African Journals Online (AJOL)

    Background: Suppurative extension of rhinosinusitis to the orbit is a complication that often results from delay in diagnosis and, or inadequate treatment. These complications may range from preseptal cellulitis, orbital cellulitis, orbital abscesses, and subperiosteal abscesses to intracranial extension with a threat to both ...

  8. Sinus Microanatomy and Microbiota in a Rabbit Model of Rhinosinusitis

    Science.gov (United States)

    Cho, Do-Yeon; Mackey, Calvin; Van Der Pol, William J.; Skinner, Daniel; Morrow, Casey D.; Schoeb, Trenton R.; Rowe, Steven M.; Swords, William E.; Tearney, Guillermo J.; Woodworth, Bradford A.

    2018-01-01

    Background: Rabbits are useful for preclinical studies of sinusitis because of similar physiologic features to humans. The objective of this study is to develop a rabbit model of sinusitis that permits assessment of microanatomy and sampling for evaluating shifts in the sinus microbiota during the development of sinusitis and to test how the mucociliary clearance (MCC) defect might lead to dysbiosis and chronic rhinosinusitis (CRS). Methods: Generation of CRS was accomplished with an insertion of a sterile sponge into the left middle meatus of New Zealand white rabbits (n = 9) for 2 weeks. After sponge removal, 4 rabbits were observed for another 10 weeks and evaluated for CRS using endoscopy, microCT, visualization of the functional micro-anatomy by micro-optical coherence tomography (μOCT), and histopathological analysis of the sinus mucosa. Samples were taken from the left middle meatus and submitted for microbiome analysis. Results: CT demonstrated opacification of all left sinuses at 2 weeks in all rabbits (n = 9), which persisted in animals followed for another 12 weeks (n = 4). Histology at week 2 showed mostly neutrophils. On week 14, significant infiltration of plasma cells and lymphocytes was noted with increased submucosal glands compared to controls (p = 0.02). Functional microanatomy at 2 weeks showed diminished periciliary layer (PCL) depth (p < 0.0001) and mucus transport (p = 0.0044) compared to controls despite a thick mucus layer. By 12 weeks, the thickened mucus layer was resolved but PCL depletion persisted in addition to decreased ciliary beat frequency (CBF; p < 0.0001). The mucin fermenting microbes (Lactobacillales, Bacteroidales) dominated on week 2 and there was a significant shift to potential pathogens (e.g., Pseudomonas, Burkholderia) by week 14 compared to both controls and the acute phase (p < 0.05). Conclusion: We anticipate this reproducible model will provide a means for identifying underlying mechanisms of airway-surface liquid

  9. Sinus Microanatomy and Microbiota in a Rabbit Model of Rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Do-Yeon Cho

    2018-01-01

    Full Text Available Background: Rabbits are useful for preclinical studies of sinusitis because of similar physiologic features to humans. The objective of this study is to develop a rabbit model of sinusitis that permits assessment of microanatomy and sampling for evaluating shifts in the sinus microbiota during the development of sinusitis and to test how the mucociliary clearance (MCC defect might lead to dysbiosis and chronic rhinosinusitis (CRS.Methods: Generation of CRS was accomplished with an insertion of a sterile sponge into the left middle meatus of New Zealand white rabbits (n = 9 for 2 weeks. After sponge removal, 4 rabbits were observed for another 10 weeks and evaluated for CRS using endoscopy, microCT, visualization of the functional micro-anatomy by micro-optical coherence tomography (μOCT, and histopathological analysis of the sinus mucosa. Samples were taken from the left middle meatus and submitted for microbiome analysis.Results: CT demonstrated opacification of all left sinuses at 2 weeks in all rabbits (n = 9, which persisted in animals followed for another 12 weeks (n = 4. Histology at week 2 showed mostly neutrophils. On week 14, significant infiltration of plasma cells and lymphocytes was noted with increased submucosal glands compared to controls (p = 0.02. Functional microanatomy at 2 weeks showed diminished periciliary layer (PCL depth (p < 0.0001 and mucus transport (p = 0.0044 compared to controls despite a thick mucus layer. By 12 weeks, the thickened mucus layer was resolved but PCL depletion persisted in addition to decreased ciliary beat frequency (CBF; p < 0.0001. The mucin fermenting microbes (Lactobacillales, Bacteroidales dominated on week 2 and there was a significant shift to potential pathogens (e.g., Pseudomonas, Burkholderia by week 14 compared to both controls and the acute phase (p < 0.05.Conclusion: We anticipate this reproducible model will provide a means for identifying underlying mechanisms of airway

  10. Canadian guidelines for acute bacterial rhinosinusitis

    Science.gov (United States)

    Kaplan, Alan

    2014-01-01

    Objective To provide a clinical summary of the Canadian clinical practice guidelines for acute bacterial rhinosinusitis (ABRS) that includes relevant considerations for family physicians. Quality of evidence Guideline authors performed a systematic literature search and drafted recommendations. Recommendations received both strength of evidence and strength of recommendation ratings. Input from external content experts was sought, as was endorsement from Canadian medical societies (Association of Medical Microbiology and Infectious Disease Canada, Canadian Society of Allergy and Clinical Immunology, Canadian Society of Otolaryngology—Head and Neck Surgery, Canadian Association of Emergency Physicians, and the Family Physicians Airways Group of Canada). Main message Diagnosis of ABRS is based on the presence of specific symptoms and their duration; imaging or culture are not needed in uncomplicated cases. Treatment is dependent on symptom severity, with intranasal corticosteroids (INCSs) recommended as monotherapy for mild and moderate cases, although the benefit might be modest. Use of INCSs plus antibiotics is reserved for patients who fail to respond to INCSs after 72 hours, and for initial treatment of patients with severe symptoms. Antibiotic selection must account for the suspected pathogen, the risk of resistance, comorbid conditions, and local antimicrobial resistance trends. Adjunct therapies such as nasal saline irrigation are recommended. Failure to respond to treatment, recurrent episodes, and signs of complications should prompt referral to an otolaryngologist. The guidelines address situations unique to the Canadian health care environment, including actions to take during prolonged wait periods for specialist referral or imaging. Conclusion The Canadian guidelines provide up-to-date recommendations for diagnosis and treatment of ABRS that reflect an evolving understanding of the disease. In addition, the guidelines offer useful tools to help

  11. Clinical trials in rhinosinusitis: Identifying areas for improvement.

    Science.gov (United States)

    Ramsey, Tam; Lai, Wanda; Guo, Eric; Svider, Peter F; Zuliani, Giancarlo; Eloy, Jean Anderson; Folbe, Adam J

    2017-11-06

    To characterize trends in rhinosinusitis clinical trials to provide recommendations for therapeutic directions, highlight possible redundancy, and provide a framework for prioritization of future clinical trials. Database analysis. Data were collected from ClinicalTrials.gov including all clinical trials that focused on rhinosinusitis with the exclusion of trials withdrawn prior to enrollment. Variables recorded included study design, study population, pharmaceutical involvement, publication, and whether a trial was a medical or surgical intervention. Associated publications were identified using the PubMed, Embase, and Cochrane databases. There were 269 rhinosinusitis clinical trials, dating from 1993 to 2017, that met inclusion reauirements. Of the studies included in this analysis, 51.7% had at least one scientific publication, and of those with publications, 80.6% had positive results and 19.3% had negative results. Twenty-three clinical trials (8.5%) studied drugs already approved for rhinosinusitis, 113 (42.0%) trials studied drugs that were approved for other uses, 42 (15.6%) trials studied experimental drugs, and 102 (39.4%) studied surgical intervention. Of the trials studying drugs, the data showed many clinical trials that studied the same drug. The data demonstrate a steady decline in clinical trials with medical intervention and a rise in clinical trials with surgical intervention. This analysis is the first to characterize rhinosinusitis clinical trials, highlighting the over-representation of certain drugs and demonstrating an increased focus on clinical trials employing surgical intervention. We provide a framework to discuss prioritization of future studies to guide clinical and research practice. 4. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Antihistamines for treating rhinosinusitis: systematic review and meta-analysis of randomised controlled studies.

    Science.gov (United States)

    Seresirikachorn, K; Khattiyawittayakun, L; Chitsuthipakorn, W; Snidvongs, K

    2018-02-01

    Without the release of histamines, patients with rhinosinusitis may not benefit from antihistamines. Additionally, anticholinergic effects may do more harm than good. This study aimed to investigate the effectiveness of antihistamines in treating rhinosinusitis. An electronic search was performed. Randomised controlled trials comparing antihistamines with either placebo or other treatments for patients with rhinosinusitis were selected. Two studies (184 patients) met the inclusion criteria. Loratadine decreased nasal obstruction in allergic rhinitis patients with acute rhinosinusitis (mean difference = -0.58; confidence interval = -0.85 to -0.31, p antihistamines in treating rhinosinusitis. The number of included studies in this systematic review is limited. Antihistamines may relieve nasal obstruction in allergic rhinitis patients with acute rhinosinusitis.

  13. Corticosteroid therapy and airflow obstruction influence the bronchial microbiome, which is distinct from that of bronchoalveolar lavage in asthmatic airways

    Energy Technology Data Exchange (ETDEWEB)

    Denner, Darcy R.; Sangwan, Naseer; Becker, Julia B.; Hogarth, D. Kyle; Oldham, Justin; Castillo, Jamee; Sperling, Anne I.; Solway, Julian; Naureckas, Edward T.; Gilbert, Jack A.; White, Steven R.

    2016-05-01

    The lung has a diverse microbiome that is modest in biomass. This microbiome differs in asthmatic patients compared with control subjects, but the effects of clinical characteristics on the microbial community composition and structure are not clear. OBJECTIVES: We examined whether the composition and structure of the lower airway microbiome correlated with clinical characteristics of chronic persistent asthma, including airflow obstruction, use of corticosteroid medications, and presence of airway eosinophilia. METHODS: DNA was extracted from endobronchial brushings and bronchoalveolar lavage fluid collected from 39 asthmatic patients and 19 control subjects, along with negative control samples. 16S rRNA V4 amplicon sequencing was used to compare the relative abundance of bacterial genera with clinical characteristics. RESULTS: Differential feature selection analysis revealed significant differences in microbial diversity between brush and lavage samples from asthmatic patients and control subjects. Lactobacillus, Pseudomonas, and Rickettsia species were significantly enriched in samples from asthmatic patients, whereas Prevotella, Streptococcus, and Veillonella species were enriched in brush samples from control subjects. Generalized linear models on brush samples demonstrated oral corticosteroid use as an important factor affecting the relative abundance of the taxa that were significantly enriched in asthmatic patients. In addition, bacterial α-diversity in brush samples from asthmatic patients was correlated with FEV1 and the proportion of lavage eosinophils. CONCLUSION: The diversity and composition of the bronchial airway microbiome of asthmatic patients is distinct from that of nonasthmatic control subjects and influenced by worsening airflow obstruction and corticosteroid use. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  14. Does industry take the susceptible subpopulation of asthmatic individuals into consideration when setting derived no‐effect levels?

    Science.gov (United States)

    Johansson, Mia K. V.; Johanson, Gunnar; Öberg, Mattias

    2016-01-01

    Abstract Asthma, a chronic respiratory disease, can be aggravated by exposure to certain chemical irritants. The objectives were first to investigate the extent to which experimental observations on asthmatic subjects are taken into consideration in connection with the registration process under the EU REACH regulation, and second, to determine whether asthmatics are provided adequate protection by the derived no‐effect levels (DNELs) for acute inhalation exposure. We identified substances for which experimental data on the pulmonary functions of asthmatics exposed to chemicals under controlled conditions are available. The effect concentrations were then compared with DNELs and other guideline and limit values. As of April 2015, only 2.6% of 269 classified irritants had available experimental data on asthmatics. Fourteen of the 22 identified substances with available data were fully registered under REACH and we retrieved 114 reliable studies related to these. Sixty‐three of these studies, involving nine of the 14 substances, were cited by the REACH registrants. However, only 17 of the 114 studies, involving four substances, were regarded as key studies. Furthermore, many of the DNELs for acute inhalation were higher than estimated effect levels for asthmatics, i.e., lowest observed adverse effect concentrations or no‐observed adverse effect concentrations, indicating low or no safety margin. We conclude that REACH registrants tend to disregard findings on asthmatics when deriving these DNELs. In addition, we found examples of DNELs, particularly among those derived for workers, which likely do not provide adequate protection for asthmatics. Copyright © 2016 The Authors Journal of Applied Toxicology Published by John Wiley & Sons Ltd. PMID:27283874

  15. Asthmatics exhibit altered oxylipin profiles compared to healthy individuals after subway air exposure.

    Science.gov (United States)

    Lundström, Susanna L; Levänen, Bettina; Nording, Malin; Klepczynska-Nyström, Anna; Sköld, Magnus; Haeggström, Jesper Z; Grunewald, Johan; Svartengren, Magnus; Hammock, Bruce D; Larsson, Britt-Marie; Eklund, Anders; Wheelock, Åsa M; Wheelock, Craig E

    2011-01-01

    Asthma is a chronic inflammatory lung disease that causes significant morbidity and mortality worldwide. Air pollutants such as particulate matter (PM) and oxidants are important factors in causing exacerbations in asthmatics, and the source and composition of pollutants greatly affects pathological implications. This randomized crossover study investigated responses of the respiratory system to Stockholm subway air in asthmatics and healthy individuals. Eicosanoids and other oxylipins were quantified in the distal lung to provide a measure of shifts in lipid mediators in association with exposure to subway air relative to ambient air. Sixty-four oxylipins representing the cyclooxygenase (COX), lipoxygenase (LOX) and cytochrome P450 (CYP) metabolic pathways were screened using liquid chromatography-tandem mass spectrometry (LC-MS/MS) of bronchoalveolar lavage (BAL)-fluid. Validations through immunocytochemistry staining of BAL-cells were performed for 15-LOX-1, COX-1, COX-2 and peroxisome proliferator-activated receptor gamma (PPARγ). Multivariate statistics were employed to interrogate acquired oxylipin and immunocytochemistry data in combination with patient clinical information. Asthmatics and healthy individuals exhibited divergent oxylipin profiles following exposure to ambient and subway air. Significant changes were observed in 8 metabolites of linoleic- and α-linolenic acid synthesized via the 15-LOX pathway, and of the COX product prostaglandin E(2) (PGE(2)). Oxylipin levels were increased in healthy individuals following exposure to subway air, whereas asthmatics evidenced decreases or no change. Several of the altered oxylipins have known or suspected bronchoprotective or anti-inflammatory effects, suggesting a possible reduced anti-inflammatory response in asthmatics following exposure to subway air. These observations may have ramifications for sensitive subpopulations in urban areas.

  16. Asthmatics exhibit altered oxylipin profiles compared to healthy individuals after subway air exposure.

    Directory of Open Access Journals (Sweden)

    Susanna L Lundström

    Full Text Available Asthma is a chronic inflammatory lung disease that causes significant morbidity and mortality worldwide. Air pollutants such as particulate matter (PM and oxidants are important factors in causing exacerbations in asthmatics, and the source and composition of pollutants greatly affects pathological implications.This randomized crossover study investigated responses of the respiratory system to Stockholm subway air in asthmatics and healthy individuals. Eicosanoids and other oxylipins were quantified in the distal lung to provide a measure of shifts in lipid mediators in association with exposure to subway air relative to ambient air.Sixty-four oxylipins representing the cyclooxygenase (COX, lipoxygenase (LOX and cytochrome P450 (CYP metabolic pathways were screened using liquid chromatography-tandem mass spectrometry (LC-MS/MS of bronchoalveolar lavage (BAL-fluid. Validations through immunocytochemistry staining of BAL-cells were performed for 15-LOX-1, COX-1, COX-2 and peroxisome proliferator-activated receptor gamma (PPARγ. Multivariate statistics were employed to interrogate acquired oxylipin and immunocytochemistry data in combination with patient clinical information.Asthmatics and healthy individuals exhibited divergent oxylipin profiles following exposure to ambient and subway air. Significant changes were observed in 8 metabolites of linoleic- and α-linolenic acid synthesized via the 15-LOX pathway, and of the COX product prostaglandin E(2 (PGE(2. Oxylipin levels were increased in healthy individuals following exposure to subway air, whereas asthmatics evidenced decreases or no change.Several of the altered oxylipins have known or suspected bronchoprotective or anti-inflammatory effects, suggesting a possible reduced anti-inflammatory response in asthmatics following exposure to subway air. These observations may have ramifications for sensitive subpopulations in urban areas.

  17. Fragranced consumer products: effects on asthmatics

    OpenAIRE

    Steinemann, Anne

    2017-01-01

    Fragranced consumer products, such as cleaning supplies, air fresheners, and personal care products, can emit a range of air pollutants and trigger adverse health effects. This study investigates the prevalence and types of effects of fragranced products on asthmatics in the American population. Using a nationally representative sample (n = 1137), data were collected with an on-line survey of adults in the USA, of which 26.8% responded as being medically diagnosed with asthma or an asthma-lik...

  18. The validity of nasal endoscopy in patients with chronic rhinosinusitis

    DEFF Research Database (Denmark)

    Larsen, K. L.; Lange, B.; Darling, P.

    2018-01-01

    Objectives: Nasal endoscopy is a cornerstone in diagnosing sinonasal disease, but different raters might generate different results using the technique. Our study aims to evaluate the agreement between multiple raters to assess the validity of nasal endoscopy. Design/Participants: Three independe...

  19. Management of chronic rhinosinusitis with nasal polyps and coexisting asthma

    DEFF Research Database (Denmark)

    Rix, Iben; Håkansson, Kåre; Larsen, Christian Grønhøj

    2015-01-01

    of the evidence for each outcome was graded on the basis of study quality and consistency in findings. RESULTS: We included seven trials in which the effect of montelukast, omalizumab, erythromycin, and functional endoscopic sinus surgery (FESS) were studied in 317 adults with CRSwNP and asthma. All...

  20. NKT Cells in the Induced Sputum of Severe Asthmatics

    Directory of Open Access Journals (Sweden)

    Agnes Hamzaoui

    2006-01-01

    of the sputum and monoclonal antibodies to CD3, CD4, CD8, CD56, CD25, and TCRγδ. The number of NKT (CD3+CD56+ cells was significantly higher in the sputum of severe asthmatics compared with mild asthmatic and healthy control groups (P<.05. CD8+CD56+ cells were the predominant subtype of the increased NKT cells in severe asthmatics. CD3+CD56+Vα24+, TCRγδ+ CD56+, and CD4+CD25+ T cells were significantly increased in severe asthmatic patients. These results suggest that the immunopathogenesis of severe asthmatics vary between severe and mild asthmatics, and that CD8+CD56+ NKT cells may play an important role in the immunopathogenesis of severe asthma.

  1. HRCT findings of asthmatic children under maintenance therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Sook; Park, Jai Soung; Goo, Dong Erk; Lee, Hae Kyung; Kwon, Kui Hyang; Choi, Deuk Lin; Pyun, Bok Yang [Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    2000-05-01

    The purpose of this study was to evaluate the HRCT findings of bronchial asthma during maintenance bronchodilator therapy and to determine whether there were irreversible bronchial changes occurred in pediatric patients with this condition. HRCT findings of the lung in 21 asthmatic children (14 boys and 7 girls aged between 3.5 and 13.8 (mean: 7.7) years) who were receiving maintenance bronchodilator therapy were retrospectively studied. At the time of CT examination, 16 were receiving nonsteroid bronchodilator therapy only, and five were receiving both bronchodilator and steroid therapy. Thirteen patients were defined as allergic and eight were nonallergic. The clinical severity of chronic asthma was graded as severe in seven cases, and moderate in 14. The duration of the disease ranged from 4 months to 6 years (mean 3.2 years). HRCT was performed in 19 cases for evaluation of the atelectasis, hyperinflation, and prominent bronchovascular bundles seen on plain radiographs, and in two cases for evaluation following acute exacerbation. A CT W-2000 scanner (Hitachi Medical Co. Tokyo, Japan) was used during the end inspiratory phase, and in addition, ten patients were scanned during the expiratory phase. Scans were reviewed for evidence of bronchial thickening, bronchiectasis, emphysema, abnormal density, mucus plugs, and other morphological abnormalities. The presence of bronchial wall thickening or air trapping was evaluated according to the duration, severity and type of asthma. Among the 21 patients, 7 (33.3%) had normal HRCT findings, while in 14 (66.7%), bronchial wall thickening was demonstrated. Eleven of the 14 patients with bronchial wall thickening(78.6%) also had air trapping. No patient was suffering from bronchiectasis or emphysema. There were no statistically significant correlations between the presence of bronchial wall thickening or air trapping and the duration of the disease, its severity, or type of asthma. There was, however, a statistically

  2. Antioxidant status in acute asthmatic attack in children

    International Nuclear Information System (INIS)

    Al-Abdulla, N.O.; Al-Naama, L.M.; Hassan, M.K.

    2010-01-01

    Objectives: To determine the oxidant - antioxidant imbalance in asthmatic children, by measuring the levels of malondialdehyde (MDA) as an oxidant marker of lipid peroxidation as well as antioxidant compounds like vitamin C, vitamin E and uric acid and to investigate whether their concentrations are associated with more severe asthma. Methods: This case controlled prospective study was conducted on 219 children aged 1-12 years, attending Basra Maternity and Children Hospital. Included were 98 asthmatic children during acute attack and 121 non asthmatic, apparently healthy children. Serum malondialdehyde (MDA) as an oxidant marker of lipid peroxidation, and vitamin C, vitamin E and uric acid (as antioxidants) were estimated in asthmatic children during acute attack and compared with non-asthmatic children. Results: Asthmatic children during exacerbation of their asthma have significant lower serum levels of antioxidant compounds like vitamin C, vitamin E and uric acid (p<0.001) and significantly high malondialdehyde as compared with the controls. MDA was significantly elevated (P< 0.001), while that of vitamin C, vitamin E and uric acid were significantly decreased with increasing severity of asthmatic attack (P<0.001). A significant negative correlation between MDA with vitamin C (P<0.05, r = - 0.44) was observed in severe asthmatic attacks. Conclusion: Asthmatic patients during acute attack suffer a high degree of reactive oxygen species formation causing considerable oxidative stress that is indicated by the high level of oxidants (MDA) and low level of antioxidants. (author)

  3. Multiple bronchoceles in a non-asthmatic patient with allergic bronchopulmonary aspergillosis.

    Science.gov (United States)

    Amin, Muhammad Umar; Mahmood, Rabia

    2008-09-01

    Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction due to a fungus, Aspergillus fumigatus. It is typically seen in patients with long-standing asthma. Our patient was a non-asthmatic 18 years old male who presented with chronic cough for 2 years. Peripheral blood eosinophilia and elevated scrum IgE were observed. His x-ray chest revealed v-shaped opacity in the left upper lobe close to the hilum. High resolution computed tomographic scan of the chest revealed multiple dilated bronchi filled with mucous (bronchoceles) and central bronchiectasis (CB) involving main segmental bronchi. Central bronchiectasis (CB) was typical of ABPA but bronchocele formation was a rare manifestation of the disease. The patient was managed with oral prednisolone and was relieved of his symptoms. Occurrence of ABPA in non-asthmatics is very rare and deserves reporting.

  4. The potential role of amlodipine on experimentally induced bacterial rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Arzu Tatar

    Full Text Available Abstract Introduction: Antibiotics are frequently used for the treatment of rhinosinusitis. Concerns have been raised regarding the adverse effects of antibiotics and growing resistance. The lack of development of new antibiotic compounds has increased the necessity for exploration of non-antibiotic compounds that have antibacterial activity. Amlodipine is a non-antibiotic compound with anti-inflammatory activity. Objective: In this study we aimed to investigate the potential role of amlodipine in the treatment of rhinosinusitis by evaluating its effects on tissue oxidative status, mucosal histology and inflammation. Methods: Fifteen adult albino guinea pigs were inoculated with Staphylococcus aureus and treated with saline, cefazolin sodium, or amlodipine for 7 days. The control group was composed by five healthy guinea pigs. Animals were sacrificed after the treatment. Histopathological changes were identified using Hematoxylin-Eosin staining. Inflammation was assessed by Polymorphonuclear Leukocyte infiltration density. Tissue levels of antioxidants (superoxide dismutase, glutathione and an oxidative product (malondialdehyde were determined. Results: In rhinosinusitis induced animals, amlodipine reduced loss of cilia, lamina propria edema and collagen deposition compared to placebo (saline and although not superior to cefazolin, amlodipine decreased polymorphonuclear leukocyte infiltration. The superoxide dismutase activity and glutathione levels were reduced, whereas the malondialdehyde levels were increased significantly in all three-treatment groups compared to the control group. Amlodipine treated group showed significantly increased superoxide dismutase and glutathione levels and decreased malondialdehyde levels compared to all treatment groups. Conclusion: The non-antibiotic compound amlodipine may have a role in acute rhinosinusitis treatment through tissue protective, antioxidant and anti-inflammatory mechanisms.

  5. Rutin has anti-asthmatic effects in an ovalbumin-induced asthmatic ...

    African Journals Online (AJOL)

    asthmatic mouse model ... 1Department of Pediatrics, Shandong Jining No.1 People's Hospital, Shandong 272000, 2Department of Pediatrics, Affiliated ..... BALF levels of IL-4, IL-5, and IL-13 versus the control group (Figure 3). However, the level of IFN-γ was slightly lower than the control group level. Rutin administration ...

  6. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists

    NARCIS (Netherlands)

    Fokkens, Wytske J.; Lund, Valerie J.; Mullol, Joachim; Bachert, Claus; Alobid, Isam; Baroody, Fuad; Cohen, Noam; Cervin, Anders; Douglas, Richard; Gevaert, Philippe; Georgalas, Christos; Goossens, Herman; Harvey, Richard; Hellings, Peter; Hopkins, Claire; Jones, Nick; Joos, Guy; Kalogjera, Livije; Kern, Bob; Kowalski, Marek; Price, David; Riechelmann, Herbert; Schlosser, Rodney; Senior, Brent; Thomas, Mike; Toskala, Elina; Voegels, Richard; Wang, De Yun; Wormald, Peter John

    2012-01-01

    The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007. The document contains chapters on definitions and classification, we now also propose definitions for 'difficult to treat' rhinosinusitis, control

  7. A survey on the management of acute rhinosinusitis among Asian physicians

    NARCIS (Netherlands)

    Wang, D. Y.; Wardani, R. S.; Singh, K.; Thanaviratananich, S.; Vicente, G.; Xu, G.; Zia, M. R.; Gulati, A.; Fang, S. Y.; Shi, L.; Chan, Y. H.; Price, D.; Lund, V. J.; Mullol, J.; Fokkens, W. J.

    2011-01-01

    Based on the `European Position Paper on Rhinosinusitis and Nasal polyps (EP3OS 2007)`, this study aimed to investigate general practitioners (GPs) and other specialists` understanding when managing patients with acute rhinosinusitis (ARS) in Asia. Among a total of 2662 questionnaires completed,

  8. Rhino-sinusitis related to endosseous implants extending into the nasal cavity - A case report

    NARCIS (Netherlands)

    Raghoebar, GM; van Weissenbruch, R; Vissink, A

    Rhino-sinusitis may develop as a result of an altered airflow in the nasal cavity causing irritation of the nasal mucosa. A patient is presented who developed recurrent rhino-sinusitis complaints following placement of endosseous implants in the maxilla. Inspection of the nasal floor revealed that

  9. Short-term growth in asthmatic children using fluticasone propionate

    NARCIS (Netherlands)

    Visser, M. J.; van Aalderen, W. M.; Elliott, B. M.; Odink, R. J.; Brand, P. L.

    1998-01-01

    Inhaled corticosteroids may reduce short-term growth velocity in asthmatic children and knemometry is the most sensitive tool to detect this short-term growth suppression. To compare lower leg growth velocity, as measured by knemometry, in asthmatic children during and after treatment with inhaled

  10. Short-term growth in asthmatic children using fluticasone propionate

    NARCIS (Netherlands)

    Visser, MJ; van Aalderen, WMC; Elliott, BM; Odink, RJ; Brand, PLP

    Background: Inhaled corticosteroids may reduce short-term growth velocity in asthmatic children and knemometry is the most sensitive tool to detect this short-term growth suppression. Study objective: To compare lower leg growth velocity, as measured by knemometry, in asthmatic children during and

  11. The frequency of vitamin D deficiency among asthmatic Egyptian ...

    African Journals Online (AJOL)

    Objective: To detect the frequency of vitamin D insufficiency and deficiency among Egyptian asthmatic children and to correlate vitamin D levels to the severity of asthma. Methods: This case control study was conducted on 60 asthmatic children and 40 healthy controls. All were subjected to clinical history taking including ...

  12. daily, sustained-release theophylline on sleep in nocturnal asthmatics

    African Journals Online (AJOL)

    asthmatics. Design. Double-blind, randomised, cross-over, placebo- controlled trial over 22 days. Seven-day period to establish therapeutic levels of theophylline (11.8 ± 3 mg/I); ... (range 3 - 11 minutes); WSW increased from 33 minutes. (range 17 - 66 ... adults (age range 20 - 51 years), diagnosed as asthmatics according ...

  13. Endogenous heparin levels in the controlled asthmatic patient ...

    African Journals Online (AJOL)

    Background. Since heparin possesses anti-inflammatory properties, it is hypothesised that asthmatic patients have decreased levels of circulating heparin compared with healthy individuals. Design. We compared endogenous heparin levels in controlled asthmatic patients (53 adults) from the Asthma Clinic at ...

  14. NKT Cells in the Induced Sputum of Severe Asthmatics

    Directory of Open Access Journals (Sweden)

    2006-01-01

    Full Text Available To determine whether there was a specific inflammatory process in severe asthmatics, the phenotypic characteristics of induced sputum immune cells were analysed among patients with severe asthma. Twenty-two induced sputa (10 severe asthmatics were studied. Flow cytometric analysis was performed using immune cells of the sputum and monoclonal antibodies to CD3, CD4, CD8, CD56, CD25, and TCRγδ . The number of NKT (CD3 + CD 56+ cells was significantly higher in the sputum of severe asthmatics compared with mild asthmatic and healthy control groups ( p<.05 . CD8+CD 56+ cells were the predominant subtype of the increased NKT cells in severe asthmatics. CD3 +CD56+Vα24 +, TCRγδ CD56+, and CD4+CD25+ T cells were significantly increased in severe asthmatic patients. These results suggest that the immunopathogenesis of severe asthmatics vary between severe and mild asthmatics, and that CD8+ CD 56+ NKT cells may play an important role in the immunopathogenesis of severe asthma.

  15. The relationship of C-reactive protein levels and positive culture with quality of life in acute rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Schalek P

    2015-01-01

    Full Text Available Petr Schalek, Zuzana Hornáčková, Aleš Hahn Ear, Nose and Throat department, 3rd Medical Faculty of Charles University, Prague, Czech Republic Background: Acute rhinosinusitis (ARS has been shown to significantly reduce patient quality of life (QoL. While the QoL in patients with chronic rhinosinusitis has been the subject of intensive research over the last decade, studies measuring the impact of ARS on patient QoL have remained relatively scarce. The aim of this study was to determine the relationship between the QoL and parameters suggestive of acute bacterial rhinosinusitis (C-reactive protein [CRP] levels and positive culture and to see if measurement of the QoL could be used as an indicator for antibiotic treatment in ARS.Methods: Eighty patients with ARS were enrolled in the study. A novel QoL instrument for patients with ARS, called Measurement of Acute Rhinosinusitis (MARS questionnaire, was given to patients at the time of diagnosis. We assessed patient QoL, obtained endoscopically guided cultures from the middle meatus, and measured levels of CRP. The relationship between QoL MARS scores (QoL-Mscores and CRP was determined using a correlation coefficient. To compare QoL-Mscores, relative to culture-positive and culture-negative patients, the Student’s t-test was used.Results: No correlation between the QoL, assessed using the MARS questionnaire, and positive middle meatus culture was demonstrated (P=0.332. A weak correlation was found between QoL-Mscores and CRP values, with a correlation coefficient of 0.221 and P=0.0498.Conclusion: No correlation between the QoL in ARS patients and positive culture was found in this study. The clinical significance of the correlation between QoL-Mscores and CRP values in the antibiotic decision making process needs further research. Keywords: endoscopy, quality of life, questionnaires, anti-bacterial agents

  16. Exploratory study comparing dysautonomia between asthmatic and non-asthmatic elite swimmers

    Directory of Open Access Journals (Sweden)

    M. Couto

    2015-01-01

    Full Text Available Background: Dysautonomia has been independently associated with training and exercise-induced bronchoconstriction. In addition, neurogenic airway inflammation was recently associated with swimmers-asthma. We aimed to assess the relation between autonomic nervous system and airway responsiveness of asthmatic elite swimmers. Methods: Twenty-seven elite swimmers, 11 of whom had asthma, were enrolled in this exploratory cross-sectional study. All performed spirometry with bronchodilation, skin prick tests and methacholine challenge according to the guidelines. Pupillometry was performed using PLR-200™ Pupillometer. One pupil light response curve for each eye was recorded and the mean values of pupil's maximal and minimal diameters, percentage of constriction, average and maximum constriction velocities (parasympathetic parameters, dilation velocity, and total time to recover 75% of the initial size (sympathetic parameters were used for analysis. Asthma was defined using IOC-MC criteria; subjects were divided into airway hyperesponsiveness (AHR severity according to methacholine PD20 in: no AHR, borderline, mild, moderate and severe AHR. Differences for pupillary parameters between groups and after categorization by AHR severity were assessed using SPSS 20.0 (p ≤ 0.05. In individuals with clinically relevant AHR, correlation between PD20 and pupillary parameters was investigated with Spearman's correlation test. Results: No statistically significant differences were observed between asthmatic and non-asthmatic swimmers regarding parasympathetic parameters. When stratified by AHR, maximal and minimal diameters and percentage of constriction were significantly lower among those with severe AHR. Among swimmers with clinically relevant AHR (n = 18, PD20 correlated with parasympathetic activity: maximal (r = 0.67, p = 0.002 and minimal diameters (r = 0.75, p < 0.001, percentage of constriction (r

  17. The mold conundrum in chronic hyperplastic sinusitis

    NARCIS (Netherlands)

    Ebbens, Fenna A.; Georgalas, Christos; Fokkens, Wytske J.

    2009-01-01

    The role of fungi in chronic rhinosinusitis (CRS) is not clear. Fungi can be detected in the nose and paranasal sinuses of virtually all CRS patients; however, they also appear to be present in healthy controls. Various theories attempt to explain the mechanisms by which fungi can exert an effect on

  18. Effect of anti-asthmatic drugs on dental health: A comparative study

    Directory of Open Access Journals (Sweden)

    P Chellaih

    2016-01-01

    Full Text Available Aims: Bronchial asthma constitutes important problem worldwide. This chronic lung disease has detrimental effect in the oral cavity like reduction of salivary secretion, change in salivary composition and pH. Materials and Methods: This study was conducted to compare the prevalence of dental caries in asthmatic children and healthy children, and also to evaluate the correlation between the Streptococcus mutans , Lactobacillus and dental caries in both the groups. Results: In this study, the mean decayed, missing, filled teeth score of children in the study group was (4.53 ± 3.38 higher than the control group (1.51 ± 1.58 (P < 0.01. The S. mutans count of the study group was (59574.47 ± 28510.67 higher than the control group (19777.78 ± 17899.83 P < 0.01. The Lactobacillus count in study group was (43553.19 ± 58776.96 higher than the control group (8843.84 ± 7982.72 P < 0.01. Subjects using inhaled corticosteroids were more prone to develop dental caries than the control group with odds ratio = 6.26 and 95% confidence interval. Conclusions: The dental caries prevalence increases with the usage of β2agonist and corticosteroid inhalers for the treatment of asthma. Thus in asthmatic children, increase in caries prevalence might be due to the drug treatment and not due to the disease by itself. It can be concluded that asthmatic children have a higher prevalence of dental caries than healthy children. Hence, special oral health care is needed for asthmatic children.

  19. Immunometabolism in obese asthmatics: are we there yet?

    Science.gov (United States)

    Periyalil, Hashim A; Gibson, Peter G; Wood, Lisa G

    2013-09-10

    Obesity is now recognised as a worldwide epidemic. The recent International Association for the Study of Obesity/International Obesity Taskforce (IASO/IOTF) analysis estimates that approximately 1.0 billion adults are currently overweight and a further 475 million are obese. Obesity has huge psychosocial impact with obese children and adolescents facing discrimination and stigmatization in many areas of their lives leading to body dissatisfaction, low self-esteem and depression. Indeed, obesity is recognised as an important risk factor for the development of several chronic diseases such as hypertension, cancer, asthma and metabolic syndrome. Chronic low grade systemic inflammation is considered as a hallmark of obesity and may possibly explain the link between obesity and chronic disease, in particular the increased incidence, prevalence and severity of asthma in obese individuals. There is now strong evidence for infiltration of immune and inflammatory cells into adipose tissue that drives systemic inflammation and subsequent end organ damage. In addition to adipocytes, the key adipose tissue resident immune cells are macrophages and mast cells. Immunometabolism, as an emerging field of investigation, explores the pivotal role of these immune cells in translating immunological changes to metabolic effects in obesity. Abundance of free fatty acids, along with other inflammatory cytokines shift the balance of metabolic homeostasis to pro-inflammatory status by influencing the development of inflammatory cell lineage, which, further exhibits distinct functional phenotypes. There is emerging evidence for macrophage activation and functional polarization of an anti-inflammatory M2 phenotype towards a pro-inflammatory M1 phenotype of macrophages in obese adipose tissue. Similarly, studies in both obese humans and murine models reveal the pathognomic presence of an increased number of mast cells in visceral adipose tissue. These suggest a possible contribution of mast

  20. Immunometabolism in Obese Asthmatics: Are We There Yet?

    Directory of Open Access Journals (Sweden)

    Lisa G. Wood

    2013-09-01

    Full Text Available Obesity is now recognised as a worldwide epidemic. The recent International Association for the Study of Obesity/International Obesity Taskforce (IASO/IOTF analysis estimates that approximately 1.0 billion adults are currently overweight and a further 475 million are obese. Obesity has huge psychosocial impact with obese children and adolescents facing discrimination and stigmatization in many areas of their lives leading to body dissatisfaction, low self-esteem and depression. Indeed, obesity is recognised as an important risk factor for the development of several chronic diseases such as hypertension, cancer, asthma and metabolic syndrome. Chronic low grade systemic inflammation is considered as a hallmark of obesity and may possibly explain the link between obesity and chronic disease, in particular the increased incidence, prevalence and severity of asthma in obese individuals. There is now strong evidence for infiltration of immune and inflammatory cells into adipose tissue that drives systemic inflammation and subsequent end organ damage. In addition to adipocytes, the key adipose tissue resident immune cells are macrophages and mast cells. Immunometabolism, as an emerging field of investigation, explores the pivotal role of these immune cells in translating immunological changes to metabolic effects in obesity. Abundance of free fatty acids, along with other inflammatory cytokines shift the balance of metabolic homeostasis to pro-inflammatory status by influencing the development of inflammatory cell lineage, which, further exhibits distinct functional phenotypes. There is emerging evidence for macrophage activation and functional polarization of an anti-inflammatory M2 phenotype towards a pro-inflammatory M1 phenotype of macrophages in obese adipose tissue. Similarly, studies in both obese humans and murine models reveal the pathognomic presence of an increased number of mast cells in visceral adipose tissue. These suggest a possible

  1. Exploratory study comparing dysautonomia between asthmatic and non-asthmatic elite swimmers.

    Science.gov (United States)

    Couto, M; Silva, D; Santos, P; Queirós, S; Delgado, L; Moreira, A

    2015-01-01

    Dysautonomia has been independently associated with training and exercise-induced bronchoconstriction. In addition, neurogenic airway inflammation was recently associated with swimmers-asthma. We aimed to assess the relation between autonomic nervous system and airway responsiveness of asthmatic elite swimmers. Twenty-seven elite swimmers, 11 of whom had asthma, were enrolled in this exploratory cross-sectional study. All performed spirometry with bronchodilation, skin prick tests and methacholine challenge according to the guidelines. Pupillometry was performed using PLR-200™ Pupillometer. One pupil light response curve for each eye was recorded and the mean values of pupil's maximal and minimal diameters, percentage of constriction, average and maximum constriction velocities (parasympathetic parameters), dilation velocity, and total time to recover 75% of the initial size (sympathetic parameters) were used for analysis. Asthma was defined using IOC-MC criteria; subjects were divided into airway hyperesponsiveness (AHR) severity according to methacholine PD20 in: no AHR, borderline, mild, moderate and severe AHR. Differences for pupillary parameters between groups and after categorization by AHR severity were assessed using SPSS 20.0 (p ≤ 0.05). In individuals with clinically relevant AHR, correlation between PD20 and pupillary parameters was investigated with Spearman's correlation test. No statistically significant differences were observed between asthmatic and non-asthmatic swimmers regarding parasympathetic parameters. When stratified by AHR, maximal and minimal diameters and percentage of constriction were significantly lower among those with severe AHR. Among swimmers with clinically relevant AHR (n = 18), PD20 correlated with parasympathetic activity: maximal (r = 0.67, p = 0.002) and minimal diameters (r = 0.75, pdysautonomia and AHR in asthmatic swimmers. Copyright © 2014 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S

  2. [Clinical analyses of the diagnosis and treatment of invasive fungal rhinosinusitis: report of 14 cases].

    Science.gov (United States)

    Shi, G G; Shi, L; Zhang, Z Y; Wan, Y Z; Li, B; Yu, L; Zhang, E P; Ju, H S; He, M Q; Ji, H Z

    2016-08-07

    Through the retrospective analysis of the clinical data in 14 cases of invasive fungal rhinosinusitis (IFRS), the clinical characteristics, diagnosis and treatment of this disease were evaluated. Fourteen clinically confirmed cases of IFRS since January 2008 to October 2015 were evaluated.collected, the clinical features, diagnosis, treatment and prognosis were analyzed to obtain a more comprehensive understanding for clinical reference. Fourteen patients were confirmed by pathological examination as IFRS, including 9 cases of aspergillus, 4 cases of mucor, and 1 case of rhinocerebral zygomycosis; including 5 cases of acute IFRS, 9 cases of chronic IFRS. All patients were treated with endoscopic surgery and intravenous antifungal therapy. Nine cases of chronic IFRS (including 1 case of mucor, 7 cases of aspergillus and 1 case of rhinocerebral zygomycosis) were cured, but the vision loss, diplopia or blindness, hard palate perforation remained. Five cases of acute IFRS included 3 cases of mucor and 2 cases of aspergillus. Among the 3 cases of mucor, 2 cases were died and 1 case was cured. Among the 2 cases of aspergillus, 1 patient was cured and the other patient died of electrolyte disorder after discharge from hospital. Patients with IFRS usually have diabetes. After the active surgical cleaning of lesion tissue and the systematic antifungal treatment with adequate dosage, these patients would have a better result. IFRS caused by mucor is ofen dangerous.

  3. 2007 San Diego wildfires and asthmatics.

    Science.gov (United States)

    Vora, Chirag; Renvall, Marian J; Chao, Peter; Ferguson, Paul; Ramsdell, Joe W

    2011-02-01

    This case series reports the changes in the respiratory health of eight asthmatic subjects and the relationship with air quality associated with the October 2007 firestorm in San Diego County of California. Participants were eight subjects with asthma enrolled in Asthma Clinical Research Network (ACRN) (NIH# U10-HL074218) studies at the University of California San Diego (UCSD), School of Medicine, who had study data collected immediately prior, during and 1 month after the 5-day firestorm in San Diego County. Air quality deteriorated to an extreme average of 71.5 mg/m(3) small particulate matter less than 2.5 μm (PM(2.5)) during the firestorm. Respiratory health data included morning and evening peak expiratory flow rates (PEFR), morning and evening Forced Expiratory Volume in one second (FEV(1)), rescue medication usage, and sputum eosinophils. Morning and evening PEFR and FEV(1) rates remained stable. The two subjects tested during the fires had elevated eosinophil counts and rescue medication usage was increased in five of the eight subjects. Pulmonary function test values were stable during the wildfires for all eight subjects but there was a statistically significant increase in rescue medication usage during the wildfires that correlated with PM(2.5) values. The two subjects tested during the fires showed increases in sputum eosinophil counts consistent with increased airways inflammation. These findings suggest that poor air quality associated with wildfires resulted in an increase in airways inflammation in these asthmatic subjects, but pulmonary function tests remained stable, possibly due to increased rescue medication usage. This is especially pertinent as there is an increase in incidence of wildfires this decade.

  4. Schizophyllum commune-induced allergic fungal rhinosinusitis and sinobronchial mycosis

    Directory of Open Access Journals (Sweden)

    Toshiaki Tsukatani

    2015-06-01

    Full Text Available We present 32- and 38-year-old males with Schizophyllum commune-induced allergic fungal rhinosinusitis (AFRS. S. commune-induced AFRS was diagnosed by clinical and radiographic findings, positive specific IgE antibodies against S. commune as measured by the ImmunoCAP system, and sequencing analysis of the fungus. Our two cases with S. commune-induced AFRS for the first time showed evidence for type 1 hypersensitivity to S. commune as determined by using specific IgE antibodies against S. commune, and the fungus was identified by sequence analysis.

  5. THE CLINICAL EFFICACY OF THE PHYTOMEDICINE IN THE TREATMENT OF ACUTE RHINOSINUSITIS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    A. G. Volkov

    2012-01-01

    Full Text Available Acute rhinosinusitis is one of the most common diseases in childhood. Difficulties in identifying pathogens increase the importance of pathogenetic therapy. A study of clinical efficacy of mucolytic agents of herbal origin in the treatment of acute rhinosinusitis of 2 days period combined with respiratory viral infection in 95 children aged 4 to 14 years was carried out. The dynamics of the disease symptoms (rhinorrhea, nasal congestion, and olfaction was estimated based on the diaries filled by parents every day. The study demonstrated the feasibility of the phytopreparation inclusion in the complex therapy of acute rhinosinusitis in children. 

  6. Call-Center Based Disease Management of Pediatric Asthmatics

    Science.gov (United States)

    2006-04-01

    Cagnani CE. Allergic rhinitis and asthma in children: disease management and outcomes. Current Allergy & Asthma Reports. 1(6):515-22, 2001. 58. Chan...of Pediatric Asthmatics PRINCIPAL INVESTIGATOR: James M. Quinn, M.D. CONTRACTING ORGANIZATION: The Geneva Foundation...CONTRACT NUMBER Call-Center Based Disease Management of Pediatric Asthmatics 5b. GRANT NUMBER DAMD17-02-1-0182 5c. PROGRAM ELEMENT NUMBER 6

  7. Management of acute rhinosinusitis in Danish general practice: a survey

    Directory of Open Access Journals (Sweden)

    Hansen JG

    2011-07-01

    Full Text Available Jens Georg HansenDepartment of Clinical Epidemiology, Aarhus University Hospital and Aalborg Hospital, Aalborg, DenmarkPurpose: To evaluate whether the ongoing debate over diagnostic problems and treatment choices for acute rhinosinusitis has had any influence on the management of the disease.Methods: We randomly selected 300 Danish general practitioners (GPs from the files of the Research Unit for General Practice at Aarhus University. Invitations to participate and a questionnaire were sent to the GPs by mail.Results: A total of 149 (49% GPs answered the questionnaire. When asked about symptoms, the highest priority was given to sinus pain and signs of tenderness. The most frequent examinations were objective examination of the ear-nose-throat (ENT, palpation of the maxillofacial area, and C-reactive protein point-of-care testing (or CRP rapid test. Nearly all GPs prescribed local vasoconstrictors, and in 70% of cases, antibiotics were prescribed. Phenoxymethylpenicillin was the preferred antibiotic. Use of the CRP rapid test, years in practice, or employment in an ENT department did not have a significant impact on the diagnostic certainty and antibiotic prescribing rate.Conclusion: The clinical diagnoses are based on a few symptoms, signs, and the CRP rapid test. Other examinations, including imaging techniques, are seldom used. Phenoxymethylpenicillin is the preferred antibiotic, and the GPs' diagnostic certainty was 70%.Keywords: general practice, acute rhinosinusitis, diagnosis, treatment, antibiotic

  8. Respiratory load perception in overweight and asthmatic children.

    Science.gov (United States)

    MacBean, Victoria; Wheatley, Lorna; Lunt, Alan C; Rafferty, Gerrard F

    2017-05-01

    Overweight asthmatic children report greater symptoms than normal weight asthmatics, despite comparable airflow obstruction. This has been widely assumed to be due to heightened perception of respiratory effort. Three groups of children (healthy weight controls, healthy weight asthmatics, overweight asthmatics) rated perceived respiratory effort throughout an inspiratory resistive loading protocol. Parasternal intercostal electromyogram was used as an objective marker of respiratory load; this was expressed relative to tidal volume and reported as a ratio of the baseline value (neuroventilatory activity ratio (NVEAR)). Significant increases in perception scores (p<0.0001), and decreases in NVEAR (p<0.0001) were observed from lowest to highest resistive load. Higher BMI increased overall perception scores, with no influence of asthma or BMI-for-age percentile on the resistance-perception relationships. These data, indicating elevated overall respiratory effort in overweight asthmatic children but comparable responses to dynamic changes in load, suggest that the greater disease burden in overweight asthmatic children may be due to altered respiratory mechanics associated with increased body mass. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Effects of massage therapy of asthmatic children on the anxiety level of mothers.

    Science.gov (United States)

    Ghazavi, Zohreh; Namnabati, Mahboubeh; Faghihinia, Jamal; Mirbod, Mohsen; Ghalriz, Parvin; Nekuie, Afsaneh; Fanian, Nasrin

    2010-01-01

    Asthma is the most common chronic disease of childhood and its prevalence is increasing all over the world. Asthma influences on many aspects of family daily life. Health care of children with chronic asthma can have deep impact on health and welfare of the family members. Studies showed a relation between the life quality of children suffering from asthma and the anxiety level of parents. These parents are looking for ways to confront with their stress, to reduce their anxiety in encountering with their asthmatic children, and to improve their performance. This research was accomplished with the aim of determining the influence of massage therapy on anxiety level of mothers with asthmatic children. This was a quasi-experimental study with two groups and a pretest and posttest design. The samples of research were 60 mothers of 5-14 year-old asthmatic children who were under treatment in medical centers of Isfahan. They were randomly divided into two groups of control and massage therapy by convenience sampling method. The data were collected by standard Spielberger questionnaire. Mothers of massage group were trained to massage head, neck, face, shoulder, hand, leg, and back of their children every night before bedtime for one month while there was no intervention for the control group during this month except the standard treatment. In both groups, the Spielberger standard questionnaire was filled by mothers. The data were analyzed by descriptive analysis, independent t-test, paired-t test, and chi-square test. The results showed no significant difference in mean anxiety level between the two groups before the intervention but there was a significant difference between them after intervention (p massage group (p massage therapy and giving an active role to the mothers in caring and treating the child. Daily massage helped mothers to have more sense of participation in caring their children and as a non-pharmacological method can be accompanied with pharmacological

  10. [Paediatric prescribing of anti-asthmatics in primary care in Castilla-León. Geographical variability].

    Science.gov (United States)

    Casares Alonso, I; Cano Garcinuño, A; Blanco Quirós, A; Pérez García, I

    2015-09-01

    Asthma is one of the most prevalent chronic diseases with effective treatment in paediatrics. The aim of this study is to describe the paediatric prescribing of anti-asthmatics in Castilla-León, analyzing its geographic variability and temporal evolution. An analysis was made of prescriptions dispensed in pharmacies of R03 therapeutic subgroup (anti-asthmatic agents), and the active ingredients mepyramine and ketotifen, prescribed in children less than 14 years of age in the Castilla-León health service from 2005 to 2010 in Primary Care. Data is presented in prescribed daily doses per thousand inhabitants per day (PDHD) for each active ingredient being calculated raw rates and age-adjusted to the variables health area, type of health zone and year of study. A total of 462,354 prescriptions of anti-asthmatic agents were dispensed to a population of 1,580,229 persons/year. There was wide variation between areas in the type and intensity of anti-asthmatic agents used, partly explained by differences in the prevalence of asthma. Montelukast predominated as controller drug in most of them (PDHD 3.1 to 7.7), being similar the consumption intensity in the three types of health zones (PDHD 4.7 to 4.8). The annual variability was low. The study describes the paediatric prescribing pattern of anti-asthmatic agents in Castilla-León between 2005-2010. It shows wide geographical variation, as well as inadequacies regarding current recommendations of asthma treatment. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  11. Antibiotic prescribing in patients with acute rhinosinusitis is not in agreement with European recommendations

    DEFF Research Database (Denmark)

    Jørgensen, Lars Christian; Friis Christensen, Sarah; Cordoba Currea, Gloria

    2013-01-01

    Abstract Objective. To assess the potential overprescribing in patients with acute rhinosinusitis across six countries with different antibiotic prescribing rates and different prevalence of antibiotic resistance. Design, setting and subjects. A cross-sectional study including GPs from two Nordic...

  12. Allergic asthmatics show divergent lipid mediator profiles from healthy controls both at baseline and following birch pollen provocation.

    Directory of Open Access Journals (Sweden)

    Susanna L Lundström

    Full Text Available Asthma is a respiratory tract disorder characterized by airway hyper-reactivity and chronic inflammation. Allergic asthma is associated with the production of allergen-specific IgE and expansion of allergen-specific T-cell populations. Progression of allergic inflammation is driven by T-helper type 2 (Th2 mediators and is associated with alterations in the levels of lipid mediators.Responses of the respiratory system to birch allergen provocation in allergic asthmatics were investigated. Eicosanoids and other oxylipins were quantified in the bronchoalveolar lumen to provide a measure of shifts in lipid mediators associated with allergen challenge in allergic asthmatics.Eighty-seven lipid mediators representing the cyclooxygenase (COX, lipoxygenase (LOX and cytochrome P450 (CYP metabolic pathways were screened via LC-MS/MS following off-line extraction of bronchoalveolar lavage fluid (BALF. Multivariate statistics using OPLS were employed to interrogate acquired oxylipin data in combination with immunological markers.Thirty-two oxylipins were quantified, with baseline asthmatics possessing a different oxylipin profile relative to healthy individuals that became more distinct following allergen provocation. The most prominent differences included 15-LOX-derived ω-3 and ω-6 oxylipins. Shared-and-Unique-Structures (SUS-plot modeling showed a correlation (R(2 = 0.7 between OPLS models for baseline asthmatics (R(2Y[cum] = 0.87, Q(2[cum] = 0.51 and allergen-provoked asthmatics (R(2Y[cum] = 0.95, Q(2[cum] = 0.73, with the majority of quantified lipid mediators and cytokines contributing equally to both groups. Unique structures for allergen provocation included leukotrienes (LTB(4 and 6-trans-LTB(4, CYP-derivatives of linoleic acid (epoxides/diols, and IL-10.Differences in asthmatic relative to healthy profiles suggest a role for 15-LOX products of both ω-6 and ω-3 origin in allergic inflammation. Prominent differences at baseline levels indicate

  13. Allergic Asthmatics Show Divergent Lipid Mediator Profiles from Healthy Controls Both at Baseline and following Birch Pollen Provocation

    Science.gov (United States)

    Lundström, Susanna L.; Yang, Jun; Källberg, Henrik J.; Thunberg, Sarah; Gafvelin, Guro; Haeggström, Jesper Z.; Grönneberg, Reidar; Grunewald, Johan; van Hage, Marianne; Hammock, Bruce D.; Eklund, Anders; Wheelock, Åsa M.; Wheelock, Craig E.

    2012-01-01

    Background Asthma is a respiratory tract disorder characterized by airway hyper-reactivity and chronic inflammation. Allergic asthma is associated with the production of allergen-specific IgE and expansion of allergen-specific T-cell populations. Progression of allergic inflammation is driven by T-helper type 2 (Th2) mediators and is associated with alterations in the levels of lipid mediators. Objectives Responses of the respiratory system to birch allergen provocation in allergic asthmatics were investigated. Eicosanoids and other oxylipins were quantified in the bronchoalveolar lumen to provide a measure of shifts in lipid mediators associated with allergen challenge in allergic asthmatics. Methods Eighty-seven lipid mediators representing the cyclooxygenase (COX), lipoxygenase (LOX) and cytochrome P450 (CYP) metabolic pathways were screened via LC-MS/MS following off-line extraction of bronchoalveolar lavage fluid (BALF). Multivariate statistics using OPLS were employed to interrogate acquired oxylipin data in combination with immunological markers. Results Thirty-two oxylipins were quantified, with baseline asthmatics possessing a different oxylipin profile relative to healthy individuals that became more distinct following allergen provocation. The most prominent differences included 15-LOX-derived ω-3 and ω-6 oxylipins. Shared-and-Unique-Structures (SUS)-plot modeling showed a correlation (R2 = 0.7) between OPLS models for baseline asthmatics (R2Y[cum] = 0.87, Q2[cum] = 0.51) and allergen-provoked asthmatics (R2Y[cum] = 0.95, Q2[cum] = 0.73), with the majority of quantified lipid mediators and cytokines contributing equally to both groups. Unique structures for allergen provocation included leukotrienes (LTB4 and 6-trans-LTB4), CYP-derivatives of linoleic acid (epoxides/diols), and IL-10. Conclusions Differences in asthmatic relative to healthy profiles suggest a role for 15-LOX products of both ω-6 and ω-3 origin in allergic

  14. Antibiotic prescribing in patients with acute rhinosinusitis is not in agreement with European recommendations.

    Science.gov (United States)

    Jørgensen, Lars Christian; Friis Christensen, Sarah; Cordoba Currea, Gloria; Llor, Carl; Bjerrum, Lars

    2013-06-01

    To assess the potential overprescribing in patients with acute rhinosinusitis across six countries with different antibiotic prescribing rates and different prevalence of antibiotic resistance. A cross-sectional study including GPs from two Nordic countries, two Baltic countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) during three weeks in January 2008 as part of the EU-funded project "Health Alliance for Prudent Prescribing, Yield And Use of antimicrobial Drugs In the Treatment of respiratory tract infections" (HAPPY AUDIT). Use of antibiotics for acute rhinosinusitis based on the recommendations in the European Position Paper on Rhinosinusitis and Nasal Polyps 2007 (EP3OS). In total, 618 participating GPs registered 33 273 patients with RTI of whom 1150 (3.46%) were considered to have acute rhinosinusitis. Over 50% of the patients with acute rhinosinusitis had symptoms for overprescribing) and 23% had symptoms overprescribing). A considerable number of patients with symptoms of acute rhinosinusitis were not managed according to European recommendations (EP3OS guidelines). To prevent overprescribing, efforts should be made to implement the recommendations in daily practice.

  15. 75 deaths in asthmatics prescribed home nebulisers.

    Science.gov (United States)

    Sears, M R; Rea, H H; Fenwick, J; Gillies, A J; Holst, P E; O'Donnell, T V; Rothwell, R P

    1987-02-21

    The circumstances surrounding the deaths of 75 asthmatic patients who had been prescribed a domiciliary nebuliser driven by an air compressor pump for administration of high dose beta sympathomimetic drugs were investigated as part of the New Zealand national asthma mortality study. Death was judged unavoidable in 19 patients who seemed to have precipitous attacks despite apparently good long term management. Delays in seeking medical help because of overreliance on beta agonist delivered by nebuliser were evident in 12 cases and possible in a further 11, but these represented only 8% of the 271 verified deaths from asthma in New Zealanders aged under 70 during the period. Evidence for direct toxicity of high dose beta agonist was not found. Nevertheless, the absence of serum potassium and theophylline concentrations and of electrocardiographic monitoring in the period immediately preceding death precluded firm conclusions whether arrhythmias might have occurred due to these factors rather than to hypoxia alone. In most patients prescribed domiciliary nebulisers death was associated with deficiencies in long term and short term care similar to those seen in patients without nebulisers. Discretion in prescribing home nebulisers, greater use of other appropriate drugs, including adequate corticosteroids, and careful supervision and instruction of patients taking beta agonist by nebuliser should help to reduce the mortality from asthma.

  16. Exhaled carbon monoxide in asthmatics: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Huang Mao

    2010-04-01

    Full Text Available Abstract Background The non-invasive assessment of airway inflammation is potentially advantageous in asthma management. Exhaled carbon monoxide (eCO measurement is cheap and has been proposed to reflect airway inflammation and oxidative stress but current data are conflicting. The purpose of this meta-analysis is to determine whether eCO is elevated in asthmatics, is regulated by steroid treatment and reflects disease severity and control. Methods A systematic search for English language articles published between 1997 and 2009 was performed using Medline, Embase and Cochrane databases. Observational studies comparing eCO in non-smoking asthmatics and healthy subjects or asthmatics before and after steroid treatment were included. Data were independently extracted by two investigators and analyzed to generate weighted mean differences using either a fixed or random effects meta-analysis depending upon the degree of heterogeneity. Results 18 studies were included in the meta-analysis. The eCO level was significantly higher in asthmatics as compared to healthy subjects and in intermittent asthma as compared to persistent asthma. However, eCO could not distinguish between steroid-treated asthmatics and steroid-free patients nor separate controlled and partly-controlled asthma from uncontrolled asthma in cross-sectional studies. In contrast, eCO was significantly reduced following a course of corticosteroid treatment. Conclusions eCO is elevated in asthmatics but levels only partially reflect disease severity and control. eCO might be a potentially useful non-invasive biomarker of airway inflammation and oxidative stress in nonsmoking asthmatics.

  17. Epidemiological profile of smoking and nicotine addiction among asthmatic adolescents.

    Science.gov (United States)

    Vázquez-Nava, F; Vázquez-Rodríguez, E M; Vázquez-Rodríguez, C F; Castillo Ruiz, O; Peinado Herreros, J

    2017-08-01

    Despite the harmful effects of cigarette smoking, this habit in asthmatic adolescents continues to be a health problem worldwide. Our objectives were to determine the epidemiological profile of smoking and the degree of nicotine dependence among asthmatic adolescents. Through a cross-sectional investigation, 3383 adolescents (13-19 years of age) were studied. Information was collected using a previously validated questionnaire. Two study groups of adolescent smokers were formed: one composed of asthmatic adolescents and the other of healthy youths. Asthmatic adolescents were found to be more likely to smoke (21.6% vs 11.8%) and to have some degree of nicotine dependence compared with healthy adolescents (51.6% vs 48.8%). The most important characteristic of smoking in asthmatic adolescents was found to be an onset before 11 years of age due to curiosity about cigarettes. Asthmatic youths continue smoking because this habit decreases their anxiety and stress. Adolescents know that smoking is addictive and often smoke on waking up in the morning or when they are sick. Yet, these adolescents do not consider smoking to be a problem. In this study, curiosity about cigarettes was the primary reason why asthmatic adolescents smoked for the first time and developed a greater dependence to nicotine compared with healthy adolescents. Moreover, the findings show that many of the factors that favour the development of smoking are preventable, given that they are present in the family and social environment. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  18. Lithium Attenuates TGF-β 1-Induced Fibroblasts to Myofibroblasts Transition in Bronchial Fibroblasts Derived from Asthmatic Patients

    Science.gov (United States)

    Michalik, Marta; Wójcik, Katarzyna Anna; Jakieła, Bogdan; Szpak, Katarzyna; Pierzchalska, Małgorzata; Sanak, Marek; Madeja, Zbigniew; Czyż, Jarosław

    2012-01-01

    Bronchial asthma is a chronic disorder accompanied by phenotypic transitions of bronchial epithelial cells, smooth muscle cells, and fibroblasts. Human bronchial fibroblasts (HBFs) derived from patients with diagnosed asthma display predestination towards TGF-β-induced phenotypic switches. Since the interference between TGF-β and GSK-3β signaling contributes to pathophysiology of chronic lung diseases, we investigated the effect of lithium, a nonspecific GSK-3β inhibitor, on TGF-β 1-induced fibroblast to myofibroblast transition (FMT) in HBF and found that the inhibition of GSK-3β attenuates TGF-β 1-induced FMT in HBF populations derived from asthmatic but not healthy donors. Cytoplasmically sequestrated β-catenin, abundant in TGF-β 1/LiCl-stimulated asthmatic HBFs, most likely interacts with and inhibits the nuclear accumulation and signal transduction of Smad proteins. These data indicate that the specific cellular context determines FMT-related responses of HBFs to factors interfering with the TGF-β signaling pathway. They may also provide a mechanistic explanation for epidemiological data revealing coincidental remission of asthmatic syndromes and their recurrence upon the discontinuation of lithium therapy in certain psychiatric diseases. PMID:22988467

  19. Lithium Attenuates TGF-β1-Induced Fibroblasts to Myofibroblasts Transition in Bronchial Fibroblasts Derived from Asthmatic Patients

    Directory of Open Access Journals (Sweden)

    Marta Michalik

    2012-01-01

    Full Text Available Bronchial asthma is a chronic disorder accompanied by phenotypic transitions of bronchial epithelial cells, smooth muscle cells, and fibroblasts. Human bronchial fibroblasts (HBFs derived from patients with diagnosed asthma display predestination towards TGF-β-induced phenotypic switches. Since the interference between TGF-β and GSK-3β signaling contributes to pathophysiology of chronic lung diseases, we investigated the effect of lithium, a nonspecific GSK-3β inhibitor, on TGF-β1-induced fibroblast to myofibroblast transition (FMT in HBF and found that the inhibition of GSK-3β attenuates TGF-β1-induced FMT in HBF populations derived from asthmatic but not healthy donors. Cytoplasmically sequestrated β-catenin, abundant in TGF-β1/LiCl-stimulated asthmatic HBFs, most likely interacts with and inhibits the nuclear accumulation and signal transduction of Smad proteins. These data indicate that the specific cellular context determines FMT-related responses of HBFs to factors interfering with the TGF-β signaling pathway. They may also provide a mechanistic explanation for epidemiological data revealing coincidental remission of asthmatic syndromes and their recurrence upon the discontinuation of lithium therapy in certain psychiatric diseases.

  20. Lithium Attenuates TGF-β(1)-Induced Fibroblasts to Myofibroblasts Transition in Bronchial Fibroblasts Derived from Asthmatic Patients.

    Science.gov (United States)

    Michalik, Marta; Wójcik, Katarzyna Anna; Jakieła, Bogdan; Szpak, Katarzyna; Pierzchalska, Małgorzata; Sanak, Marek; Madeja, Zbigniew; Czyż, Jarosław

    2012-01-01

    Bronchial asthma is a chronic disorder accompanied by phenotypic transitions of bronchial epithelial cells, smooth muscle cells, and fibroblasts. Human bronchial fibroblasts (HBFs) derived from patients with diagnosed asthma display predestination towards TGF-β-induced phenotypic switches. Since the interference between TGF-β and GSK-3β signaling contributes to pathophysiology of chronic lung diseases, we investigated the effect of lithium, a nonspecific GSK-3β inhibitor, on TGF-β(1)-induced fibroblast to myofibroblast transition (FMT) in HBF and found that the inhibition of GSK-3β attenuates TGF-β(1)-induced FMT in HBF populations derived from asthmatic but not healthy donors. Cytoplasmically sequestrated β-catenin, abundant in TGF-β(1)/LiCl-stimulated asthmatic HBFs, most likely interacts with and inhibits the nuclear accumulation and signal transduction of Smad proteins. These data indicate that the specific cellular context determines FMT-related responses of HBFs to factors interfering with the TGF-β signaling pathway. They may also provide a mechanistic explanation for epidemiological data revealing coincidental remission of asthmatic syndromes and their recurrence upon the discontinuation of lithium therapy in certain psychiatric diseases.

  1. The parenting attitudes and the stress of mothers predict the asthmatic severity of their children: a prospective study

    Directory of Open Access Journals (Sweden)

    Sudo Nobuyuki

    2010-10-01

    Full Text Available Abstract Objective To examine relationships between a mother's stress-related conditions and parenting attitudes and their children's asthmatic status. Methods 274 mothers of an asthmatic child 2 to 12 years old completed a questionnaire including questions about their chronic stress/coping behaviors (the "Stress Inventory", parenting attitudes (the "Ta-ken Diagnostic Test for Parent-Child Relationship, Parent Form", and their children's disease status. One year later, a follow-up questionnaire was mailed to the mothers that included questions on the child's disease status. Results 223 mothers (81% responded to the follow-up survey. After controlling for non-psychosocial factors including disease severity at baseline, multiple linear regression analysis followed by multiple logistic regression analysis found chronic irritation/anger and emotional suppression to be aggravating factors for children aged Conclusions Different types of parental stress/coping behaviors and parenting styles may differently predict their children's asthmatic status, and such associations may change as children grow.

  2. Medical treatment for rhinosinusitis associated with adenoidal hypertrophy in children: an evaluation of clinical response and changes on magnetic resonance imaging

    NARCIS (Netherlands)

    Georgalas, Christos; Thomas, Karen; Owens, Catherine; Abramovich, Solomon; Lack, Gideon

    2005-01-01

    OBJECTIVES: The association between adenoidal hypertrophy and rhinosinusitis with upper airway inflammation is increasingly recognized; however, no study has used magnetic resonance imaging (MRI) to assess the changes in adenoid size after medical treatment of rhinosinusitis. METHODS: Thirteen

  3. Superoxide dismutase levels and peak expiratory flow in asthmatic children

    Directory of Open Access Journals (Sweden)

    Arie Kurniasih

    2016-11-01

    Full Text Available Background Asthma is a chronic inflammatory process which involve variety of cells such as inflammatory mediators, reactive oxygen species (ROS, and cytokines. The inflammatory process would be exacerbated in the presence of oxidative stress. Superoxide dismutase (SOD is the first important enzyme to protect the respiratory tract against oxidative stress. The decreased of SOD has a correlation with increased of airway obstruction and bronchospasm. Objective To assess for a correlation between superoxide dismutase (SOD levels and peak expiratory flow, as well as to determine the impact of SOD levels for predicting asthma attacks. Methods We conducted a prospective cohort study at Dr. Sardjito Hospital, Yogyakarta, between February and April 2011 involving asthmatic children aged 5-18 years. Subjects’ serum SOD levels and peak expiratory flow were measured at the same time point. We then performed a prospective study following up on the same subjects to find out if they had a recurrent asthma attack within one month of the tests. We also reassessed their peak expiratory flow one month after blood specimens were obtained. Results Thirty-nine patients were enrolled in this study. There was no significant correlation between SOD level and peak expiratory flow [r=0.289; 95%CI -0.025 to 0.47; P=0.074]. However, older age was significantly associated with higher peak expiratory flow (=0.5; 95%CI 3.10 to 11.57; P=0.01. Lower levels of SOD increased the risk of asthma attacks in a month following the initial measurements (RR=5.5; 95%CI 1.6 to 18.9; P=0.009. Conclusion Superoxide dismutase (SOD level is not significantly associated with peak expiratory flow. However, we find a relationship between older age and higher peak expiratory flow and a relationship between lower SOD levels and risk of asthma attacks within one month following the tests.

  4. Noninvasive positive pressure ventilation in acute asthmatic attack

    Directory of Open Access Journals (Sweden)

    A. Soroksky

    2010-03-01

    Full Text Available Asthma is characterised by reversible airway obstruction. In most patients, control of disease activity is easily achieved. However, in a small minority, asthma may be fatal. Between the two extremes lie patients with severe asthmatic attacks, refractory to standard treatment. These patients are at an increased risk of recurrent severe attacks, with respiratory failure, and mechanical ventilation. Invasive mechanical ventilation of the asthmatic patient is associated with a higher risk of complications and, therefore, is a measure of last resort. Noninvasive positive pressure ventilation (NPPV is another treatment modality that may be beneficial in patients with severe asthmatic attack who are at an increased risk of developing respiratory failure. These patients have the potential to benefit from early respiratory support in the form of NPPV. However, reports of NPPV in asthmatic patients are scarce, and its usage in asthmatic attacks is, therefore, still controversial. Only a few reports of NPPV in asthma have been published over the last decade. These studies mostly involve small numbers of patients and those who have problematic methodology. In this article we review the available evidence for NPPV in asthma and try to formulate our recommendations for NPPV application in asthma based on the available evidence and reports.

  5. Longitudinal analysis of inflammatory biomarkers during acute rhinosinusitis.

    Science.gov (United States)

    Autio, Timo J; Koskenkorva, Timo; Leino, Tuomo K; Koivunen, Petri; Alho, Olli-Pekka

    2017-02-01

    To illuminate the pathophysiology of acute rhinosinusitis (ARS) with sequential monitoring of inflammatory biomarkers during an ARS episode and to clarify their diagnostic usability in bacterial ARS. Inception cohort study with 50 conscripts with ARS. We collected peripheral blood high-sensitive C-reactive protein (hs-CRP), white blood cell (WBC), procalcitonin, and nasal nitric oxide (nNO) counts at 2 to 3 and 9 to 10 days of symptoms during an ARS episode. We simultaneously gathered various clinical parameters and microbiological samples. Bacterial ARS was confirmed with a positive culture of sinus aspirate. Reciprocal correlations and a significant change in biomarker levels between the two visits suggest that ARS involves a local and systemic inflammatory response that was strongest at 2 to 3 days. High-sensitive CRP and nNO reflected responses best (52% had increased CRP levels at 2-3 days; 66% had decreased nNO levels). White blood cell and procalcitonin counts rarely exceeded the reference range. Increased local and systemic inflammatory response were linked to multiple, adenoviral, or influenza A viral etiology or the detection of bacterial ARS. Local response correlated with imaging findings of wide paranasal sinus involvement and ostiomeatal complex occlusion. At 9 to 10 days, elevated (≥ 11 mg/L) and moderately elevated (≥ 49 mg/L) hs-CRP predicted bacterial ARS well (likelihood ratio [LR]+ 3.3 and LR+ 15.8, respectively), but the sensitivity for both findings remained low. Acute rhinosinusitis (particularly bacterial ARS) involves a local and systemic inflammatory response that is strongest at the beginning of symptoms. Elevated hs-CRP supports the diagnosis of bacterial ARS. 4. Laryngoscope, 2016 127:E55-E61, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  6. Gastroesophageal reflux episodes in asthmatic patients and their temporal relation with sleep architecture

    Directory of Open Access Journals (Sweden)

    L. Mello-Fujita

    2008-02-01

    Full Text Available Gastroesophageal reflux (GER is common in asthma patients and can contribute to sleep disruption. The aim of the present study was to determine the time-related distribution of GER events together with their impact on sleep in asthmatic subjects with GER disease symptoms. The inclusion criteria were: 18-65 years, controlled moderate to severe asthma and GER-compatible clinical evidence. The exclusion criteria were: chronic obstructive lung disease, smoking, infections of the upper airways, use of oral corticosteroids, other co-morbidities, pregnancy, sleep-related disorders, night-time shift work, and the use of substances with impact on sleep. Asthmatic patients with nocturnal symptoms were excluded. All-night polysomnography and esophageal pH monitoring were recorded simultaneously. Of the 147 subjects selected, 31 patients and 31 controls were included. Seventeen patients were classified as DeMeester positive and 14 as DeMeester negative. Both groups displayed similar outcomes when general variables were considered. Sleep stage modification one minute prior to GER was observed in the DeMeester-positive group. Awakening was the most frequent occurrence at GER onset and during the 1-min period preceding 38% of the nocturnal GER. Sleep stage 2 was also prevalent and preceded 36% of GER events. In the DeMeester-negative group, awakening was the most frequent response before and during GER. Modifications in sleep stages, arousals or awakenings were associated with 75% of the total GER events analyzed during the period of one minute before and after the fall of esophageal pH below 4 in the DeMeester-positive group. These data provide evidence that sleep modifications precede the GER events in asthmatic patients.

  7. Effect of an intranasal conrticosteroid on exercide induced bronchocostriction in asthmatic children

    NARCIS (Netherlands)

    Kersten, E.T.; Leeuwen, J.C. van; Brand, P.L.; Duiverman, E.J.; de Jongh, Franciscus H.C.; Thio, B.J.; Driessen, J.M.

    2012-01-01

    Rationale: Allergic rhinitis and exercise induced bronchoconstriction (EIB) are common in asthmatic children. The aim of this study was to investigate whether treatment of allergic rhinitis with an intranasal corticosteroid protects against EIB in asthmatic children. Methods: This was a

  8. Relationship between airway pathophysiology and airway inflammation in older asthmatics

    DEFF Research Database (Denmark)

    Porsbjerg, Celeste M; Gibson, Peter G; Pretto, Jeffrey J

    2013-01-01

    , neutrophil airway inflammation increases airway closure during bronchoconstriction, while eosinophil airway inflammation increases airway hyperresponsiveness (AHR). METHODS: Asthmatic subjects (n = 26), aged ≥55 years (68% female), were studied, and AHR to 4.5% saline challenge was measured by the response...... or eNO. CONCLUSIONS: In older patients with asthma, airway inflammatory cells are linked to abnormal airway physiology. Eosinophilic airway inflammation is associated with AHR while neutrophilic inflammation may be an important determinant of airflow limitation at rest and airway closure during......BACKGROUND AND OBJECTIVE: Asthma-related morbidity is greater in older compared with younger asthmatics. Airway closure is also greater in older asthmatics, an observation that may be explained by differences in airway inflammation. We hypothesized that in older adult patients with asthma...

  9. Impact of socioeconomic status on the use of inhaled corticosteroids in young adult asthmatics

    DEFF Research Database (Denmark)

    Davidsen, Jesper Rømhild; Søndergaard, Jens; Hallas, Jesper

    2011-01-01

    OBJECTIVE: The aim of this population-based longitudinal study was to examine the associations between socioeconomic status (SES) and anti-asthmatic treatment with inhaled corticosteroids (ICS) among young Danish adult asthmatics, and to investigate whether these associations were consistent over...... use in young adult asthmatics. To encourage ICS use, special attention should be paid to asthmatics with low educational level and low income. Further studies are needed to elucidate underlying mechanisms for this socioeconomic inequality....

  10. Association of school social networks' influence and mass media factors with cigarette smoking among asthmatic students.

    Science.gov (United States)

    Kanamori, Mariano; Beck, Kenneth H; Carter-Pokras, Olivia

    2015-03-01

    Around 10% of adolescent students under 18 years have current asthma. Asthmatic adolescents smoke as much or more than non-asthmatic adolescents. We explored the association between exposure to mass media and social networks' influence with asthmatic student smoking, and variations of these exposures by sex. This study included 9755 asthmatic and 38,487 non-asthmatic middle and high school students. Secondary data analysis incorporated the complex sample design; and univariate, bivariate, and logistic regression statistics. Asthmatic students had greater odds of smoking than non-asthmatic students. Asthmatic female students were more likely than asthmatic male students to have been exposed to secondhand smoke in rooms or cars and to smoking actors, but less likely to associate smoking with intent to wear tobacco-marketing products, or with looking cool/fitting in. Asthmatic male and female students, who have smoking friends, were exposed to secondhand smoke in rooms (only girls) or cars, intended to smoke if best friends offered cigarettes, or received/bought tobacco marketing products had greater odds of smoking than other asthmatic students. The observed associations suggest the need for general interventions to reduce middle and high school students' cigarette smoking as well as targeted interventions for asthmatic adolescent students. © 2015, American School Health Association.

  11. Psychosocial Context of Differences Between Asthmatic and Diabetic Patients in Adaptation to Disease.

    Science.gov (United States)

    Wilczyńska, Agnieszka; Sikora, Jagoda; Pituła, Beata

    2016-01-01

    A significant rise in the incidence of asthma and diabetes makes the psychosocial underpinnings of these diseases an increasingly important issue. This article examines differences in psychosocial functioning between healthy people and patients suffering from asthma and diabetes, as separate disease entities. Psychological factors seem to play a significant role particularly in the process of recovery and adaptation to the disease. Our assumption was that a time perspective, a sense of belonging, and a hope may be related to the functioning of people with chronic asthma and diabetes. The study involved a total of 90 people assigned to three groups: healthy individuals, asthmatic patients, and diabetic patients. The findings demonstrate that patients suffering from asthma have a different attitude toward the future and a sense of fatalism in the present. Yet there are no significant differences between asthma patients and healthy individuals in the sense of belonging and hope. Diabetic patients perceive the present as more fatalistic than asthmatic patients and healthy individuals, and they are less oriented at setting and achieving future goals. The finding that the type and course of the disease are associated with specific psychosocial adaptation may have functional and therapeutic implications, and thus should get psycho-clinical attention.

  12. The use ofnatural substances in thetreatment of rhinosinusitis in thelight of the EuropeanPosition Paper on Rhinosinusitis and Nasal Polyps 2012

    Directory of Open Access Journals (Sweden)

    Małgorzata Pachecka

    2014-12-01

    Full Text Available Rhinosinusitis is a very common condition of the upper respiratory tract. The disease may be caused by viral, bacterial or fungal infections as well as by allergens or air pollution (e.g. tobacco smoke, with viral infections being the most common cause. The first phase of viral rhinosinusitis therapy involves the use of antipyretics, analgesics, anti-oedematous agents as well as nasal decongestants, occasionally, topical glucocorticosteroids, nasal irrigation and adjunct phytotherapy. Viral or allergic rhinosinusitis does not require antibiotic therapy. Antibiotics should be used if symptoms persist after 7–10 days or bacterial superinfection develops. More intense treatment (antibiotic, metronidazole, intranasal glucocorticosteroid as well as formulations that dilute mucous secretions and have anti-oedematous effects for up to several days is necessary in cases of acute rhinosinusitis in children, which is quite often a very serious disease bordering on sepsis (pansinusitis. According to the 2012 European Position Paper on Rhinosinusitis and Nasal Polyps 2012 (EPOS 2012, natural compounds may be used as an adjunct treatment in some cases and in certain periods of the disease. These include nasal irrigation with saline or an appropriate seawater solution as well as the use of herbal medicinal products. The paper discusses in detail the use of different herbal medicinal products and presents literature data related to the efficacy and tolerance of these products.

  13. J. . Sulphur dioxide sensitivity in South African asthmatic children

    African Journals Online (AJOL)

    asthma subjects.] Allergy Clin Immuno11981; 68: 26-32. 7. Simon RA. Sulfire sensitivity. Ann Allergy 1986; 56: 281-288. 8. Celeste A. Update on sulfites. Assoe Food Drug US Off Q Bull 1986;. 50: 46. 9. Sreinman HA, Weinberg EG. The effects of soft-drink preservatives on asthmatic children. S AftMed J 1986; 70: 404-406.

  14. Bronchoprotection with a leukotriene receptor antagonist in asthmatic preschool children

    DEFF Research Database (Denmark)

    Bisgaard, H; Nielsen, K G

    2000-01-01

    We hypothesized that a leukotriene receptor antagonist (LTRA) could provide bronchoprotection against the cold, dry air-induced response in asthmatic preschool children. In a randomized, double-blind, placebo-controlled crossover study, we examined the effect of the specific LTRA montelukast at 5...

  15. Cockroach hypersensitivity in asthmatics in Lagos, Nigeria | Adanijo ...

    African Journals Online (AJOL)

    Background: Cockroach allergy occurs frequently in asthmatics in urban areas, where the level of cockroach infestation is usually high. The prevalence of cockroach allergy, as well as the effect of associated factors on cockroach sensitisation in Nigeria is largely unknown. Objective: To determine the prevalence of ...

  16. BMI predicts exercise induced bronchoconstriction in asthmatic boys

    NARCIS (Netherlands)

    van Veen, Wilma J.; Driessen, Jean M. M.; Kersten, Elin T. G.; van Leeuwen, Janneke C.; Brusse-Keizer, Marjolein G. J.; van Aalderen, Wim M. C.; Thio, Bernard J.

    2017-01-01

    BackgroundExercise induced bronchoconstriction (EIB) is a frustrating morbidity of asthma in children. Obesity has been associated with asthma and with more severe EIB in asthmatic children. ObjectivesTo quantify the effect of BMI on the risk of the occurrence of EIB in children with asthma.

  17. Lung Function Test in Asthmatics Patients in UBTH: Medical ...

    African Journals Online (AJOL)

    2004-06-30

    This report describes the result of a study on lung function tests on 75 asthmatics seen within a 6-month period (January 1 to June 30, 2004) at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. There was a preponderance of females (60%) to males (40%); The result also showed that a large proportion ...

  18. ASCORBID ACID IS DECREASED IN INDUCED SPUTUM OF MILD ASTHMATICS

    Science.gov (United States)

    ABSTRACTEvidence suggests that the antioxidant ascorbic acid (AA), plays an essential role in defending against oxidant attack in the airways. Decreased levels of AA have been reported in asthmatics but not at the site directly proximal to asthma pathology, i.e. the bronchial...

  19. Clinical Effects of Yoga on Asthmatic Patients: A Preliminary Clinical ...

    African Journals Online (AJOL)

    There was statistically significant reduction in day and night asthma attacks in the yoga group. CONCLUSION: Yoga exercise among asthmatic patients resulted in a decreased number of day and night attacks and use of drugs. It also shows significant improvement in the peak expiratory flow rate. Further large scale study is ...

  20. BMI predicts exercise induced bronchoconstriction in asthmatic boys

    NARCIS (Netherlands)

    van Veen, Wilma J.; Driessen, Jean M. M.; Kersten, Elin T. G.; van Leeuwen, Janneke C.; Brusse-Keizer, Marjolein G. J.; van Aalderen, Wim M. C.; Thio, Bernard J.

    Background: Exercise induced bronchoconstriction (EIB) is a frustrating morbidity of asthma in children. Obesity has been associated with asthma and with more severe EIB in asthmatic children. Objectives: To quantify the effect of BMI on the risk of the occurrence of EIB in children with asthma.

  1. daily, sustained-release theophylline on sleep in nocturnal asthmatics

    African Journals Online (AJOL)

    We examined the quality and efficiency of sleep as well as changes in lung function in nocturnal asthmatics in a double- blind, randomised, cross-over, placebo-controlled study. Once-daily, sustained-release, evening-administered theophylline was compared with placebo while concurrent anti-asthma medication (inhaled ...

  2. Functional phenotype of airway myocytes from asthmatic airways

    NARCIS (Netherlands)

    Wright, David B.; Trian, Thomas; Siddiqui, Sana; Pascoe, Chris D.; Ojo, Oluwaseun O.; Johnson, Jill R.; Dekkers, Bart G. J.; Dakshinamurti, Shyamala; Bagchi, Rushita; Burgess, Janette K.; Kanabar, Varsha

    In asthma, the airway smooth muscle (ASM) cell plays a central role in disease pathogenesis through cellular changes which may impact on its microenvironment and alter ASM response and function. The answer to the long debated question of what makes a 'healthy' ASM cell become 'asthmatic' still

  3. Rhinosinusitis derived Staphylococcal enterotoxin B possibly associates with pathogenesis of ulcerative colitis

    Directory of Open Access Journals (Sweden)

    An Zi-Yuan

    2005-09-01

    Full Text Available Abstract Background During clinical practice, we noticed that some patients with both ulcerative colitis (UC and chronic rhinosinusitis (CRS showed amelioration of UC after treatment of CRS. This study was designed to identify a possible association between CRS and UC. Methods Thirty-two patients with both CRS and UC received treatment with functional endoscopic sinus surgery (FESS for CRS. Clinical symptom scores for CRS and UC, as well as serum levels of anti-Staphylococcal enterotoxin B (SEB were evaluated at week 0 and week 12. Sinus wash fluid SEB content was measured with enzyme-linked immunosorbent assay (ELISA. The surgically removed tissues were cultured to identify growth of Staphylococcus. aureus (S. aureus. Immunohistochemistry was employed to identify anti-SEB positive cells in the colonic mucosa. Colonic biopsies were obtained and incubated with SEB. Mast cell activation in the colonic mucosa in response to incubation with SEB was observed with electron microscopy and immunoassay. Results The clinical symptom scores of CRS and UC severe scores (UCSS were significantly reduced in the UC-CRS patients after FESS. The number of cultured S. aureus colonies from the surgically removed sinus mucosa significantly correlated with the decrease in UCSS. High levels of SEB were detected in the sinus wash fluids of the patients with UC-CRS. Histamine and tryptase release was significantly higher in the culture supernate in the patients with UC-CRS than the patients with UC-only and normal controls. Anti-SEB positive cells were located in the colonic mucosa. Conclusion The pathogenesis of UC in some patients may be associated with their pre-existing CRS by a mechanism of swallowing sinusitis-derived SEB. We speculate that SEB initiates inappropriate immune reactions and inflammation in the colonic mucosa that further progresses to UC.

  4. HLA-G Haplotypes Are Differentially Associated with Asthmatic Features

    Directory of Open Access Journals (Sweden)

    Camille Ribeyre

    2018-02-01

    Full Text Available Human leukocyte antigen (HLA-G, a HLA class Ib molecule, interacts with receptors on lymphocytes such as T cells, B cells, and natural killer cells to influence immune responses. Unlike classical HLA molecules, HLA-G expression is not found on all somatic cells, but restricted to tissue sites, including human bronchial epithelium cells (HBEC. Individual variation in HLA-G expression is linked to its genetic polymorphism and has been associated with many pathological situations such as asthma, which is characterized by epithelium abnormalities and inflammatory cell activation. Studies reported both higher and equivalent soluble HLA-G (sHLA-G expression in different cohorts of asthmatic patients. In particular, we recently described impaired local expression of HLA-G and abnormal profiles for alternatively spliced isoforms in HBEC from asthmatic patients. sHLA-G dosage is challenging because of its many levels of polymorphism (dimerization, association with β2-microglobulin, and alternative splicing, thus many clinical studies focused on HLA-G single-nucleotide polymorphisms as predictive biomarkers, but few analyzed HLA-G haplotypes. Here, we aimed to characterize HLA-G haplotypes and describe their association with asthmatic clinical features and sHLA-G peripheral expression and to describe variations in transcription factor (TF binding sites and alternative splicing sites. HLA-G haplotypes were differentially distributed in 330 healthy and 580 asthmatic individuals. Furthermore, HLA-G haplotypes were associated with asthmatic clinical features showed. However, we did not confirm an association between sHLA-G and genetic, biological, or clinical parameters. HLA-G haplotypes were phylogenetically split into distinct groups, with each group displaying particular variations in TF binding or RNA splicing sites that could reflect differential HLA-G qualitative or quantitative expression, with tissue-dependent specificities. Our results, based on a

  5. HLA-G Haplotypes Are Differentially Associated with Asthmatic Features.

    Science.gov (United States)

    Ribeyre, Camille; Carlini, Federico; René, Céline; Jordier, François; Picard, Christophe; Chiaroni, Jacques; Abi-Rached, Laurent; Gouret, Philippe; Marin, Grégory; Molinari, Nicolas; Chanez, Pascal; Paganini, Julien; Gras, Delphine; Di Cristofaro, Julie

    2018-01-01

    Human leukocyte antigen (HLA)-G, a HLA class Ib molecule, interacts with receptors on lymphocytes such as T cells, B cells, and natural killer cells to influence immune responses. Unlike classical HLA molecules, HLA-G expression is not found on all somatic cells, but restricted to tissue sites, including human bronchial epithelium cells (HBEC). Individual variation in HLA-G expression is linked to its genetic polymorphism and has been associated with many pathological situations such as asthma, which is characterized by epithelium abnormalities and inflammatory cell activation. Studies reported both higher and equivalent soluble HLA-G (sHLA-G) expression in different cohorts of asthmatic patients. In particular, we recently described impaired local expression of HLA-G and abnormal profiles for alternatively spliced isoforms in HBEC from asthmatic patients. sHLA-G dosage is challenging because of its many levels of polymorphism (dimerization, association with β2-microglobulin, and alternative splicing), thus many clinical studies focused on HLA-G single-nucleotide polymorphisms as predictive biomarkers, but few analyzed HLA-G haplotypes. Here, we aimed to characterize HLA-G haplotypes and describe their association with asthmatic clinical features and sHLA-G peripheral expression and to describe variations in transcription factor (TF) binding sites and alternative splicing sites. HLA - G haplotypes were differentially distributed in 330 healthy and 580 asthmatic individuals. Furthermore, HLA-G haplotypes were associated with asthmatic clinical features showed. However, we did not confirm an association between sHLA-G and genetic, biological, or clinical parameters. HLA-G haplotypes were phylogenetically split into distinct groups, with each group displaying particular variations in TF binding or RNA splicing sites that could reflect differential HLA-G qualitative or quantitative expression, with tissue-dependent specificities. Our results, based on a multicenter

  6. Association of Body Mass Index with Asthma Severity and Pulmonary Function among Asthmatic Children

    Directory of Open Access Journals (Sweden)

    Rasuol Nasiri Kalmarzi

    2016-09-01

    Full Text Available Background Asthma is a chronic inflammatory disease in respiratory system and obesity is another inflammatory disease which incidence rate is increasing. Although, many studies have been conducted on severity of asthma and its relationship with obesity, but different results have been obtained. This study aimed to determine a relationship between asthma severity, Body Mass Index (BMI and pulmonary function in Kurdistan province, Iran. Materials and Methods: In this cross sectional study 90 asthmatic patients referred to referral hospital in Kurdistan, North West of Iran, were selected by simple random method. BMI was calculated by dividing weight by height.Pulmonary Function Test (PFT and bronchial-stimulation-test were used for confirmation and investigation of asthma severity. Data were analyzed using SPSS-15 and Chi-square and spearman correlation coefficient tests. Results: Relationship between BMI and severity of asthma (mild, medium and severe was evaluated, there was a relationship and positive relationship between them (P

  7. Pediatric invasive fungal rhinosinusitis: An investigation of 17 patients.

    Science.gov (United States)

    Vinh, Daniel; Yim, Michael; Dutta, Ankhi; Jones, John K; Zhang, Wei; Sitton, Matthew

    2017-08-01

    To investigate outcomes of pediatric patients at a single institution with invasive fungal rhinosinusitis (IFRS) and to determine variables that impact overall survival. All pediatric patients at a large tertiary children's hospital diagnosed with IFRS confirmed by surgical pathology from 2009 to 2015 were retrospectively reviewed. Demographics, underlying diseases, symptoms, antifungal therapy, absolute neutrophil count (ANC), surgical management,and outcomes were analyzed. Seventeen patients were identified with IFRS with an average age of 8.7 years and 53% male. Hematologic malignancy was the most common (n = 13) underlying disease. The most common presenting symptoms were fever (82%) and congestion (41%). 15 patients had severe neutropenia (Absolute Neutrophil Count (ANC) IFRS. Overall survival at 6 months was 41%. Pediatric IFRS is a life-threatening disease that requires a coordinated surgical and medical approach. Despite a relatively high local control rate, overall mortality remains disappointingly high, reflecting the disease's underlying pathogenesis - lack of host defense and risk of disseminated fungal infection. Further investigation is necessary to reveal optimal management with regards to antifungal therapy, surgery, and utility of labs. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. A novel model of invasive fungal rhinosinusitis in rats.

    Science.gov (United States)

    Zhang, Fang; An, Yunfang; Li, Zeqing; Zhao, Changqing

    2013-01-01

    Invasive fungal rhinosinusitis (IFRS) is a life-threatening inflammatory disease that affects immunocompromised patients, but animal models of the disease are scarce. This study aimed to develop an IFRS model in neutropenic rats. The model was established in three consecutive steps: unilateral nasal obstruction with Merocel sponges, followed by administration of cyclophosphamide (CPA), and, finally, nasal inoculation with Aspergillus fumigatus. Fifty healthy Wistar rats were randomly divided into five groups, with group I as the controls, group II undergoing unilateral nasal obstruction alone, group III undergoing nasal obstruction with fungal inoculation, group IV undergoing nasal obstruction with administration of CPA, and group V undergoing nasal obstruction with administration of CPA and fungal inoculation. Hematology, histology, and mycology investigations were performed. The changes in the rat absolute neutrophil counts (ANCs) were statistically different across the groups. The administration of CPA decreased the ANCs, whereas nasal obstruction with fungal inoculation increased the ANCs, and nasal obstruction did not change them. Histological examination of the rats in group V revealed the hyphal invasion of sinus mucosa and bone, thrombosis, and tissue infarction. No pathology indicative of IFRS was observed in the remaining groups. Positive rates of fungal culture in tissue homogenates from the maxillary sinus (62.5%) and lung (25%) were found in group V, whereas groups I, II, III, and IV showed no fungal culture in the homogenates. A rat IFRS model was successfully developed through nasal obstruction, CPA-induced neutropenia, and fungal inoculation. The disease model closely mimics the pathophysiology of anthropic IFRS.

  9. Asthmatic Children And Immunological Effects Of BCG Vaccine Key words: Asthmatic children, BCG vaccine

    International Nuclear Information System (INIS)

    Saaed, A.I.

    2011-01-01

    A TH2 screwed immune response is known to play a crucial role in the pathogenesis of allergy, so, preventing the differentiation of TH cells. The TH2 cells are appeared as a logical therapeutic approach to atopic asthma. The purpose of TH1 study was to determine the possible role of BCG vaccine on asthma and whether a TH1 type immune response elicited by BCG immunization could suppress the allergic sensitization in childhood asthma. Seventy asthmatic patients (50 atopic and 20 non-atopic) and fifty healthy individuals were subjected to TH1 study. Tuberculin test was performed for all groups then subjects with positive tuberculin test were excluded. The BCG vaccine was given for all groups with assessment of TH1 and TH2 cytokine response by measuring total IgE, IL-4 (for TH2 response) and INF-γ (for TH1 response). Significant reduction in IgE and IL-4, and elevation in INF-γ were determined in group I (atopic asthma) following BCG vaccination. There was non-significant change observed in IgE and IL-4 levels of group II while significant reduction in IL-4 and significant increase in INF-γ was observed after BCG vaccine

  10. TREATMENT OF STEROID DEPENDENT ASTHMATICS WITH LOW DOSES OF CYCLOSPORINE

    Directory of Open Access Journals (Sweden)

    Stanislav Šuškovič

    2004-01-01

    Full Text Available Background. Asthmatics with glucocorticoid dependent asthma should be treated with systemic steroids. Cyclosporine is in many ways a potent anti-inflammatory drug. Cyclosporine is sometimes very effective in treating asthmatics and could allow us to lower the dose of oral steroid. In some randomized, double blind studies steroid dependent asthmatics were treated 12–36 weeks with cyclosporine in dose 5 mg/kg/day. We tried cyclosporine in steroid dependent asthmatics in shorter course and in lower dose.Methods. 13 steroid dependent asthmatics were in the first four weeks of the study treated by their own drugs (phase 1. Then they were for the next four weeks (phase 2 randomly and in double blind fashion treated with either cyclosporine (mean 1.7 mg/kg/day, SD 0.5, 6 patients – group 1 or by identical placebo (7 patients – group 2. To the patients in the group 2 serum concentration of cyclosporine was measured on the eight day of the study.Results. Morning peak expiratory flow (PEF raised significantly in group 1 (200 L/sec to 247 L/sec or for 23%. Patients in group1 had significantly less episodes of nocturnal asthma (2.2 episodes/night to 1.5 episodes/night or for 32%. In group 2 were not found any changes between first phase and second phase of the study. Steroid consumption did not change in any group. Mean serum concentration of cyclosporine in patients of group1 was 35.7 µg/L. We did not find any adverse effects of cyclosporine or placebo.Conclusions. Cyclosporine could have dangerous side effects, which are dependent on its serum concentration. So it should be administered in the lowest possible dose and for the most possible short period. In our study it was found that it is possible to successfully treat steroid dependent asthmatics with lower daily dose and for shorter time, than was found in other similar studies.

  11. Co-inhalation of roflumilast, rather than formoterol, with fluticasone more effectively improves asthma in asthmatic mice.

    Science.gov (United States)

    Murad, Hussam A; Habib, Hamed S; Rafeeq, Misbahuddin M; Sulaiman, Mansour I; Abdulrahman, Amer S; Khabaz, Mohamad Nidal

    2017-03-01

    Roflumilast is approved as an add-on therapy for chronic obstructive pulmonary disease. The inflammation in chronic obstructive pulmonary disease is mainly neutrophilic, while in asthma it is mainly eosinophilic, studies addressing role of roflumilast in eosinophilic inflammation are recommended. Also in severe asthma, the dominant inflammatory cells are neutrophils. Thus, roflumilast has a potential off-label use in the treatment of asthma. This study was designed to evaluate the effects of co-inhalation of roflumilast and fluticasone compared to that of formoterol and fluticasone in ovalbumin-sensitized and-challenged BALB/c mice. Besides normal control group, the ovalbumin-asthmatic mice were randomly divided into seven groups (n = 8): positive control, vehicle-treated, and five drug-treated groups. Treatments (µg/kg) were given as 15 min-inhalation once/day for five days as follows: roflumilast (500), formoterol (50), fluticasone (1000), roflumilast + fluticasone (500 + 1000), and formoterol + fluticasone (50 + 1000). Penh values were measured in conscious unrestrained mice using the single-chamber whole-body plethysmography. Airway hyperreactivity to inhaled methacholine was evaluated. Bronchoalveolar lavage fluid was used for the measurements of levels of IL-4, IL-5, TNF-α, OVA-specific IgE, and total and differential white cells. Lung sections were stained with hematoxylin and eosin and periodic acid-Schiff. The asthmatic mice showed significant increases in airway hyperreactivity which were significantly reversed by the combination treatments. The asthmatic mice showed significant increases in levels of IL-4, IL-5, TNF-α, ovalbumin-specific IgE, and total and differential white cells in bronchoalveolar lavage fluid. All treatments (except formoterol) significantly reversed these changes mainly with roflumilast + fluticasone. The asthmatic mice showed severe inflammatory infiltration and goblet cell hyperplasia which were

  12. Mortality Rate and Predictive Factors for Invasive Fungal Rhinosinusitis: Experience in Siriraj Hospital

    Directory of Open Access Journals (Sweden)

    Premyot Ngaotepprutaram, M.D.

    2018-01-01

    Full Text Available Objective: To elucidate the mortality rate and prognostic factors in patients with invasive fungal rhinosinusitis in Siriraj Hospital. Methods: Thirty-nine patients with a definitive diagnosis of invasive fungal rhinosinusitis were recruited from October 2003 to September 2014. The mortality rate was retrieved, and the impacts of underlying diseases, clinical presentation, disease extension, fungal types, antifungal drugs, and time to treatment were statistically analyzed. Results: The overall mortality rate was 23.1%. All patients except one were immunocompromised. Cranial nerve involvement was the most common symptom. The ethmoid sinus was the most commonly affected intranasal site (46.2%, and the majority of extranasal lesions were located in the orbit (17.9%. Most patients were affected by Aspergillus spp. (64.1%. Alteration of consciousness and periorbital pain were significant negative prognostic factors [adjusted odds ratio (95% confidence interval, 10.37 (1.31–82.07 and 8.67 (1.30–57.88, respectively]. Other factors such as time to treatment, age, and central nervous system involvement had no effect on mortality. Conclusion: The mortality rate of invasive fungal rhinosinusitis in this study was 23.1%. Negative prognostic factors were alteration of consciousness and periorbital pain. Clinicians must have a high index of suspicion for invasive fungal rhinosinusitis, and aggressive treatment should be considered.

  13. Treatment of acute rhinosinusitis: discrepancy between guideline recommendations and clinical practice

    NARCIS (Netherlands)

    Venekamp, R.P.; Rovers, M.M.; Verheij, T.J.; Bonten, M.J.; Sachs, A.P.

    2012-01-01

    Background A revised primary care guideline on acute rhinosinusitis (ARS) has been introduced in the Netherlands in 2005, which advocates a more judicious use of antibiotics. Objective To investigate whether consultation and prescription rates for ARS in adults changed over recent years in order to

  14. The value of Nigella sativa in the treatment of experimentally induced rhinosinusitis.

    Science.gov (United States)

    Yoruk, O; Tatar, A; Keles, O N; Cakir, A

    2017-02-01

    The aim of this study was to investigate the effect of Nigella sativa and cephalexin in the therapy of experimental bacterial rhinosinusitis. Bacterial rhinosinusitis was induced with Staphylococcus aureus. Rabbits were divided into five groups; control (n = 6), N. sativa 50 mg/ kg/d (n = 6), N. sativa 100 mg/kg/d (n = 6), N. sativa 200 mg/kg/d (n = 6), and cephalexin 20 mg/kg/d (n = 6) groups. N. sativa was given orally for 7 days. The same volume of normal saline (0.9% NaCl) was given as a vehicle to the control group for the same period. After treatment period, sinus mucosa samples were evaluated using stereological and histopathological methods. Half of the maxillary sinus mucosa samples were frozen at -800C for further analysis of NO levels. Pathology revealed a severe acute inflammatory process in rabbits treated with saline. Only mild inflammation was determined in cephalexin group, N. sativa 100 mg/kg/d and N. sativa 200 mg/kg/d groups. The level of NO increased in the saline group was significantly reduced in all treatment groups. N. sativa may prevent histopathological changes of rhinosinusitis via decreased NO levels in a dose dependent manner and can be used in the treatment of rhinosinusitis diseases. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

  15. The connection between seasonal allergies, food allergies, and rhinosinusitis: what is the evidence?

    Science.gov (United States)

    Dutta, Rahul; Dubal, Pariket M; Eloy, Jean Anderson

    2015-02-01

    Rhinosinusitis affects an estimated one in seven adults in the United States. Otolaryngologists are intimately involved in the care of patients with rhinosinusitis and other upper airway inflammatory conditions through procedures such as endoscopic sinus surgery and, therefore, would benefit from a deeper understanding of the associated comorbidities and their management. Recent evidence has suggested several connections between the underlying disease of rhinosinusitis, seasonal allergies, and food allergies. The authors of the present review seek to provide a focused analysis of the recent literature with respect to epidemiology, pathophysiology, and treatment options concerning these conditions. Evidence has connected the function of filaggrin, a skin barrier protein, with the pathogenesis of allergic rhinosinusitis and food allergy. Additionally, decreased levels of regulatory B cells and T cells are associated with and play a role in atopic disease. Overlapping treatment modalities between these conditions suggest similar conclusions. Future research into the role of the skin barrier, regulatory immune cell functioning, transforming growth factor-β, and other cytokine signaling, and treatment options such as omalizumab and azelastine is likely to have profound impact on clinicians' management of patients with these disorders and their comorbidities.

  16. Imaging follow-up study of acute rhinosinusitis.

    Science.gov (United States)

    Autio, Timo J; Koskenkorva, Timo; Närkiö, Mervi; Leino, Tuomo K; Koivunen, Petri; Alho, Olli-Pekka

    2016-09-01

    To evaluate with imaging the course of acute rhinosinusitis (ARS) and the associations between paranasal imaging results, symptoms, bony anatomic variations, and culture-proven bacterial ARS. Inception cohort study with 50 conscripts with ARS. During a single ARS episode, we collected symptoms daily and took sequential cone-beam computed tomography (CBCT) scans of the paranasal sinuses of the same patients 2 to 3, 5 to 6 and 9 to 10 days after the onset of symptoms. Culture-proven bacterial ARS was verified with maxillary sinus aspiration and bacterial culture at 9 to 10 days. At 2 to 3 days, 38% of the patients had major abnormalities, 42% had minor abnormalities in their paranasal sinuses, and 68% had an occluded ostiomeatal complex (OMC). At 5 to 6 days and 9 to 10 days, these proportions remained essentially the same. At 2 to 3 days, patients with bacterial ARS had slightly higher CBCT scores than those without bacterial ARS. Later, the CBCT and symptom scores gradually increased in patients with bacterial ARS and decreased in those without bacterial ARS. The CBCT and symptom scores had only a weak correlation (rs = 0.36), and anatomic variations were not related to development of bacterial ARS. Paranasal mucosal abnormalities and occlusion of the OMC do not develop gradually during ARS, but are present when symptoms begin and remain fairly constant in most patients both with and without bacterial ARS. This indicates that the spread of the disease process to the paranasal sinuses and obstruction of the OMC may not be etiological factors in the development of bacterial ARS. 4 Laryngoscope, 126:1965-1970, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  17. Body Mass Index and Comorbidities in Adult Severe Asthmatics

    Directory of Open Access Journals (Sweden)

    Andreina Bruno

    2014-01-01

    Full Text Available Both severe asthma and obesity are growing health problems. Severe asthma leads to a poor quality of life. The relationship among BMI, comorbidities, and severe asthma control in adults is still unclear. The aim of the study is to better understand the effect of the comorbidities as atopy, type II diabetes, OSAS, gastroesophageal reflux, hypertension, cardiovascular diseases, osteoporosis, infections, and psychological factors with BMI on asthma control in a cohort of adult severe asthmatics. One hundred and two patients were enrolled in a cross-sectional study assessing asthma control, treatments, pulmonary function, inflammatory markers, and comorbidities. Patients were divided into 3 classes according to BMI: normal weight, overweight, and obese. We found that the optimal state of asthma control is lower. whereas the score of Asthma Control Questionnaire, the number of asthma exacerbations during last year, the oral corticosteroids requirement during the previous year, and the LABA treatments are higher in obese than in overweight and normal weight severe asthmatics. The number of subjects with type II diabetes and OSAS are higher among obese and overweight patients than in normal weight asthmatics. In conclusion, BMI represents per se a factor for the deterioration in disease control in severe asthma.

  18. Enforced mouth breathing decreases lung function in mild asthmatics.

    Science.gov (United States)

    Hallani, Mervat; Wheatley, John R; Amis, Terence C

    2008-06-01

    Nasal breathing provides a protective influence against exercise-induced asthma. We hypothesized that enforced oral breathing in resting mild asthmatic subjects may lead to a reduction in lung function. Asymptomatic resting mild asthmatic volunteers (n = 8) were instructed to breathe either nasally only (N; tape over lips) or orally only (O; nose clip) for 1 h each, on separate days. Lung function (% predicted FEV(1)) was measured using standard spirometry at baseline and every 10 min for 1 h. 'Difficulty in breathing' was rated using a Borg scale at the conclusion of the N and O periods. Baseline FEV(1) on the N (101.2 +/- 3.8% predicted) and O (102.7 +/- 3.9% predicted) days was not significantly different (P > 0.3). At 60 min, FEV(1) on the O day (96.5 +/- 4.1% predicted) was significantly less than on the N day (101.0 +/- 3.5% predicted; P 0.3), whereas on the O day, FEV(1) fell progressively (slope = -0.06 +/- 0.01% FEV(1)/min, P breathing in' at the end of the O day (1.5 +/- 0.4 arbitrary units) than on the N day (0.4 +/- 0.3 arbitrary unit; P oral breathing causes a decrease in lung function in mild asthmatic subjects at rest, initiating asthma symptoms in some. Oral breathing may play a role in the pathogenesis of acute asthma exacerbations.

  19. PIKO-6® vs. forced spirometry in asthmatic children.

    Science.gov (United States)

    Gochicoa-Rangel, Laura; Larios-Castañeda, Pablo José; Miguel-Reyes, José Luis; Briseño, David Martínez; Flores-Campos, Roberto; Sáenz-López, Juan Arturo; Torre-Bouscoulet, Luis

    2014-12-01

    The PIKO-6® is an electronic device that measures forced expiratory volume at seconds 1 (FEV1) and 6 (FEV6) of a forced vital capacity (FVC) maneuver. This device could aid in diagnosing obstructive respiratory diseases. To determine the concordance of FEV1, FEV6, and the FEV1/FEV6 quotient achieved with PIKO-6® versus spirometric values from asthmatic patients, and compare results with measures from healthy children. A cross-sectional study with asthmatic and healthy 6-to-14-year-old children, all of whom performed a forced spirometry as well as a PIKO-6® test. The study included 82 subjects (58 asthmatics, 24 healthy children). Except for the functional parameters, the basal characteristics of the two groups were similar. The concordance correlation coefficient (CCC) for FEV1 was 0.938 (P spirometry was lower in patients with partially controlled or uncontrolled asthma compared to controlled or healthy children. The broad limits of agreement show that the FEV1, FEV6, and FEV1/FEV6 obtained with the PIKO-6® are not interchangeable with spirometry results. Longitudinal evaluations of asthma patients are necessary to assess the utility of PIKO-6®. © 2014 Wiley Periodicals, Inc.

  20. Exercise-induced asthma in asthmatic children of southern Iran.

    Science.gov (United States)

    Fayezi, Abbas; Amin, Reza; Kashef, Sara; Al Yasin, Soheila; Bahadoram, Mohammad

    2014-09-28

    Asthma is a common illness, especially among children. Exercise-induced asthma is an important consideration, both as a factor, limiting physical activity of patients, and also as an indicator of poor long term control. We investigated pre-Valence of exercise-induced asthma in a group of asthmatic children living in southern Iran. We conducted treadmill exercise challenge test in 40 young asthmatic patients aged 6 to 18. After 8 minutes exercise to achieve 80% of maximum heart rate predicted for age, patients were examined and spirometry values recorded at frequent intervals. We defined exercise-induced asthma as 10% or more decline in Forced Expiratory Volume in one second (FEV1) within 30 minutes after exercise challenge. Of 40 patients evaluated, 22 patients ( 55% of total ) met our criteria for exercise-induced asthma. Most positive responses (7 of 22, 31.8%) occurred at about 10 minutes after exercise. Cough was the most consistent sign (18 of 22 patients, 81%). In 2 patients (9%), FEV 1 decline did not accompany any symptom or sign. We concluded that Exercise- induced asthma occurs in a relatively smaller subset of southern Iranian asthmatic children. Also treadmill exercise challenge performed by a trained staff, following standard protocol and using enough monitoring and precautions is safe and diagnostic in children and adolescents.

  1. Pattern of clinical features of chronic simple rhino-sinusitus in Port ...

    African Journals Online (AJOL)

    sinusitis. Patients and Methods: This is prospective work done over a 2-year period. All the patients had symptoms of more than 8 weeks duration. Only patients with symptoms indicative of chronic rhino-sinusitis were included in the study. All the ...

  2. The role of plain radiographs in the diagnosis of chronic maxillary ...

    African Journals Online (AJOL)

    Background: Computed tomography is currently the gold standard for the diagnosis of chronic rhinosinusitis. However, this facility is not readily available in many developing countries. Thus, plain sinus radiography is still widely in use in our practice. Objectives: To assess the diagnostic value of plain radiographs in adult ...

  3. Sulforaphane improves the bronchoprotective response in asthmatics through Nrf2-mediated gene pathways

    OpenAIRE

    Brown, Robert H.; Reynolds, Curt; Brooker, Allison; Talalay, Paul; Fahey, Jed W.

    2015-01-01

    Background It is widely recognized that deep inspiration (DI), either before methacholine (MCh) challenge (Bronchoprotection, BP) or after MCh challenge (Bronchodilation, BD) protects against this challenge in healthy individuals, but not in asthmatics. Sulforaphane, a dietary antioxidant and antiinflammatory phytochemical derived from broccoli, may affect the pulmonary bronchoconstrictor responses to MCh and the responses to DI in asthmatic patients. Methods Forty-five moderate asthmatics we...

  4. Attitudes of Hungarian asthmatic and COPD patients affecting disease control: empirical research based on Health Belief Model.

    Science.gov (United States)

    Simon, Judit

    2013-01-01

    Patient non-adherence to treatment is a major problem across most chronic diseases. In COPD and asthma treatments it is a complex issue because people need to make behavioral and lifestyle changes while taking medications. Poor adherence results in increased rates of morbidity and mortality, more frequent hospitalizations, and ultimately higher healthcare expenditures. The objective of the study was to assess asthmatic and COPD patient's attitudes toward adherence in Hungary. Health Belief Model was used to help explain reasons of non-adherence. The results of the study should provide additional support to understanding health-related behaviors and to developing health related programs enhancing adherence of asthmatic and COPD patients. 145 diagnosed COPD patients and 161 diagnosed asthmatic patients were involved in 6 pulmonary centers. The questions were designed to measure Health Belief Model dimensions A 1-5 point verbal Likert scale was used. As a second stage, the answers were compared with the registered patient's personal health data available in pulmonary center's documentation. The data was analyzed using SPSS software. More than 32% of patients are very interested in new asthma or COPD research results, but their main information source is physician. The trust toward the physician is very high. Patients accept treatments and rarely ask questions. Respondents are cooperative but sometimes fail to follow therapeutic recommendations. There is no willingness to join self-help groups or associations. The paternalistic approach was generally accepted, moreover expected by the patients from the physicians. It is important to train patients, increase their self-efficacy, responsibility and involve them into self-management programs. Both physicians and patients should be trained how to communicate-this approach can lead to increased understanding and better adherence.

  5. Tripterygium polyglycosid attenuates the established airway inflammation in asthmatic mice.

    Science.gov (United States)

    Chen, Chang-Gui; Wang, Hui-Ying; Dai, Yu; Wang, Jiao-Li; Xu, Wei-Hua

    2013-04-01

    To investigate the effect of Tripterygium polyglycosid on establishing airway eosinophil infiltration and related airway hyperresponsiveness of asthmatic mice. A mature murine asthmatic model was made with ovabulmin sensitized and challenged C57BL/6 mice. Forty mice were divided into four groups with 10 mice in each group: mice sensitized and challenged with saline (WS group), mice sensitized and challenged with ovalbumin (WO group), mice sensitized and challenged with ovalbumin and treated with Tripterygium polyglycosid (TP group) and Dexamethasone (DXM group). The mice were intraperitoneally injected with 20 μg chicken ovabulmin emulsified in injected alum on days 0 and 14, then were challenged with an aerosol generated from 1% ovabulmin on days 24, 25 and 26. Tripterygium polyglycosid was injected intraperitoneally at 50 mg/kg on days 25, 26 and 27 after ovabulmin challenge. Dexamethasone was administrated to mice at 2 mg/kg on day 21, 23 before ovabulmin challenge. The airway hyperresponsiveness, mucus production, eosinophils in parabronchial area and bronchoalveolar lavage fluid and the level of interleukin-5, granulo-macrophage clone stimulating factor in bronchoalveolar lavage fluid were measured as indexes of inflammation. Tripterygium polyglycosid treatment after ovabulmin challenge completely inhibited eosinophil infiltration in bronchoalveolar lavage fluid [(0.63 ± 0.34)× 10(4) vs. (75.0 ± 14.8)× 10(4), Pbronchoalveolar lavage fluid (28.8 ± 2.8 pg/mL vs. 7.5 ± 3.5 pg/mL, Pbronchoalveolar lavage fluid didn't change with drugs intervention. The administration of Tripterygium polyglycosid could inhibit the established airway inflammation and reduce the airway hyperresponsiveness of allergic asthmatic mice. It provides a possible alternative therapeutic for asthma.

  6. Attenuated response to repeated daily ozone exposures in asthmatic subjects

    Energy Technology Data Exchange (ETDEWEB)

    Gong, H. Jr.; Linn, W.S. [Rancho Low Amigos Medical Center, Downey, CA (United States); McManus, M.S. [Univ. of California, Los Angeles, CA (United States)

    1997-01-01

    The development of attenuated response ({open_quotes}tolerance{close_quotes}) to daily ozone (O{sub 3}) exposures in the laboratory is well established in healthy adult volunteers. However, the capability of asthmatics to develop tolerance during multiday ozone exposures in unclear. We exposed 10 adult volunteers with mild asthma to 0.4 ppm O{sub 3} in filtered air for 3 h/d on 5 consecutive d. Two similar filtered-air exposures during the preceding week served as controls. Follow-up O{sub 3} exposures were performed 4 and 7 d after the most recent consecutive exposure. All exposures were performed in an environmental chamber at 31 {degrees}C and 35% relative humidity. The subjects performed moderate exercise (mean ventilation rate of 32 l/min) for 15 min of each half-hour. Responses were measured with spirometry and symptom evaluations before and after each exposure, and a bronchial reactivity test (methacholine challenge) was conducted after each exposure. All response measurements showed clinically and statistically significant day-to-day variation. Symptom and forced-expiratory-volume-in-1-s responses were similarly large on the 1st and 2nd O{sub 3} exposure days, after which they diminished progressively, approaching filtered air response levels by the 5th consecutive O{sub 3} day. This tolerance was partially lost 4 and 7 d later. Bronchial reactivity peaked after the first O{sub 3} exposure and remained somewhat elevated after all subsequent O{sub 3} exposures, relative to its control level following filtered-air exposures. Individual responses varied widely; more severe initial responses to O{sub 3} predicted less rapid attenuation. We concluded that asthmatics can develop tolerance to frequent high-level O{sub 3} exposures in much the same manner as normal subjects, although the process may be slower and less fully effective in asthmatics. 27 refs., 3 figs., 4 tabs.

  7. Rutin has anti-asthmatic effects in an ovalbumin-induced asthmatic ...

    African Journals Online (AJOL)

    Allergic asthma is a chronic airway disorder characterised by airway inflammation, airway hyperresponsiveness (AHR) ... °C, 40–60 % humidity) and were supplied with water and food ad libitum. The mice were acclimatised to ..... Ovalbumin induced allergic rhinitis and development of prediabetes to rats: possible role of.

  8. Diabetes mellitus and insulin in an aspirin sensitive asthmatic.

    Science.gov (United States)

    Caplin, I

    1976-03-01

    The infrequency of diabetes mellitus and asthma in the same individual is re-examined. The antagonism between epinephrine and insulin, as suggested by Konig in 1935, is indeed accurate. The assays done by the Eli Lilly Research Department revealed no in vitro effect of insulin on the CAMP and GMP level of mast cells as occurs in liver cells. It is felt that this effect is probably an in vivo effect produced via the vagus nerve and alpha-adrenergic receptor system stimulation. This would explain the mechanism of aggravation of asthma by excess insulin. Dr. Petersen's studies, the negative intradermal skin tests to insulin and the absence of change on either beef or pork insulin usage by our patient all point to a nonatopic factor in the aggravation of the asthma of this patient. In the uncommon occurrence of asthma and diabetes in the same patient, insulin dosage should be considered as a factor in all such asthmatics who do not respond well to conventional therapy. Two additional asthmatics who also have diabetes did improve with cessation of nocturnal asthma by a reduction of their evening dose of insulin. A high fat, low carbohydrate diet, as suggested by Abrahamson to avoid dietary hyperinsulinism, is certainly worth considering in patients with nocturnal asthma. If patients cannot be made to follow a diet requiring frequent feedings high in protein and fats and low in carbohydrates, another approach suggests itself. Abrahamson was able to relieve the patients who developed nocturnal asthma with hypoglycemia by having them drink a glass of milk. Assuming other causes have been eliminated and a patient awakens each day at 3:00 a.m., an alarm clock could be set at 2:00 a.m. Milk or a milk substitute in milk sensitive patients could be taken at 2:00 a.m. to raise the blood sugar and hopefully prevent the asthma associated with hypoglycemia. Also to be noted is the ubiquitous use of tartrazine in so many drugs, including those used to relieve asthmatic symptoms

  9. Ethnic and migrant differences in the use of anti-asthmatic medication for children

    DEFF Research Database (Denmark)

    Cantarero-Arévalo, Lourdes; Ersbøll, Annette Kjaer; Holstein, Bjørn E

    2014-01-01

    Ethnic differences in the use of anti-asthmatic medication have been reported, with ethnic minorities being at a higher risk of suboptimal asthma control. As contextual socioeconomic characteristics may play a role, we analysed whether ethnic differences in the use of anti-asthmatic medication am...

  10. Exhaled nitric oxide and inducible nitric oxide synthase gene polymorphism in Japanese asthmatics

    Directory of Open Access Journals (Sweden)

    Suguru Sato

    2016-07-01

    Conclusions: The number of CCTTT repeats in the iNOS promoter region was associated with FeNO levels in asthmatics before treatment, suggesting the importance of iNOS genotype in the clinical application of FeNO for asthmatics.

  11. Effect of an intranasal corticosteroid on exercise induced bronchoconstriction in asthmatic children

    NARCIS (Netherlands)

    Kersten, Elin T. G.; van Leeuwen, Janneke C.; Brand, Paul L. P.; Duiverman, Eric J.; de Jongh, Frans H. C.; Thio, Bernard J.; Driessen, Jean M. M.

    Rationale Allergic rhinitis and exercise induced bronchoconstriction (EIB) are common in asthmatic children. The aim of this study was to investigate whether treatment of allergic rhinitis with an intranasal corticosteroid protects against EIB in asthmatic children. Methods: This was a double-blind,

  12. Clinical effects of air cleaners in homes of asthmatic children sensitized to pet allergens

    NARCIS (Netherlands)

    van der Heide, S.; van Aalderen, W. M.; Kauffman, H. F.; Dubois, A. E.; de Monchy, J. G.

    1999-01-01

    Exposure to cat and dog allergens is very common in the Western World and is a serious cause of asthma in sensitized subjects. We sought to study the clinical effects of air cleaners in living rooms and bedrooms of asthmatic children sensitized to cat or dog allergens. Twenty asthmatic children

  13. Defects in cellular immunity in chronic upper airway infections are associated with immunosuppressive retroviral p15E-like proteins

    NARCIS (Netherlands)

    Scheeren, R. A.; Keehnen, R. M.; Meijer, C. J.; van der Baan, S.

    1993-01-01

    Partial defects in cell-mediated immunity have been shown in patients with chronic purulent rhinosinusitis. These defects, ie, impaired delayed-type hypersensitivity (type IV) skin reactions on commensal microorganisms of the upper respiratory tract and impaired chemotactic responsiveness of

  14. Association of School Social Networks' Influence and Mass Media Factors with Cigarette Smoking among Asthmatic Students

    Science.gov (United States)

    Kanamori, Mariano; Beck, Kenneth H.; Carter-Pokras, Olivia

    2015-01-01

    Background: Around 10% of adolescent students under 18 years have current asthma. Asthmatic adolescents smoke as much or more than non-asthmatic adolescents. We explored the association between exposure to mass media and social networks' influence with asthmatic student smoking, and variations of these exposures by sex. Methods: This study…

  15. Use of nasopharyngeal culture to determine appropriateness of antibiotic therapy in acute bacterial rhinosinusitis.

    Science.gov (United States)

    Lee, Stella; Woodbury, Kristin; Ferguson, Berrylin J

    2013-04-01

    Rhinosinusitis is one of the top 5 diagnoses for which an antibiotic is prescribed, often without a clear bacterial etiology. This study evaluated whether nasopharyngeal culture and gram stain could serve as a surrogate for endoscopically obtained middle meatal cultures in directing appropriate therapy for acute bacterial rhinosinusitis (ABRS). This study also investigated the utility of a rapid sinus test screen in differentiating bacterial from nonbacterial rhinosinusitis. Thirty-one adult patients met inclusion criteria for ABRS. Samples were obtained from both the middle meatus and nasopharynx for Gram stain and culture. Nasal mucous samples were tested with a rapid sinus test strip measuring pH, levels of protein, nitrites, and leukocyte esterase. Sixty-one percent (61%) of nasopharyngeal and 48% of middle meatal samples grew pathogenic bacteria. The concordance rate was 84% between the 2 sites (p = 0.0006). The following pathogenic organisms were detected: Moraxella catarrhalis, Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, and Staphylococcus aureus. For nasopharyngeal samples, reliance on Gram stain alone exhibited a sensitivity of 31% and specificity of 100% and, similarly, for middle meatus samples, 47% and 93%, respectively. The rapid sinus test revealed a sensitivity of 83% and specificity of 7%. Nasopharyngeal and middle meatal cultures exhibited high concordance for pathogenic bacteria. Gram stain exhibited moderate sensitivity and excellent specificity. Nasopharyngeal cultures could provide a viable method, especially in a primary care setting, for determining the appropriateness of antibiotic therapy. The rapid sinus test's lack of specificity precluded its utility in the differentiation between bacterial and nonbacterial rhinosinusitis. © 2013 ARS-AAOA, LLC.

  16. Evaluation of the ability of an experimental model to induce bacterial rhinosinusitis in rabbits.

    Science.gov (United States)

    Dolci, Eduardo Landini Lutaif; Campos, Carlos Augusto Correia de; Silva, Leonardo da; Dolci, Ricardo Landini Lutaif; Dolci, José Eduardo Lutaif

    2014-01-01

    For decades, animals have been used in sinonasal experimental models, and the practice has increased substantially in the last few years. This study aimed to assess the pathogenesis of infectious process and medication efficiency to treat rhinosinusitis. To evaluate the efficiency of the proposed experimental model to induce an acute bacterial sinonasal infectious process through histological analysis and sinus secretion cultures. This was an experimental study with 22 New Zealand rabbits, divided into: group A (six rabbits), group B (seven rabbits), group C (seven rabbits), and group D (control group with two rabbits). Rhinosinusitis was induced by the insertion of a synthetic sponge into the right nasal cavity of 20 animals (study groups), followed by the instillation of bacterial strains (50% Staphylococcus sp. and 50% Streptococcus sp.). The groups were euthanized within 10 days (group A), 17 days (group B), and 30 days (groups C and D). All the rabbits of the study group developed acute bacterial rhinosinusitis, which was diagnosed through macroscopic evaluation, histological analysis, and sinus secretion culture. The proposed model is technically simple to perform, it is similar to the rhinogenic model in human beings, and it is highly efficient to reproduce an acute bacterial sinus infection. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  17. Elevation of IL-6 in the allergic asthmatic airway is independent of inflammation but associates with loss of central airway function

    Directory of Open Access Journals (Sweden)

    Bunn Janice Y

    2010-03-01

    Full Text Available Abstract Background Asthma is a chronic inflammatory disease of the airway that is characterized by a Th2-type of immune response with increasing evidence for involvement of Th17 cells. The role of IL-6 in promoting effector T cell subsets suggest that IL-6 may play a functional role in asthma. Classically IL-6 has been viewed as an inflammatory marker, along with TNFα and IL-1β, rather than as regulatory cytokine. Objective To investigate the potential relationship between IL-6 and other proinflammatory cytokines, Th2/Th17 cytokines and lung function in allergic asthma, and thus evaluate the potential role of IL-6 in this disease. Methods Cytokine levels in induced sputum and lung function were measured in 16 healthy control and 18 mild-moderate allergic asthmatic subjects. Results The levels of the proinflammatory biomarkers TNFα and IL-1β were not different between the control and asthmatic group. In contrast, IL-6 levels were specifically elevated in asthmatic subjects compared with healthy controls (p S = 0.53, p Conclusions In mild-moderate asthma, IL-6 dissociates from other proinflammatory biomarkers, but correlates with IL-13 levels. Furthermore, IL-6 may contribute to impaired lung function in allergic asthma.

  18. Lovastatin-induced decrease of intracellular cholesterol level attenuates fibroblast-to-myofibroblast transition in bronchial fibroblasts derived from asthmatic patients.

    Science.gov (United States)

    Michalik, Marta; Soczek, Ewelina; Kosińska, Milena; Rak, Monika; Wójcik, Katarzyna Anna; Lasota, Sławomir; Pierzchalska, Małgorzata; Czyż, Jarosław; Madeja, Zbigniew

    2013-03-15

    Chronic inflammation of the airways and structural changes in the bronchial wall are basic hallmarks of asthma. Human bronchial fibroblasts derived from patients with diagnosed asthma display in vitro predestination towards TGF-β-induced fibroblast-to-myofibroblast transition (FMT), a key event in the bronchial wall remodelling. Statins inhibit 3-hydroxymethyl-3-glutaryl coenzyme A reductase, a key enzyme in the cholesterol synthesis pathway and are widely used as antilipidemic drugs. The pleiotropic anti-inflammatory effects of statins, independent of their cholesterol-lowering capacity, are also well established. Since commonly used anti-asthmatic drugs do not reverse the structural remodelling of the airways and statins have tentative anti-asthmatic activity, we have studied the effect of lovastatin on FMT in populations of human bronchial fibroblasts derived from asthmatic patients. We demonstrate that the intensity of FMT induced by TGF-β1 was strongly and dose-dependently attenuated by lovastatin. Furthermore, we show that neither the suppression of prenylation of signalling proteins nor the effect on reactive oxygen species formation are important for lovastatin-induced inhibition of myofibroblast differentiation. On the other hand, we show that a squalene synthase inhibitor, zaragozic acid A, reduced the TGF-β1-induced FMT to an extent comparable to lovastatin effect. Additionally we demonstrate that in bronchial fibroblast populations, both inhibitors (lovastatin and zaragozic acid A) attenuate the TGF-β1-induced Smad2 nuclear translocation in a manner dependent on intracellular cholesterol level. Our data suggest that statins can directly, by decrease of intracellular cholesterol level, affect basic cell signalling events crucial for asthmatic processes and potentially prevent perilous bronchial wall remodelling associated with intensive myofibroblast formation. Copyright © 2013 Elsevier B.V. All rights reserved.

  19. Exhaled nitric oxide predicts exercise-induced bronchoconstriction in asthmatic school children

    DEFF Research Database (Denmark)

    Buchvald, Frederik; Hermansen, Mette N; Nielsen, Kim G

    2005-01-01

    reducing the need for exercise testing. OBJECTIVE: The aim of this study was to estimate the value of FeNO as a predictor of EIB in asthmatic children. METHODS: Stable outpatient asthmatic school children performed standard exercise challenge tests and measurement of FeNO. RESULTS: FeNO and response...... to a standardized submaximal exercise test on the treadmill were measured in 111 school children with asthma. EIB could be excluded with a probability of 90% in asthmatic children with FeNO levels

  20. Inhaled beclomethasone in pregnant asthmatic women--a systematic review.

    Science.gov (United States)

    de Aguiar, M M; da Silva, H J; Rizzo, J Â; Leite, D F B; Silva Lima, M E P L; Sarinho, E S C

    2014-01-01

    The aim of this study was to systematically review the safety and efficacy of inhaled beclomethasone for asthma treatment in pregnant women. We performed a systematic review in Medline, LILACS and SciELO electronic databases in December 2012. A total of 3433 articles were found by using the keywords asthma, pregnancy and beclomethasone. Among these, 1666 were from Medline, via PubMed, and 1767 were from LILACS and SciELO. Nine of these articles were selected. Only one paper suggested an increased foetal risk for congenital malformations, and one other for offspring endocrine and metabolic disturbances. Data are mostly reassuring, supporting the use of glucocorticoid inhalants during pregnancy, and we found no evidence of inferiority in relation to efficacy and safety of beclomethasone compared to other drugs used in pregnant asthmatic women. Copyright © 2013 SEICAP. Published by Elsevier Espana. All rights reserved.

  1. The therapeutic physical Culture in the rehabilitation to asthmatic students

    Directory of Open Access Journals (Sweden)

    Manuel Alejandro Romero-León

    2016-05-01

    Full Text Available Treating asthmatic students in the university environment has been a ministerial concern. Multiple actions aimed at preparing teachers to conduct the teaching of therapeutic physical culture are developed from the methodological work. In it offered theoretical, methodological and experiential tools for therapeutic exercises generate a developer student learning. Nevertheless, there are still limitations that reveal the need to give continuity to these intentions. One is the traditional approach of the exercises for therapeutic purposes. If we consider that today's society demands the formation of a subject becomes heir and transmitter of a culture of physical activity that achieves deal with their conditions, increasing growing life expectancy, then more than rehabilitation the physical must achieve a comprehensive educational impact.

  2. Comparison of morning and afternoon exercise training for asthmatic children

    Directory of Open Access Journals (Sweden)

    C.S. Silva

    2006-01-01

    Full Text Available Fitness improvement was used to compare morning with afternoon exercise periods for asthmatic children. Children with persistent moderate asthma (according to GINA criteria, 8 to 11 years old, were divided into 3 groups: morning training group (N = 23, afternoon training group (N = 23, and non-training group (N = 23. The program was based on twice a week 90-min sessions for 4 months. We measured the 9-min running distance, resting heart rate and abdominal muscle strength (sit-up number before and after the training. All children took budesonide, 400 µg/day, and an on demand inhaled ß-agonist. The distance covered in 9 min increased (mean ± SEM from 1344 ± 30 m by 248 ± 30 m for the morning group, from 1327 ± 30 m by 162 ± 20 m for the afternoon group, and from 1310 ± 20 m by 2 ± 20 m for the control group (P 0.05 for morning with afternoon comparison. The reduction of resting heart rate from 83 ± 1, 85 ± 2 and 86 ± 1 bpm was 5.1 ± 0.8 bpm in the morning group, 4.4 ± 0.8 bpm in the afternoon group, and -0.2 ± 0.7 bpm in the control group (P > 0.05 for morning with afternoon comparison and P 0.05 for morning with afternoon comparison and P < 0.05 versus control. No statistically significant differences were detected between the morning and afternoon groups in terms of physical training of asthmatic children.

  3. Pulmonary ventilation studies of asthmatic children with Kr-81m

    International Nuclear Information System (INIS)

    Uchiyama, Guio; Hotta, Toshiko; Arimizu, Noboru; Sugimoto, Kazuo.

    1979-01-01

    Krypton-81 m gas was eluted from the 81 Rb-sup(81m)Kr generator by using compressed air or oxygen as an eluting agent. The continuous inhalation of mixed gas of sup(81m)Kr and air or oxygen with the use of a scintillation camera produced a pulmonary image of which density was proportional to regional ventilation. Because of short half life of sup(81m)Kr (13 seconds), exhaled gas was not necessary to be trapped by the charcoal filter, and the several pulmonary views of a patient could readily be available in a short period of time. The great advantage of sup(81m)Kr generator was found in use for the studies of small children who were not usually cooperative to medical examination. Thirty seven patients with bronchial asthma of any state were so far studied. Their ages ranged from 3 to 15 years old. Studies revealed the definite ventilation defects in scans of patients with asthmatic attack. Re-scans right after the use of bronchodilators showed marked improvement of the ventilation defects. Exercise-induced asthma (EIA) was easily identified by the sup(81m)Kr ventilation study. After premedications for EIA with disodium cromoglicate, the next exercises produced less or no ventilation defects, and the preventive effect could be individually examined. The sup(81m)Kr ventilation study was also used for estimating the patient's sensitivity to provokative substances of bronchial asthma. House dust was continuously inhaled with sup(81m)Kr gas by patients. The threshold dose of house dust of disclosing ventilation defects in scans was definitely less than that of provokating the symptom of asthmatic attack. The sensitive sup(81m)Kr ventilation study could be another provokative test which induces no clinical symptoms. (author)

  4. Inhalation of hydrogen gas attenuates airway inflammation and oxidative stress in allergic asthmatic mice.

    Science.gov (United States)

    Zhang, Ning; Deng, Changwen; Zhang, Xingxing; Zhang, Jingxi; Bai, Chong

    2018-01-01

    Asthma is a worldwide common chronic airway disease that cannot be cured and results in the huge burden in public health. Oxidative stress was considered an important mechanism in the pathogenesis of asthma. Hydrogen gas been demonstrated to function as a novel antioxidant and exert therapeutic antioxidant activity in a number of diseases and the function of this nontoxic gas in asthma was unclear. The purpose of the study aims to examine the effect of inhalation hydrogen gas on the pathophysiology of a mouse model of asthma. A murine model of ovalbumin (OVA)-induced allergic airway inflammation was used in this study. Briefly, Mice were sensitized to ovalbumin and received inhalation of 67% high concentration of hydrogen gas for 60 min once a day for 7 consecutive days after OVA or PBS challenge respectively. Lung function was assessed in the apparatus with 4 channels of biological signal system. Morphology and goblet cell hyperplasia were stained by H/E and Periodic acid-Schiff staining. Cytologic classification in the bronchial alveolar lavage fluid (BALF) was analyzed by Wright Giemsa staining. Serum, BALF and lung tissue were collected for biochemical assay. One-way analysis of variance (ANOVA) was used to determine statistical significance between groups. Multiple comparisons were made by Bonferroni's Multiple Comparison Test by using GraphPad Prism 5 software. Inhalation of hydrogen gas abrogated ovalbumin-induced the increase in lung resistance. Concomitantly, the asthmatic mice showed severe inflammatory infiltration and goblet cell hyperplasia which were reversed by hydrogen gas inhalation. Hydrogen gas inhalation reduced significantly the number of total cells, eosinophils and lymphocytes in BALF. Increased level of IL-4, IL-13, TNF-α and CXCL15 in the BALF and IL-4 in the serum were decreased significantly after inhalation. Hydrogen gas inhalation markedly upregulated the activity of decreased superoxide dismutase and significantly attenuated the

  5. C-reactive protein testing in patients with acute rhinosinusitis leads to a reduction in antibiotic use

    DEFF Research Database (Denmark)

    Llor, Carl; Bjerrum, Lars; Arranz, Javier

    2012-01-01

    assigned to FIG and 71 to PIG. In 2009, 59 new physicians were included as a control group. Two hundred and sixty-seven GPs visited contacts with rhinosinusitis (78.5%) registering a total of 836 cases. In the group of GPs with access to CRP rapid test, 207 patients with rhinosinusitis (75.3%) were tested...... and antibiotics were prescribed in 156 patients (56.7%). Antibiotics were prescribed in 87 patients (82.9%) in the group of GPs exposed to PIG and in 52 patients (86.7%) in the control group (P assigned to FIG...

  6. Effects of Pranlukast Hydrate on Airway Hyperresponsiveness in Non-Asthmatic Patients with Japanese Cedar Pollinosis

    Directory of Open Access Journals (Sweden)

    Hironori Sagara

    2009-01-01

    Conclusions: The results indicate that pranlukast hydrate inhibits airway hyperresponsiveness in non-asthmatic patients with Japanese cedar pollinosis. In turn, this suggests that cysteinyl leukotrienes have a role in increased airway responsiveness.

  7. Influenza enhances caspase-1 in bronchial epithelial cells from asthmatic volunteers and is associated with pathogenesis

    Science.gov (United States)

    Background: The leading cause of asthma exacerbation is respiratory viral infection. Innate antiviral defense pathways are altered in the asthmatic epithelium, yet involvement of inflammasome signaling in virus-induced asthma exacerbation is not known. Objective: This study com...

  8. Do dental procedures affect lung function and arterial oxygen saturation in asthmatic patients?

    Directory of Open Access Journals (Sweden)

    Magdy Mahmoud Emara

    2013-04-01

    Conclusion: Asthmatic patients may be at a higher risk of developing oxygen desaturation after dental procedures regardless of their type with and without local anesthesia and a decrease in PEF after dental procedures with local anesthesia.

  9. Cyclin D1 in ASM Cells from Asthmatics Is Insensitive to Corticosteroid Inhibition.

    Science.gov (United States)

    Allen, Jodi C; Seidel, Petra; Schlosser, Tobias; Ramsay, Emma E; Ge, Qi; Ammit, Alaina J

    2012-01-01

    Hyperplasia of airway smooth muscle (ASM) is a feature of the remodelled airway in asthmatics. We examined the antiproliferative effectiveness of the corticosteroid dexamethasone on expression of the key regulator of G(1) cell cycle progression-cyclin D1-in ASM cells from nonasthmatics and asthmatics stimulated with the mitogen platelet-derived growth factor BB. While cyclin D1 mRNA and protein expression were repressed in cells from nonasthmatics in contrast, cyclin D1 expression in asthmatics was resistant to inhibition by dexamethasone. This was independent of a repressive effect on glucocorticoid receptor translocation. Our results corroborate evidence demonstrating that corticosteroids inhibit mitogen-induced proliferation only in ASM cells from subjects without asthma and suggest that there are corticosteroid-insensitive proliferative pathways in asthmatics.

  10. Analysis of anti-asthmatic drug patents published in China between 2004 and 2013.

    Science.gov (United States)

    Xie, Hua; Zhang, Huiyun; Cao, Ke; He, Ping; Dai, Hongliang; He, Shaoheng

    2016-01-01

    We previously reported that 789 anti-allergic patents were granted in China between 1988 and 2008, but the number of patents seems to have grown much faster in China in recent years. Therefore, it is necessary to analyse the patents for anti-asthmatic products between 2004 and 2013 to give pharmaceutical companies and individuals a better understanding of potential candidates for anti-asthmatic drug development from patents published in China. The current report analyses the scientific progress that supports anti-asthmatic drug patent applications and reviews the published patent literature in China from 2004 to 2013. The rapid increase in the number of anti-asthmatic patents in China indicates that more specific discoveries have been made and that more people are aware of the importance of intellectual property protection in China. Holding patents may guarantee protection for an innovative new product.

  11. Dietary supplementation with soybean lecithin increases pulmonary PAF bioactivity in asthmatic rats.

    Science.gov (United States)

    Muehlmann, Luis A; Zanatta, Ana L; Farias, Carolina L A; Bieberbach, Eloyse W; Mazzonetto, Ana C; Michellotto, Pedro V; Fernandes, Luiz C; Nishiyama, Anita

    2010-06-01

    The prevalence of asthma has risen over the last few decades, and some studies correlate this with the greater consumption of polyunsaturated fatty acids (PUFAs). Dietary PUFAs are known to increase the susceptibility of biological structures to lipid peroxidation, a process by which platelet-activating factor (PAF)-like lipids can be generated. These lipids functionally mimic the bioactivity of PAF, a potent proinflammatory mediator that exerts several deleterious effects on asthma. Thus, this work aimed to investigate if dietary supplementation with soybean lecithin (SL), a source of PUFAs, increases lipid peroxidation and PAF bioactivity in lungs of asthmatic Wistar rats. Animals were separated into groups: control, supplemented, asthmatic, asthmatic supplemented with SL (2 g/kg body weight), asthmatic supplemented with SL (2 g/kg body weight) and DL-alpha-tocopheryl acetate (100 mg/kg body weight). Asthmatic inflammation increased pulmonary lipid peroxidation, PAF bioactivity, alveolar-capillary barrier permeability and production of nitric oxide. In asthmatics, dietary supplementation with SL promoted an increase in pulmonary lipid peroxidation and PAF bioactivity, and an increase in the permeability of the alveolar-capillary barrier. Moreover, the treatment of asthmatic rats with DL-alpha-tocopheryl acetate inhibited the lipid peroxidation and decreased the PAF bioactivity. Therefore, the increase in pulmonary PAF bioactivity in asthmatic individuals elicited by the dietary supplementation with SL probably involves the generation of PAF-like lipids. This finding suggests that PAF-like lipids may account for the deleterious effects of dietary PUFAs on asthma. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  12. Prevalence of chronic rhinosinusitis in a population of patients with gastroesophageal reflux disease

    DEFF Research Database (Denmark)

    Bohnhorst, Idar; Jawad, Samir; Lange, Bibi

    2015-01-01

    and anterior/posterior rhinoscopy results. Sinonasal-related quality of life was assessed by using the Sino-Nasal Outcome Test 22 (SNOT-22). These results were compared with those of a population-based control group examined for CRS in the same way. RESULTS: The prevalence of CRS among patients with GERD......-related quality of life is decreased in patients with CRS who also suffer from GERD....

  13. Chronic osteitic rhinosinusitis as a manifestation of cystic fibrosis: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Jadhav, Aniket B. [Dept. of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston, Houston (United States); Lurie, Alan G.; Tadinata, Aditya [Dept. of Diagnostic Sciences, Oral and Maxillofacial Radiology, The University of Connecticut School of Dental Medicine, Farmington (United States)

    2014-09-15

    A 28 year old male patient with a history of cystic fibrosis (CF) was referred to the University of Connecticut School of Dental Medicine for an evaluation of a cystic lesion in the right maxilla using cone-beam computed tomography (CBCT). CF is an autosomal recessive disease characterized by an abnormal production of viscous mucus, affecting the mucociliary clearance. The CBCT scan revealed a large cystic lesion in the right maxilla extending from the right maxillary second molar to the midline in the region of the right central incisor with a significant buccal expansion. Further evaluation revealed complete opacification of the paranasal sinuses with medial bulging of the lateral maxillary sinus walls. The maxillary and sphenoid sinuses also appeared hypoplastic. The peculiar finding seen in this case was the presence of marked sclerosis and an increase in the thickness of the adjacent bony framework. This report aimed to describe the common sinonasal findings associated with CF and its underlying pathophysiology.

  14. FUNGAL SPECIATION USING QUANTITATIVE POLYMERASE CHAIN REACTION (QPCR) IN PATIENTS WITH AND WITHOUT CHRONIC RHINOSINUSITIS

    Science.gov (United States)

    Objectives/Hypothesis: 1. to determine the mycology of the middle meatus using an endoscopically guided brush sampling technique and polymerase chain reaction laboratory processing of nasal mucous. 2. To compare the mycology of the middle meatus in patients with sinus disease to...

  15. Nasal Irrigation for Chronic Rhinosinusitis and Fatigue in Patients with Gulf War Syndrome

    Science.gov (United States)

    2016-09-01

    11]. NI-X solution is made with crystallized xylitol pre-packaged for use in this study by the manufacturer (http://www.danisco. com/ food - beverages ...measures would demonstrate that nasal irrigation (NI) can provide effective adjunctive therapy for CRS and fatigue, improving quality of life for GWI...year five of the project involved the enrollment, retention, coordination and management of study subjects and data collection. Currently, the study

  16. Heterogenous inflammatory patterns in chronic rhinosinusitis without nasal polyps in Chicago, Illinois

    Science.gov (United States)

    Tan, Bruce K.; Klingler, Aiko I.; Stevens, Whitney W.; Poposki, Julie A.; Peters, Anju T.; Suh, Lydia A.; Norton, James; Carter, Roderick G.; Hulse, Kathryn E.; Harris, Kathleen E.; Grammer, Leslie C.; Schleimer, Robert P.; Welch, Kevin C.; Smith, Stephanie S.; Conley, David B.; Kern, Robert C.; Kato, Atsushi

    2016-01-01

    Summary CRSsNP is a heterogenous disease but type 2 inflammation in CRSsNP was more common than type 1 inflammation among patients in Chicago, Illinois. Distinct therapeutic strategies may be needed depending on the type of inflammation found in CRSsNP. PMID:27639939

  17. Chronic osteitic rhinosinusitis as a manifestation of cystic fibrosis: A case report

    International Nuclear Information System (INIS)

    Jadhav, Aniket B.; Lurie, Alan G.; Tadinata, Aditya

    2014-01-01

    A 28 year old male patient with a history of cystic fibrosis (CF) was referred to the University of Connecticut School of Dental Medicine for an evaluation of a cystic lesion in the right maxilla using cone-beam computed tomography (CBCT). CF is an autosomal recessive disease characterized by an abnormal production of viscous mucus, affecting the mucociliary clearance. The CBCT scan revealed a large cystic lesion in the right maxilla extending from the right maxillary second molar to the midline in the region of the right central incisor with a significant buccal expansion. Further evaluation revealed complete opacification of the paranasal sinuses with medial bulging of the lateral maxillary sinus walls. The maxillary and sphenoid sinuses also appeared hypoplastic. The peculiar finding seen in this case was the presence of marked sclerosis and an increase in the thickness of the adjacent bony framework. This report aimed to describe the common sinonasal findings associated with CF and its underlying pathophysiology.

  18. Orbital tumour due rhinosinusal extension in a patient with Wegener's granulomatosis.

    Science.gov (United States)

    Molina-Sócola, F E; Galván-Carrasco, M P; Del Estad-Cabello, A; Sánchez-Vicente, J L; Contreras-Díaz, M; Rueda-Rueda, T

    2016-09-01

    The case is presented of a 49 year-old woman with an orbital mass originating from the rhinosinus. She had a history of Wegener's granulomatosis, refractory to both biological and immunosuppressive therapy. Clinical examination showed proptosis, diplopia, and restriction of ocular movements. Orbital mass resection was performed, due to its rapid growth, and lack of response to medical treatment. Copyright © 2016 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  19. Molecular mechanisms of glucocorticoids action: implications for treatment of rhinosinusitis and nasal polyposis.

    Science.gov (United States)

    Grzanka, Alicja; Misiołek, Maciej; Golusiński, Wojciech; Jarząb, Jerzy

    2011-02-01

    Intra-nasal glucocorticoids are the most effective drugs available for rhinosinusitis and nasal polyposis treatment. Their effectiveness depends on many factors and not all of them have been well recognized so far. The authors present the basic information on molecular mechanisms of glucocorticoid action, direct and indirect effects of glucocorticoids on transcription of genes encoding inflammatory mediators. They focus on recently proved nongenomic mechanisms which appear quickly, from several seconds to minutes after glucocorticoid administration and discuss clinical implications resulting from this knowledge. Discovery of nongenomic glucocorticoid actions allows for better use of these drugs in clinical practice.

  20. Oral health status and treatment needs of asthmatic children aged 6 – 12 Years in Lucknow

    Directory of Open Access Journals (Sweden)

    Pramod Kumar Yadav

    2017-01-01

    Full Text Available Introduction: Asthma is a growing public health problem affecting over 300 million people worldwide. Asthmatic children have an altered immune response and a high tendency to mouth breathing especially during an episode of rhinitis or an attack thus predisposing them to serious oral health problems. Aim: This study aims to assess oral health status of asthmatic children aged 6–12. Materials and Methods: A cross-sectional study was conducted among 450 asthmatic children aged 6–12 years in Lucknow, asthmatic children were chosen from pediatric department of major hospitals. Gingival index (GI, oral hygiene index-simplified (OHI-S, and dentition status and treatment need of World Health Organization oral health survey pro forma (1997 were used to assess oral health status. ANOVA, Chi-square test, and descriptive statistics were carried out. SPSS 16 was used for the data analysis. Results: Mean dynamical mean-field theory (DMFT was 2.98 ± 1.52 and 3.05 ± 1.60, mean GI score was 1.55 ± 0.52 and 1.53 ± 0.42 and mean OHI-S was 2.59 ± 0.68 and 2.48 ± 0.77 among the male and female asthmatic children. Conclusion: Female asthmatic children had higher mean DMFT score, but lower mean GI score and oral hygiene score than male children in comparison and also they had a compromised oral hygiene status.

  1. Efficacy of steroid treatments in the asthmatic preschool child

    DEFF Research Database (Denmark)

    Bisgaard, H

    2002-01-01

    Asthma represents the most common chronic disease in preschool children. Hospital admission for wheezy disorders is the most common paediatric chronic disease causing hospital admission and more common in young children than later in life.......Asthma represents the most common chronic disease in preschool children. Hospital admission for wheezy disorders is the most common paediatric chronic disease causing hospital admission and more common in young children than later in life....

  2. Exhaled nitric oxide levels are elevated in persons with tetraplegia and comparable to that in mild asthmatics.

    Science.gov (United States)

    Radulovic, Miroslav; Schilero, Gregory J; Wecht, Jill M; La Fountaine, Michael; Rosado-Rivera, Dwindally; Bauman, William A

    2010-06-01

    The role of airway inflammation in mediating airflow obstruction in persons with chronic traumatic tetraplegia is unknown. Measurement of the fraction of exhaled nitric oxide (FeNO) affords a validated noninvasive technique for gauging the airway inflammatory response in asthma, although it has never been assessed in persons with tetraplegia. This study was designed to determine the FeNO in individuals with chronic tetraplegia compared with that in patients with mild asthma and healthy able-bodied individuals. Nine subjects with chronic tetraplegia, seven subjects with mild asthma, and seven matched healthy able-bodied controls were included in this prospective, observational, pilot study. All subjects were nonsmokers and clinically stable at the time of study. Spirometry was performed on all participants at baseline. FENO was determined online by a commercially available closed circuit, chemiluminescence method, using a single-breath technique. Subjects with tetraplegia had significantly higher values of FeNO than controls (17.72 +/- 3.9 ppb vs. 10.37 +/- 4.9 ppb; P tetraplegia and those with asthma (17.72 +/- 3.9 ppb vs. 20.23 +/- 4.64 ppb, P tetraplegia have FeNO levels that are comparable to that seen in mild asthmatics and higher than that in healthy able-bodied controls. The clinical relevance of this observation has yet to be determined.

  3. Clinical Experience of Using Nasal Drops Milt and Elimination Therapy with Nasal Spray Pshyk in Children with Acute Rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Yu.V. Havrylenko

    2015-09-01

    Full Text Available The article deals with the treatment of acute rhinosinusitis in children. Attention is paid to unwarranted use of antibiotics, misuse of vasoconstrictor drops. It is emphasized that broad-spectrum antibiotics in accordance with the recommendations of EPOS 2012 should be administered after the 5th day of the disease or in the presence of severe symptoms. Saline irrigation has the highest level of evidence advisability for the administration from the first day of acute rhinosinusitis. The findings of the clinical study on therapeutic effect and tolerability of nasal drops Milt in combination with nasal spray Pshyk manufactured by Farmak сompany (Ukraine when treating children with acute rhinosinusitis are presented. It is shown that use of these drugs helps maintain and significantly improve the functional state of the nasal mucosa and mucociliary clearance in children with acute rhinosinusitis as well as quickly and safely reduce the signs of inflammation in the nasal cavity and paranasal sinuses. This makes it possible to avoid invasive treatments not only by reducing the symptoms, but also the provision of pathogenetic therapeutic effect.

  4. [The role of non-medicamental technologies in the rehabilitation of the children presenting with acute rhinosinusitis].

    Science.gov (United States)

    Khan, M A; Khoruzhenko, O V; Vakhova, E L; Lyan, N A; Radetskaya, L I

    2015-01-01

    Despite the recent achievements in diagnostics and pharmacotherapy of acute rhinosinusitis in the children, the problem of management of this pathology, thus far remains a serious challenge for practical medicine. The objective of the present study was to develop a scientifically sound rationale for the application of halotherapy (HT) and magnetic therapy (MT) or their combination for the treatment of acute rhinosinusitis in the children. The clinical observations and special investigations were carried out in the comparative aspect and encompassed 120 children at the age varying from 5 to 15 years suffering from acute rhinosinusitis. The therapeutic effectiveness of the rehabilitative treatment was evaluated based on the results of the endoscopic study of the nasal cavity, analysis of the X-ray images of paranasal sinuses, rhinomanometry, investigations into the ciliary activity, and assessment of the mucosal immunity. The results of the present study gave evidence of the feasibility of incorporating HT and MT in the combined treatment of the children presenting with acute rhinosinusitis. The integrated use of the two methods proved to have the advantage over the separate application of either of them. The specific effects of HT and MT on the clinical course of acute sinusitis and the functional state of intranasal mucosa are described. The optimal methods of the treatment are proposed.

  5. Comparative study of the efficacy of topical steroid and antibiotic combination therapy versus oral antibiotic alone when treating acute rhinosinusitis.

    Science.gov (United States)

    El-Hennawi, D M; Ahmed, M R; Farid, A M; Al Murtadah, A M

    2015-05-01

    Acute rhinosinusitis arises as a consequence of viral rhinitis, and bacterial infection can subsequently occur. Intranasal antibiotics as an adjunct to corticosteroids usually demonstrate the greatest symptom relief. We wanted to clinically evaluate the effects of a topical antibiotic and steroid combination administered intranasally, versus an oral antibiotic alone when treating acute rhinosinusitis. Forty patients with acute bacterial rhinosinusitis were divided into two groups. Group A received an antibiotic and steroid combination (ofloxacin 0.26 per cent and dexamethasone 0.053 per cent nasal drops) for 10 days, administered intranasally (5 drops in each nostril/8 hours). Group B, the control group, received an oral antibiotic alone (amoxicillin 90 mg/kg). Eight hours after commencing treatment, facial pain was more severe in group B and nasal obstruction was reduced in both groups. Ten days after commencing treatment, anterior nasal discharge was 0.15 per cent in group A and absent in group B. The application of a topical antibiotic and steroid combination into the nasal cavity is an effective way of treating uncomplicated, acute bacterial rhinosinusitis with the theoretical advantages of easy administration, high local drug concentration and minimal systemic adverse effects.

  6. Effect of catastrophic wildfires on asthmatic outcomes in obese children

    Science.gov (United States)

    Tse, Kevin; Chen, Lie; Tse, Mabel; Zuraw, Bruce; Christiansen, Sandra

    2015-01-01

    Background Air pollutants from wildfires and obesity independently exacerbate asthma, yet no study has determined the combined effects of these 2 variables on asthma outcomes. Objective To determine the effect of 2 catastrophic wildfires affecting the Southern California region (in 2003 and 2007) on several asthma outcomes in a cohort of children. Methods To investigate the association between wildfire exposure and asthma outcomes, we stratified our study population by body mass index categories (underweight, normal, overweight, and obese) and zip codes (to distinguish individuals who were closer to the fires vs farther away). The primary outcome was the prevalence of physician-dispensed short-acting β-agonist (SABAs). Secondary outcomes included the rate of emergency department visits and/or hospitalizations for asthma, the frequency of oral corticosteroid use for asthma, and number of new diagnoses of asthma. Results A total of 2,195 and 3,965 asthmatic children were analyzed as part of our retrospective cohort during the 2003 and 2007 wildfires, respectively. SABA dispensing increased the most in the obese group after the 2003 wildfires (P wildfire. Conclusion Catastrophic wildfires lead to worsening asthma outcomes, particularly in obese individuals. This study gives further evidence of a link between obesity and asthma severity and suggests that air pollutants released during wildfires can have substantial detrimental effects on asthma control. PMID:25747784

  7. Nocturnal GERD - a risk factor for rhinitis/rhinosinusitis: the RHINE study.

    Science.gov (United States)

    Schiöler, L; Ruth, M; Jõgi, R; Gislason, T; Storaas, T; Janson, C; Forsberg, B; Sigsgaard, T; Torén, K; Hellgren, J

    2015-06-01

    It has been suggested that gastroesophageal reflux disease (GERD) is a risk factor for developing rhinitis/rhinosinusitis, but data are lacking. This is a prospective 10-year follow-up study of a large multicenter cohort from Northern Europe, evaluating the relationship between nocturnal GERD and noninfectious rhinitis (NIR). The study comprised 5417 subjects born between 1945 and 1973, who answered a questionnaire in 1999-2001 and again in 2010-2012. Noninfectious rhinitis was defined as having nasal obstruction, secretion, and/or sneezing without having the common cold. Odds ratios for developing NIR in relation to age, gender, BMI, smoking, asthma, and nocturnal GERD were calculated. During the 10-year observation period, 1034 subjects (19.1%) developed NIR. Subjects reporting nocturnal gastroesophageal reflux in both 1999 and 2010 had more NIR in 2010 (2.8% vs 1.2%, P rhinitis/rhinosinusitis. GERD should therefore be considered in patients with rhinitis of known and unknown origin. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Sulforaphane improves the bronchoprotective response in asthmatics through Nrf2-mediated gene pathways.

    Science.gov (United States)

    Brown, Robert H; Reynolds, Curt; Brooker, Allison; Talalay, Paul; Fahey, Jed W

    2015-09-15

    It is widely recognized that deep inspiration (DI), either before methacholine (MCh) challenge (Bronchoprotection, BP) or after MCh challenge (Bronchodilation, BD) protects against this challenge in healthy individuals, but not in asthmatics. Sulforaphane, a dietary antioxidant and antiinflammatory phytochemical derived from broccoli, may affect the pulmonary bronchoconstrictor responses to MCh and the responses to DI in asthmatic patients. Forty-five moderate asthmatics were administered sulforaphane (100 μmol daily for 14 days), BP, BD, lung volumes by body-plethsmography, and airway morphology by computed tomography (CT) were measured pre- and post sulforaphane consumption. Sulforaphane ameliorated the bronchoconstrictor effects of MCh on FEV1 significantly (on average by 21 %; p = 0.01) in 60 % of these asthmatics. Interestingly, in 20 % of the asthmatics, sulforaphane aggravated the bronchoconstrictor effects of MCh and in a similar number was without effect, documenting the great heterogeneity of the responsiveness of these individuals to sulforaphane. Moreover, in individuals in whom the FEV1 response to MCh challenge decreased after sulforaphane administration, i.e., sulforaphane was protective, the activities of Nrf2-regulated antioxidant and anti-inflammatory genes decreased. In contrast, individuals in whom sulforaphane treatment enhanced the FEV1 response to MCh, had increased expression of the activities of these genes. High resolution CT scans disclosed that in asthmatics sulforaphane treatment resulted in a significant reduction in specific airway resistance and also increased small airway luminal area and airway trapping modestly but significantly. These findings suggest the potential value of blocking the bronchoconstrictor hyperresponsiveness in some types of asthmatics by phytochemicals such as sulforaphane.

  9. Barrier disrupting effects of alternaria alternata extract on bronchial epithelium from asthmatic donors.

    Science.gov (United States)

    Leino, Marina S; Loxham, Matthew; Blume, Cornelia; Swindle, Emily J; Jayasekera, Nivenka P; Dennison, Patrick W; Shamji, Betty W H; Edwards, Matthew J; Holgate, Stephen T; Howarth, Peter H; Davies, Donna E

    2013-01-01

    Sensitization and exposure to the allergenic fungus Alternaria alternata has been associated with increased risk of asthma and asthma exacerbations. The first cells to encounter inhaled allergens are epithelial cells at the airway mucosal surface. Epithelial barrier function has previously been reported to be defective in asthma. This study investigated the contribution of proteases from Alternaria alternata on epithelial barrier function and inflammatory responses and compared responses of in vitro cultures of differentiated bronchial epithelial cells derived from severely asthmatic donors with those from non-asthmatic controls. Polarised 16HBE cells or air-liquid interface (ALI) bronchial epithelial cultures from non-asthmatic or severe asthmatic donors were challenged apically with extracts of Alternaria and changes in inflammatory cytokine release and transepithelial electrical resistance (TER) were measured. Protease activity in Alternaria extracts was characterised and the effect of selectively inhibiting protease activity on epithelial responses was examined using protease inhibitors and heat-treatment. In 16HBE cells, Alternaria extracts stimulated release of IL-8 and TNFα, with concomitant reduction in TER; these effects were prevented by heat-treatment of the extracts. Examination of the effects of protease inhibitors suggested that serine proteases were the predominant class of proteases mediating these effects. ALI cultures from asthmatic donors exhibited a reduced IL-8 response to Alternaria relative to those from healthy controls, while neither responded with increased thymic stromal lymphopoietin (TSLP) release. Only cultures from asthmatic donors were susceptible to the barrier-weakening effects of Alternaria. Therefore, the bronchial epithelium of severely asthmatic individuals may be more susceptible to the deleterious effects of Alternaria.

  10. Identification of Relationships Between Interleukin 15 mRNA and Brain-Derived Neurotrophic Factor II mRNA Levels With Formal Components of Temperament in Asthmatic Patients.

    Science.gov (United States)

    Panek, Michał; Jonakowski, Mateusz; Zioło, Jan; Pietras, Tadeusz; Wieteska, Łukasz; Małachowska, Beata; Mokros, Łukasz; Szemraj, Janusz; Kuna, Piotr

    2017-04-01

    Asthma is a chronic inflammatory and heterogeneous disease developing mostly through allergic inflammation, which modifies the expression of various cytokines and neurotrophins. Previous studies suggest the involvement of interleukin (IL)-15 in the regulation of immune response in asthma. Brain-derived neurotrophic factor (BDNF) II plays an important role as a regulator of development and survival of neurons as well as maintenance of their physiological activity. Chronic stress associated with asthma and elevated IL-15 mRNA and BDNFII mRNA levels may affect the mood and a subjective sensation of dyspnoea-inducing anxiety. Psychopathological variables and numerous cytokine/neurotrophin interactions influence the formation of temperament and strategies of coping with stress. The aim of the study was to identify the role of IL-15 mRNA and BDNFII mRNA expressions and their effect on components of temperament and strategies of coping with stress in asthmatics. A total of 352 subjects (176 healthy volunteers and 176 asthmatic patients) participated in the study. The Formal Characteristic of Behaviour-Temperament Inventory (FCB-TI), Coping Inventory for Stressful Situations (CISS), Beck Depression Inventory, State-Trait Anxiety Inventory, and Borg Rating of Perceived Exertion (RPE) Scale were applied in all the subjects. The expression of IL-15 and BDNFII gene was measured using quantitative real-time polymerase chain reaction (qRT-PCR). Different levels of IL-15 and BDNFII expressions between healthy volunteers and patients were revealed in the study. IL-15 enhanced the BDNFII mRNA expression among patients with bronchial asthma. The depression level negatively correlated with the BDNFII mRNA expression. This neurotrophin modified the temperament variable. BDNFII significantly affected (proportional relationship) the level of briskness in asthmatic patients. BDNFII might influence the level and style of coping with stress (emotion-oriented style). This hypothesis

  11. Direct costs of asthma in Brazil: a comparison between controlled and uncontrolled asthmatic patients

    Directory of Open Access Journals (Sweden)

    L.A. Santos

    2007-07-01

    Full Text Available Asthma is a common chronic illness that imposes a heavy burden on all aspects of the patient's life, including personal and health care cost expenditures. To analyze the direct cost associated to uncontrolled asthma patients, a cross-sectional study was conducted to determine costs related to patients with uncontrolled and controlled asthma. Uncontrolled patient was defined by daytime symptoms more than twice a week or nocturnal symptoms during two consecutive nights or any limitations of activities, or need for relief rescue medication more than twice a week, and an ACQ score less than 2 points. A questionnaire about direct cost stratification in health services, including emergency room visits, hospitalization, ambulatory visits, and asthma medications prescribed, was applied. Ninety asthma patients were enrolled (45 uncontrolled/45 controlled. Uncontrolled asthmatics accounted for higher health care expenditures than controlled patients, US$125.45 and US$15.58, respectively [emergency room visits (US$39.15 vs US$2.70 and hospitalization (US$86.30 vs US$12.88], per patient over 6 months. The costs with medications in the last month for patients with mild, moderate and severe asthma were US$1.60, 9.60, and 25.00 in the uncontrolled patients, respectively, and US$6.50, 19.00 and 49.00 in the controlled patients. In view of the small proportion of uncontrolled subjects receiving regular maintenance medication (22.2% and their lack of resources, providing free medication for uncontrolled patients might be a cost-effective strategy for the public health system.

  12. DETERMINATION OF THE HABITS OF ASTHMATIC PATIENTS ABOUT USING SUBSTANCE CONTAINING PERFUME

    Directory of Open Access Journals (Sweden)

    Ercan GOCGELDI

    2005-06-01

    Full Text Available Introduction: Air pollution, perfume, aerosol substances, odors of paint and detergent are the most important non-specific irritants stimulating the asthmatic attack. The odors of these substances exist for long time and form the serious risk for the asthmatic patients. This study was planned to determine the frequency of using perfume and substance containing perfume and the sensitivities to the substances among the asthmatic patients using inhaling steroid and b2-mimetic ant asthmatic drugs. Methods: This is a descriptive study and conducted among patients who applied to the Allergic Diseases outpatient service of Gulhane Military Medical Academia in October-December 2004. 83 asthmatic patients who accepted to participate to the study filled out a questionnaire that including patients habits relating perfume, cleaners with perfume, perfume for living room, toilets and bathrooms, and having dyspnea or not when exposed any kind of perfumes and using any b2-mimetik or not. Results: 73.5% (n=61 of participants were male, and 26.5 % (n=22 were women. Their ages were from 18 to 57 years. 79.5% (n=66 of participants expressed that they were sensitive to the odors mentioned and experienced the respiratory problems when they were at the surroundings by odour and 26.5% (n=22 of participants sometimes used the B2-mimetic antiasthmatic drugs for this reason. On the other hand; It was found that 68.7% (n=57 of participants regularly used the perfume for themselves everyday, 85.5% (n=71 of participants washed their clothings by using cleaners and/or softeners with perfume, 44.6% (n=37 of participants used the perfume for their rooms frequently, 62.7% (n=52 of participants used substance with perfume in their toilets and bathrooms. Conclusion: We conclude that the asthmatic patients have not sufficient knowledge about non-spesific irritants stimulating the asthmatic attack, and don’t behave sensitive. It’s important to plan properly the medical

  13. Microbial content of household dust associated with exhaled NO in asthmatic children

    Science.gov (United States)

    Johansson, Elisabet; Reponen, Tiina; Vesper, Stephen; Levin, Linda; Lockey, James; Ryan, Patrick; Bernstein, David I.; Villareal, Manuel; Hershey, Gurjit K. Khurana; Schaffer, Chris; LeMasters, Grace

    2013-01-01

    Exhaled nitric oxide (eNO) is increasingly used as a non-invasive measure of airway inflammation. Despite this, little information exists regarding the potential effects of indoor microbial components on eNO. We determined the influence of microbial contaminants in house dust and other indoor environmental characteristics on eNO levels in seven-year-olds with and without a physician- diagnosis of asthma. The study included 158 children recruited from a birth cohort study, and 32 were physician-diagnosed as asthmatic. The relationship between eNO levels and exposures to home dust streptomycetes, endotoxin, and molds was investigated. Streptomycetes and endotoxin were analyzed both as loads and concentrations in separate models. Dog, cat, and dust mite allergens also were evaluated. In the multivariate exposure models high streptomycetes loads and concentrations were significantly associated with a decrease in eNO levels in asthmatic (p Dust endotoxin was not significant. The relationship between eNO and indoor exposure to common outdoor molds was u-shaped. In non-asthmatic children, none of the exposure variables were significantly associated with eNO levels. To our knowledge, this is the first study demonstrating a significant association between microbial components in the indoor environment and eNO levels in asthmatic children. This study demonstrates the importance of simultaneously assessing multiple home exposures of asthmatic children to better understand opposing effects. Common components of the indoor Streptomyces community may beneficially influence airway inflammation. PMID:23807177

  14. Hypothalamic-pituitary-adrenal axis suppression in asthmatic school children.

    Science.gov (United States)

    Zöllner, Ekkehard Werner; Lombard, Carl J; Galal, Ushma; Hough, F Stephen; Irusen, Elvis M; Weinberg, Eugene

    2012-12-01

    Hypothalamic-pituitary-adrenal axis suppression (HPAS) when treating children with corticosteroids is thought to be rare. Our objective was to determine the prevalence of and predictive factors for various degrees of HPAS. Clinical features of HPAS, doses, adherence, asthma score, and lung functions were recorded in 143 asthmatic children. The overnight metyrapone test was performed if morning cortisol was >83 nmol/L. Spearman correlations coefficients (r) were calculated between 3 postmetyrapone outcomes and each continuous variable. A multiple linear regression model of √postmetyrapone adrenocorticotropic hormone (ACTH) and a logistic regression model for HPAS were developed. Hypocortisolemia was seen in 6.1% (1.8-10.5), hypothalamic-pituitary suppression (HPS) in 22.2% (14.5-29.9), adrenal suppression in 32.3% (23.7-40.9), HPAS in 16.3% (9.3-23.3), and any hypothalamic-pituitary-adrenal axis dysfunction in 65.1% (56.5-72.9). Log daily nasal steroid (NS) dose/m(2) was associated with HPAS in the logistic regression model (odds ratio = 3.7 [95% confidence interval: 1.1-13.6]). Daily inhaled corticosteroids (ICSs) + NS dose/m(2) predicted HPAS in the univariate logistic regression model (P = .038). Forced expiratory volume in 1 second/forced vital capacity HPAS (odds ratio = 4.1 [95% confidence interval: 1.0-14.8]). Daily ICS + NS/m(2) dose was correlated with the postmetyrapone ACTH (r = -0.29, P HPAS are NS use, BMI, and adherence to ICS and NS.

  15. Genetic polymorphisms of the beta-2 adrenergic receptor in Israelis with severe asthma compared to non-asthmatic Israelis.

    Science.gov (United States)

    Shachor, Joshua; Chana, Ziv; Varsano, Shabtai; Erlich, Tamar; Goldman, Elizabeth; Dror, Yigal; Yakovy, Ilana; Navon, Ruth

    2003-11-01

    It has been argued that arginine replacement in locus 16 (Arg16) of beta 2 adrenergic receptor with glycin (Gly16) increases asthma severity, while glutamin replacement in locus 27 (Gln27) with glutamic acid (Glu27) decreases it. In addition, ethnic dependency of these polymorphisms has been described, but few studies investigated its relation to asthma severity in a non-anglosaxic population. To investigate non-anglosaxic ethnic influences on beta 2AR polymorphisms and its correlations to asthma severity. Sixty-six Israeli Jewish and Arab asthmatics who had near-fatal asthma and/or severe nocturnal asthma and/or steroid-dependency were investigated for genetic polymorphisms of beta 2AR and compared to matched controls. The Jewish patients included both Ashkenazi (of European origin) and non-Ashkenazi (originating from the Middle East or North Africa). The results were compared with those of ethnically matched 113 non-asthmatic Israelis and non-asthmatic Anglo-Saxons described in the literature. We found no significant genetic differences between the asthmatics and their controls or between the various ethnic groups of our population. However, the prevalence of Glu27 was significantly lower in non-asthmatic Israelis compared to non-asthmatic Anglo-Saxons. The genetic distribution of beta 2AR polymorphisms in severe Israeli asthmatics is not different from that of non-asthmatic Israelis and therefore its clinical impact on asthma is probably minimal.

  16. Exhaled nitric oxide collected with two different mouthpieces: a study in asthmatic patients

    Directory of Open Access Journals (Sweden)

    A.S. Leme

    2002-10-01

    Full Text Available Techniques for collecting exhaled nitric oxide (ENO recommend the use of antibacterial filters of 0.3 µm. The aim of the present study was to compare the measurements of ENO obtained with two different filtering devices. Air samples from 17 asthmatic and 17 non-asthmatic subjects were collected by a recommended off-line technique using two different mouthpieces: 1 the Sievers disposable tool (A under a breathing pressure of 18 cmH2O, and 2 a mouthpiece containing a HEPA filter (B under a breathing pressure of 12 cmH2O. The nitric oxide samples were collected into an impermeable reservoir bag. Values for ENO were compared using two-way repeated measures ANOVA followed by the Tukey test. Agreement was assessed by Bland-Altman analysis. ENO values obtained with mouthpieces A and B were comparable for asthmatic (mean ± SEM, 42.9 ± 6.9 vs 43.3 ± 6.6 ppb and non-asthmatic (13.3 ± 1.3 vs 13.7 ± 1.1 ppb subjects. There was a significant difference in ENO between asthmatics and non-asthmatics using either mouthpiece A (P<0.001 or B (P<0.001. There was a positive correlation between mouthpiece A and mouthpiece B for both groups. The Bland-Altman limits of agreement were considered to be acceptable. Mouthpiece B was less expensive than A, and these data show that it can be used without compromising the result. Our data confirm reports of higher ENO values in the presence of airway inflammation.

  17. Interdisciplinary therapy improves biomarkers profile and lung function in asthmatic obese adolescents.

    Science.gov (United States)

    da Silva, Patrícia Leão; de Mello, Marco Túlio; Cheik, Nadia Carla; Sanches, Priscila Lima; Correia, Fabíola Alvise; de Piano, Aline; Corgosinho, Flávia Campos; Campos, Raquel Munhoz da Silveira; do Nascimento, Claudia M O; Oyama, Lila M; Tock, Lian; Tufik, Sérgio; Dâmaso, Ana R

    2012-01-01

    The simultaneous rise in the prevalence of asthma and obesity in the world, have demonstrated the importance of the development of treatment strategies. The purpose of this study was to evaluate the short- and long-term results of interdisciplinary therapy on inflammatory biomarkers and lung function in asthmatics obese adolescents. Seventy-six post-pubertal obese adolescents were recruited, including 50 non-asthmatics [body mass index (BMI), 36 ± 5 kg/m(2) ) and 26 asthmatics (BMI, 39 ± 4 kg/m(2) ). Body composition was measured by plethysmography, and visceral fat was analyzed by ultrasound. Serum levels of adiponectin, leptin, and C-reactive protein (CRP) were analyzed. Asthma and lung function were evaluated according to the American Thoracic Society criteria. Patients were submitted to 1-year weight loss interdisciplinary intervention consisting of medical, nutritional, exercise, and psychological therapy. After interdisciplinary intervention, the lung function and pro/anti-inflammatory adipokines improved significantly in both groups. Most importantly, there was an increase in adiponectin [4 (1.86-12.9) to 5.1 (2.48-16)], a reduction in CRP [2,073 (385-9,174) to 1,538 (205-7,083)] and leptin concentrations [59 (29-69) to 33 (9-49)] in the asthmatics patients. Furthermore, it was observed a reduction in asthma severity after treatment. In addition, Δ adiponectin was an independent factor to improve lung function after therapy in both groups. Interdisciplinary therapy resulted in beneficial changes in inflammatory biomarkers profile and lung function in asthmatic and non-asthmatic obese adolescents. Additionally, for the first time we showed that change in adiponectin level was an independent predictor to improve lung function in Brazilian obese adolescents. Copyright © 2011 Wiley Periodicals, Inc.

  18. Invasive aspergillosis in a user of inhaled cocaine: rhinosinusitis with bone and cartilage destruction

    Directory of Open Access Journals (Sweden)

    Luna Azulay-Abulafia

    2014-07-01

    Full Text Available Aspergillosis is an infection caused by saprophytic fungi of the genus Aspergillus, which typically occurs in immunosuppressed individuals, but has also been reported in immunocompetent patients. The main routes of entry are the respiratory tract, skin, cornea, and ear, and the infection may be localized or disseminated by contiguity or vascular invasion. We report a severe case of rhinosinusitis with cutaneous involvement, caused by invasive aspergillosis, in an immunocompetent user of inhaled cocaine. Invasive aspergillosis related to cocaine abuse has not yet been reported in the literature. After itraconazole treatment and surgical debridement, complete clinical remission was achieved. Nasal reconstruction with a skin graft over a silicone prosthesis resulted in a satisfactory esthetic outcome.

  19. Antibiotic prescriptions for outpatient acute rhinosinusitis in Canada, 2007-2013.

    Science.gov (United States)

    Sharma, Prateek; Finley, Rita; Weese, Scott; Glass-Kaastra, Shiona; McIsaac, Warren

    2017-01-01

    Acute rhinosinusitis (ARS) is a respiratory disease commonly caused by viral infections. Physicians regularly prescribe antibiotics despite bacterial etiologies being uncommon. This is of concern, as this use adds to the selection pressure for resistance. Here we present the descriptive epidemiology of acute rhinosinusitis and corresponding antibiotic prescribing practices by Canadian outpatient physicians from 2007-2013. Diagnosis and antibiotic prescription data for ARS were extracted from the Canadian Disease and Therapeutic Index for 2007 to 2013, and population data were acquired from Statistics Canada. ARS diagnosis and antibiotic prescription rates and frequencies of antibiotic classes were calculated. Eighty-eight percent of patients diagnosed with ARS in 2013 were adults, with a greater rate of antibiotic prescriptions observed among the adults relative to the pediatric patients (1632.9 and 468.6 antibiotic prescriptions per 10,000 inhabitants). Between 2007 and 2013, the ARS diagnosis rate decreased from 596 to 464 diagnoses per 10,000 inhabitants, while the percentage of diagnoses with antibiotic prescriptions at the national level remained stable (87% to 84%). From 2007 to 2013, prescription rates for macrolides decreased from 203.5 to 105.4 prescriptions per 10,000 inhabitants. In 2013, penicillins with extended spectrum were more commonly prescribed compared to macrolides among adult patients (153.5 and 105.4 prescriptions per 10,000 inhabitants, respectively). This study is the first to describe physician antibiotic prescribing practices for treatment of ARS in Canada. Results show that antibiotic treatment for ARS represents an area for implementing antimicrobial stewardship, and through it, managing antibiotic resistance. Further work is required to better understand diagnosing practices and treatment criteria for ARS, and use this information to further assist physicians to limit unnecessary antibiotic prescribing practices.

  20. Sputum RNA signature in allergic asthmatics following allergen bronchoprovocation test

    Directory of Open Access Journals (Sweden)

    Rob G.J.A. Zuiker

    2016-07-01

    correlated significantly with lung function and sputum eosinophil counts. Conclusion: Our RNA extraction and profiling protocols allowed reproducible assessments of inflammatory signatures in sputum including quantification of drug effects on this response in allergic asthmatics. This approach offers novel possibilities for the development of pharmacodynamic (PD biomarkers in asthma.

  1. Prevalence of secondhand smoke exposure in asthmatic children at home and in the car: A cross-sectional study.

    Science.gov (United States)

    Antunes, H; Precioso, J; Araújo, A C; Machado, J C; Samorinha, C; Rocha, V; Gaspar, Â; Becoña, E; Belo-Ravara, S; Vitória, P; Rosas, M; Fernandez, E

    2016-01-01

    To compare secondhand smoke exposure (SHSe) prevalence at home and inside the car between asthmatic and non-asthmatic Portuguese children. This is a cross-sectional study that assessed children's SHSe in a representative sample of nine Portuguese cities. A validated self-reported questionnaire was administered to a random sample of 4th grade students during the school year of 2010/2011. The asthma prevalence was defined by the answers to three questions regarding asthma symptoms, medication and inhaler use. We performed chi-square tests and analysed frequencies, contingency tables, confidence intervals, and odd-ratios. The self-reported questionnaire was administered to 3187 students. Asthma prevalence was 14.8% (472 students). Results showed that 32.3% of non-asthmatic children and 32.4% of asthmatic children were exposed to secondhand smoke as at least one of their household members smoked at home. The prevalence of parental smoking, smoking among fathers and smoking among mothers at home was also similar in both groups (asthmatic and non-asthmatic children). SHSe inside the car was 18.6% among non-asthmatic children and 17.9% among asthmatic children. Asthmatic and non-asthmatic children were equally exposed to secondhand smoke, because no significant differences were found between the two groups concerning the prevalence of SHSe at home and inside the car. These findings highlight the need to include SHSe brief advice in paediatric asthma management. Copyright © 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  2. Prevalence of secondhand smoke exposure in asthmatic children at home and in the car: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    H. Antunes

    2016-07-01

    Full Text Available Objective: To compare secondhand smoke exposure (SHSe prevalence at home and inside the car between asthmatic and non-asthmatic Portuguese children. Materials and methods: This is a cross-sectional study that assessed children's SHSe in a representative sample of nine Portuguese cities. A validated self-reported questionnaire was administered to a random sample of 4th grade students during the school year of 2010/2011. The asthma prevalence was defined by the answers to three questions regarding asthma symptoms, medication and inhaler use. We performed chi-square tests and analysed frequencies, contingency tables, confidence intervals, and odd-ratios. Results: The self-reported questionnaire was administered to 3187 students. Asthma prevalence was 14.8% (472 students. Results showed that 32.3% of non-asthmatic children and 32.4% of asthmatic children were exposed to secondhand smoke as at least one of their household members smoked at home. The prevalence of parental smoking, smoking among fathers and smoking among mothers at home was also similar in both groups (asthmatic and non-asthmatic children. SHSe inside the car was 18.6% among non-asthmatic children and 17.9% among asthmatic children. Conclusions: Asthmatic and non-asthmatic children were equally exposed to secondhand smoke, because no significant differences were found between the two groups concerning the prevalence of SHSe at home and inside the car. These findings highlight the need to include SHSe brief advice in paediatric asthma management. Keywords: Secondhand smoke, Children, Asthma

  3. Preclinical evaluation of Luffa operculata Cogn. and its main active principle in the treatment of bacterial rhinosinusitis.

    Science.gov (United States)

    Silva, Leonardo; Costa, Henrique Olival; Souza, Flávia Coelho de; Lopes, Elaine Monteiro Cardoso; Ueda, Suely Mitoi Ykko

    2016-12-26

    The prevalence of rhinosinusitis is quite high. Despite the widespread use of antibiotics for rhinosinusitis, there are other forms of treatment, including phytotherapy. One of the most widely used herbal medicines for treatment of rhinosinusitis is Luffa operculata. This study aimed to evaluate the efficacy of topical nasal solution of the aqueous extract of L. operculata, determining the toxicity to its use and identifying the active principles presented in the aqueous extract. The secondary objective was to evaluate the action of active principles on bacteria commonly involved in acute rhino sinusitis. The study was conducted in experimental model of sinusitis. Three different concentrations of L. operculata were used as local treatment of rhino sinusitis. The results were compared with those observed in control groups that received nasal saline solution. Histological examination of the liver, kidney, spleen, myocardium, brain and lungs of all animals evaluated the toxicity of L. operculata. The aqueous extract used was subjected to chromatographic analysis and an active principle was isolated and tested for in vitro inhibition of bacterial colonies usually found in rhino sinusitis. Intranasal treatment of sinusitis with L. operculata showed better clinical evolution than control group. Statistically significant difference (p>0.10) between the treated group and the control group was observed in the histologic evaluation for inflammatory pattern. The aqueous extract of L. operculata used presented a predominance of 2,3-dicafeoilglicaric acid, a substance not yet described in the literature. There was a significant difference in bacterial growth of Streptococcus pyogenes on blood-agar plates when under the influence of both the aqueous extract and the active substance. Topical nasal solution of the aqueous extract of L. operculata is effective compared to the application of saline solution for the treatment of bacterial rhinosinusitis in an experimental model. L

  4. Quantification of metoprolol beta 2-adrenoceptor antagonism in asthmatic patients by pharmacokinetic-pharmacodynamic modelling

    NARCIS (Netherlands)

    Braat, M. C.; Jonkers, R. E.; van Boxtel, C. J.

    1992-01-01

    An integrated pharmacokinetic-pharmacodynamic model was used to quantify the beta 2-blocking activity of metoprolol in seven asthmatic patients. The patients received a subcutaneous dose of terbutaline on two consecutive days. On day 1 they were pretreated with placebo and on day 2 with metoprolol

  5. Asthmatic airways obstruction assessment based on detailed analysis of respiratory sound spectra

    NARCIS (Netherlands)

    Oud, M.; Dooijes, E. H.; van der Zee, J. S.

    2000-01-01

    This paper concerns the analysis of adventitious sounds produced by individual asthmatic patients, and relates the sounds to the degree of airways obstruction at the moment of sound recording. In this study, airways obstruction is represented by a parameter commonly used in clinical tests, the

  6. Bronchial Asthma in Sokoto: A Study of 128 Adult Asthmatic Patients ...

    African Journals Online (AJOL)

    128 adult asthmatics, made up of 62 males and 66 females were seen at Usmanu Danfodiyo University Teaching Hospital, Sokoto between the 1st of January 1993 and 31 st of December 1998. The mean age of presentation for the males was 34.8 years while for the females it was 28.2 years. Those between the age of 20 ...

  7. Uncoordinated production of Laminin-5 chains in airways epithelium of allergic asthmatics

    Directory of Open Access Journals (Sweden)

    Virtanen Ismo

    2005-09-01

    Full Text Available Abstract Background Laminins are a group of proteins largely responsible for the anchorage of cells to basement membranes. We hypothesized that altered Laminin chain production in the bronchial mucosa might explain the phenomenon of epithelial cell shedding in asthma. The aim was to characterize the presence of Laminin chains in the SEBM and epithelium in allergic and non-allergic asthmatics. Patients and methods Biopsies were taken from the bronchi of 11 patients with allergic and 9 patients with non-allergic asthma and from 7 controls and stained with antibodies against the Laminin (ln chains alpha1-alpha5, beta1-beta2 and gamma1-gamma2. Results Lns-2,-5 and -10 were the main Laminins of SEBM. The layer of ln-10 was thicker in the two asthmatic groups while an increased thickness of lns-2 and -5 was only seen in allergic asthmatics. The ln gamma2-chain, which is only found in ln 5, was exclusively expressed in epithelial cells in association with epithelial injury and in the columnar epithelium of allergic asthmatics. Conclusion The uncoordinated production of chains of ln-5 in allergic asthma could have a bearing on the poor epithelial cell anchorage in these patients.

  8. House dust mite exposure in asthmatic and healthy children : The difference is carpeting

    NARCIS (Netherlands)

    vanderHeide, S; Postma, DS; deReus, DM; Koeter, GH; vanAalderen, WMC; Meijer, G.

    1995-01-01

    Aim - To determine whether house dust mite (HDM) exposure in living rooms and bedrooms is higher in asthmatic children than in those of age and sex matched healthy children, living in the same area. Methods - Types of floor-coverings were recorded and dust samples were collected by vacuum cleaning

  9. House dust mite exposure in asthmatic and healthy children: the difference is carpeting

    NARCIS (Netherlands)

    Meijer, G. G.; van der Heide, S.; Postma, D. S.; de Reus, D. M.; Koëter, G. H.; van Aalderen, W. M.

    1995-01-01

    To determine whether house dust mite (HDM) exposure in living rooms and bedrooms is higher in asthmatic children than in those of age and sex matched healthy children, living in the same area. Types of floor-coverings were recorded and dust samples were collected by vacuum cleaning the total area of

  10. FINE PARTICLE MATTER ASSOCIATED WITH AIRWAY NEUTROPHILIA IN A SUBPOPULATION OF ADULT ASTHMATICS

    Science.gov (United States)

    Asthmatic adults are a heterogeneous group that is sensitive to the mass concentration of ambient particulate matter (PM). However, it is not clear which components of PM are responsible for these effects, nor are the mechanisms understood. We evaluated whether increases in ambi...

  11. Adolescent asthmatics' needs and preferences regarding medication counseling: results from online focus groups.

    NARCIS (Netherlands)

    Koster, E.S.; Philbert, D.; Dijk, L. van; Vries, T.W. de; Bouvy, M.L.

    2014-01-01

    Background: In adolescents, non-adherence is a major problem and leads to uncontrolled disease. Objectives: To assess adolescents needs and preferences regarding counseling and support with focus on use of new media. Methods: Asthmatic adolescents needs and preferences were examined by means of

  12. Effects of Ramadan Fasting on Spirometric Values and Clinical Symptoms in Asthmatic Patients

    Directory of Open Access Journals (Sweden)

    Abdolreza Norouzy

    2013-07-01

    Full Text Available Introduction: Ramadan is the 9th Islamic lunar month during which Muslims avoid eating and drinking from sunrise to sunset. The effect of Ramadan intermittent fasting on asthma control is controversial. The aim of this study was to investigate the effects of Ramadan fasting on the spirometric variables and clinical symptoms on well-controlled asthmatic patients during Ramadan. Material and Methods: a cohort study was conducted in Mashhad, Khorasan Razavi, Iran. Twenty-nine (19 females and 10 males well-controlled asthmatic patients aged 47 (12 years completed the study. The average duration of fasting was 26.5 days. Assessment of spirometric variables (daily peak expiratory flow, peak expiratory flow variability, peak expiratory flow home monitoring as well as asthma clinical symptoms including dyspnea, cough, wheezing, and chest tightness were carried out. Results: No significant changes in clinical symptoms were reported in asthmatic patients at the end of Ramadan fasting. Among spirometric variables, only peak expiratory flow improved after Ramadan (p <0.05. There was a reduction in the mean peak expiratory flow variability from 13% at the first week of fasting to 10% at the fourth week (p <0.05. Conclusion: In well-controlled asthmatic patients, Ramadan fasting resulted in improvement in peak expiratory flow and peak expiratory flow variability.

  13. Effect of inhaled dust mite allergen on regional particle deposition and mucociliary clearance in allergic asthmatics**

    Science.gov (United States)

    Background Acute exacerbations in allergic asthmatics may lead to impaired ability to clear mucus from the airways, a key factor in asthma morbidity. Objective The purpose of this study was to determine the effect of inhaled house dust mite challenge on the regional deposition of...

  14. The effect of inhaled fluticasone propionate in the treatment of young asthmatic children

    DEFF Research Database (Denmark)

    Bisgaard, H; Gillies, J; Groenewald, M

    1999-01-01

    The response in asthmatic young children to inhaled steroids within the usual pediatric dose range is unknown. We therefore evaluated the dose-related response in young children with moderate asthma to inhaled fluticasone propionate (FP) (delivered via the Babyhaler spacer device) within the pedi...

  15. Effects of exercise rehab on male asthmatic patients: Aerobic verses rebound training

    Directory of Open Access Journals (Sweden)

    Vahid Zolaktaf

    2013-01-01

    Conclusions: Regular exercise strengthens the respiratory muscles and improves the cellular respiration. At the same time, it improves the muscular, respiratory, and cardio-vascular systems. Effects of rebound exercise seem to be promising. Findings suggest that rebound exercise is a useful complementary means for asthmatic male patients.

  16. Treatment of nocturnal airway obstruction improves daytime cognitive performance in asthmatics

    NARCIS (Netherlands)

    Weersink, EJM; vanZomeren, EH; Koeter, GH; Postma, DS

    1997-01-01

    It has been shown that asthmatics have nocturnal symptoms associated with impaired cognitive performance. We explored more carefully different therapeutic approaches on this performance in relation to lung function in 46 atopics with mild to moderate asthma and with a circadian variation in peak

  17. Hookah Smoking and Harm Perception among Asthmatic Adolescents: Findings from the Florida Youth Tobacco Survey

    Science.gov (United States)

    Martinasek, Mary P.; Gibson-Young, Linda; Forrest, Jamie

    2014-01-01

    Background: Hookah tobacco smoking has increased in prevalence among Florida adolescents and is often viewed as a safer alternative to cigarette smoking by young adults. Asthmatic adolescents are at increased risk of the negative health effects of hookah smoking. The purpose of this study is to examine if hookah use and harm perception vary by…

  18. [A survey of perioperative asthmatic attack among patients with bronchial asthma underwent general anesthesia].

    Science.gov (United States)

    Ie, Kenya; Yoshizawa, Atsuto; Hirano, Satoru; Izumi, Sinyuu; Hojo, Masaaki; Sugiyama, Haruhito; Kobayasi, Nobuyuki; Kudou, Kouichirou; Maehara, Yasuhiro; Kawachi, Masaharu; Miyakoshi, Kouichi

    2010-07-01

    We investigated the risk factor of perioperative asthmatic attack and effectiveness of preventing treatment for asthmatic attack before operation. We performed retrospective chart review of one hundred eleven patients with asthma underwent general anesthesia and surgical intervention from January 2006 to October 2007 in our hospital. The rate of perioperative asthmatic attack were as follows; 10.2% (5 in 49 cases) in no pretreatment group, 7.5% (3 in 40 cases) in any pretreatments except for systemic steroid, and 4.5% (1 in 22 cases) in systemic steroid pretreatment group. Neither preoperative asthma severity nor duration from the last attack had significant relevancy to perioperative attack rate. The otolaryngological surgery, especially those have nasal polyp and oral surgery had high perioperative asthma attack rate, although there was no significant difference. We recommend the systemic steroid pretreatment for asthmatic patients, especially when they have known risk factor such as administration of the systemic steroid within 6 months, or possibly new risk factor such as nasal polyp, otolaryngological and oral surgery.

  19. The actin regulator zyxin reinforces airway smooth muscle and accumulates in airways of fatal asthmatics.

    Directory of Open Access Journals (Sweden)

    Sonia R Rosner

    Full Text Available Bronchospasm induced in non-asthmatic human subjects can be easily reversed by a deep inspiration (DI whereas bronchospasm that occurs spontaneously in asthmatic subjects cannot. This physiological effect of a DI has been attributed to the manner in which a DI causes airway smooth muscle (ASM cells to stretch, but underlying molecular mechanisms-and their failure in asthma-remain obscure. Using cells and tissues from wild type and zyxin-/- mice we report responses to a transient stretch of physiologic magnitude and duration. At the level of the cytoskeleton, zyxin facilitated repair at sites of stress fiber fragmentation. At the level of the isolated ASM cell, zyxin facilitated recovery of contractile force. Finally, at the level of the small airway embedded with a precision cut lung slice, zyxin slowed airway dilation. Thus, at each level zyxin stabilized ASM structure and contractile properties at current muscle length. Furthermore, when we examined tissue samples from humans who died as the result of an asthma attack, we found increased accumulation of zyxin compared with non-asthmatics and asthmatics who died of other causes. Together, these data suggest a biophysical role for zyxin in fatal asthma.

  20. Safety and efficacy of tiotropium in children aged 1-5 years with persistent asthmatic symptoms

    DEFF Research Database (Denmark)

    Vrijlandt, Elianne J L E; El Azzi, Georges; Vandewalker, Mark

    2018-01-01

    BACKGROUND: Few studies have assessed the safety and efficacy of potential asthma medications in children younger than 5 years. We descriptively assessed the safety and efficacy of tiotropium, a long-acting anticholinergic drug, in children aged 1-5 years with persistent asthmatic symptoms. METHO...... are needed to further assess the safety and efficacy of tiotropium in young children. FUNDING: Boehringer Ingelheim....

  1. Endothelin-1 As A Biochemical Marker in Asthmatic Children Using Induced Sputum Method

    International Nuclear Information System (INIS)

    Noureldin, A.M.; Ahmed, A.M.; Ayad, S.K.

    2004-01-01

    Endothelin-1 is a physiological normal potent bronchoconstrictor peptide produced in the respiratory airways and increase excessively their inflammation. Endothelin-1 (Et-1) level was measured by radioimmunoassay (RIA) in saliva, sputum and plasma of thirty children suffering from mild to moderate asthma with age ranged from 6-12 years. Ten healthy children of matching age and sex were used as control group. The patients were further classified according to previous regular treatment into 21 steroid dependent and 9 non-steroid dependent. The results revealed that the saliva, sputum and plasma levels of ET-1 in asthmatic patients were significantly higher than that of control children. In both control and asthmatic children, ET-1 levels were more pronounced in the order of saliva>sputum>plasma. On the other hand, the saliva, sputum and plasma levels of ET-1 were significantly lower in steroid dependent asthmatic children than that of the non-steroid dependent ones. High levels of ET-1 in mild to moderate asthmatic children clarify the implication of this biochemical mediator marker in the pathology of the disease. The regular inhaled steroid therapy reduced the level of this mediator but did not return to the basal levels of controls, so, ET-1 antagonist may be useful in management of bronchial asthma in children. Moreover, ET-1 in sputum was more valuable biochemical indicator to monitor airway inflammation than in plasma

  2. Cardiorespiratory fitness of asthmatic children and validation of predicted aerobic capacity

    DEFF Research Database (Denmark)

    Lochte, Lene; Angermann, Marie; Larsson, Benny

    2009-01-01

    INTRODUCTION: Predicted aerobic capacity (PAC) was estimated by submaximal exercise test and compared with monitored aerobic capacity (MAC) measured by laboratory conditions [maximal oxygen uptake (VO(2peak))] in 18 children and adolescents, 10 asthmatics and 8 matched controls. Objectives...... warrant exploration by large-scale paediatric asthma epidemiology....

  3. L-Arginine deficiency causes airway hyperresponsiveness after the late asthmatic reaction

    NARCIS (Netherlands)

    Maarsingh, H.; Bossenga, B. E.; Bos, I. S. T.; Volders, H. H.; Zaagsma, J.; Meurs, H.

    Peroxynitrite has been shown to be crucially involved in airway hyperresponsiveness (AHR) after the late asthmatic reaction (LAR). Peroxynitrite production may result from simultaneous synthesis of nitric oxide (NO) and superoxide by inducible NO-synthase (iNOS) at low L-arginine concentrations.

  4. Clinical effects of air cleaners in homes of asthmatic children sensitized to pet allergens

    NARCIS (Netherlands)

    van der Heide, S; van Aalderen, WMC; Kauffman, HF; Dubois, AEJ; de Monchy, JGR

    Background: Exposure to cat and dog allergens is very common in the Western World and is a serious cause of asthma in sensitized subjects. Objective: We sought to study the clinical effects of air cleaners in living rooms and bedrooms of asthmatic children sensitized to cat or dog allergens.

  5. [Allergenic and antigenic activities of the osmophilic fungus Wallemia sebi asthmatic patients].

    Science.gov (United States)

    Sakamoto, T; Torii, S; Yamada, M; Urisu, A; Iguchi, H; Ueda, M; Matsuda, Y

    1989-04-01

    Recently large amounts of Wallemia sebi, a species of osmophilic fungi, have been detected in house dust by low water activity media. The allergenic activity of W. sebi was examined by skin prick tests and radioallergosorbent tests (RAST) in 74 asthmatic patients (mean age 11.7, range 6-32). Aspergillus fumigatus and house dust were used for comparison. In the skin prick tests, W. sebi extract, A. fumigatus extract and house dust extract elicited positive reactions in 4 (5.4%), 4 (5.4%) and 51 (68.9%) patients, respectively. RAST showed positive results in 14 subjects (18.9%) for W. sebi extract, in 8 (10.8%) for A. fumigatus extract and in 59 (79.7%) for house dust extract. These results indicated that some asthmatic individuals showed immediate type hypersensitivity to W. sebi, which means this fungal species may be important as a causative agent in atopic diseases. Additionally, the authors measured W. sebi-specific IgG by enzyme-linked immunosorbent assay in asthmatic (n = 28) and non-atopic patients (n = 28). W. sebi-specific IgG was found in sera from all subjects in each group. W. sebi-specific IgG in asthmatics (mean +/- SD = 0.686 +/- 0.160) was significantly higher than that in non-atopics (mean +/- SD = 0.572 +/- 0.188) (p less than 0.01).

  6. NO in exhaled air of asthmatic children is reduced by the leukotriene receptor antagonist montelukast

    DEFF Research Database (Denmark)

    Bisgaard, H; Loland, L; Oj, J A

    1999-01-01

    Nitric oxide in exhaled air (FENO) is increased in asthmatic children, probably reflecting aspects of airway inflammation. We have studied the effect of the leukotriene receptor antagonist (LTRA) montelukast on FENO with a view to elucidate potential anti-inflammatory properties of LTRAs. Twenty-...

  7. Air trapping on HRCT in asthmatics: correlation with pulmonary function test

    International Nuclear Information System (INIS)

    Hwang, Jung Hwa; Cha, Chull Hee; Park, Jai Soung; Kim, Young Beom; Lee, Hae Kyung; Choi, Deuk Lin; Kim, Kyung Ho; Park, Choon Sik

    1997-01-01

    To evaluate on the basis of the pulmonary function test the correlation between the extent of air trapping on HRCT with the severity of airway obstruction and also to identify the prognostic effect of the extent of air trapping after treatment of asthma. Thirty five patients with clinically diagnosed bronchial asthma and air trapping, as seen on HRCT, were included in this study. We quantitatively analysed on HRCT the extent of air trapping and then statistically compared this with the clinical parameters of the pulmonary function test. We classified the patients into two groups on the basis of the pulmonary function test and clinical status : Group 1 (N=35), the total number of asthmatic patients; Group 2 (N=18), relatively stable asthmatics without acute asthmatic attack who showed FEV1 of more than 80% of the predicted value. Using the functional paramenters of PEFR, one of the obijective indicators of improvement in airway obstruction, we also classified the patients into three groups on the basis of interval between treatment and clinical improvement. The result of this was as follows : group 1, asymptomatic group (initial PEFR within normal limit, N=7); group 2, early responder (improvement of PEFR within three hospital days, N=18); group 3, late responder (improvement of PEFR within fourteen hospital days should there be a number here). Using HRCT, we then statistically analysed the differences between the three groups in the extent of air trapping. Among the total of 35 asthmatics, the extent of air trapping on HRCT showed significant correlation with FEV1 (r= -0.6161, p < 0.001) and MEFR (r= -0.6012, p < 0.001). Among the relatively stable asthmatics who showed FEV1 more than 80% of the predicted value, MEFR (r= -0.7553, p < 0.001) and FEF75 (r= -0.7529, p=0.012) showed statistically significant correlation with the extent of air trapping on HRCT, but there was no significant correlation between air trapping on HRCT and FEV1. In the three groups of

  8. Modulation Of Immune Response In Asthmatic Patients By Using ...

    African Journals Online (AJOL)

    Bronchial asthma is a chronic immuno inflammatory reversible lung disease with airway responsiveness to various stimuli which relived by proper therapy using inhaled steroids or the highly expensive recombinant interferon gamma (IFN- ). This study undertaken to investigate for the first time a novel treatment method ...

  9. Socio-demographic and clinical characteristics of asthmatic children ...

    African Journals Online (AJOL)

    Introduction: Asthma is a chronic inflammatory disorder associated with variable air flow obstruction and bronchial hyperresponsiveness. It is characterised clinically by recurrent episodes of cough, difficulty in breathing and wheezing which resolves spontaneously or with treatment. The socio-demographic and clinical ...

  10. Asthmatic airway smooth muscle CXCL10 production: mitogen-activated protein kinase JNK involvement

    Science.gov (United States)

    Alrashdan, Yazan A.; Alkhouri, Hatem; Chen, Emily; Lalor, Daniel J.; Poniris, Maree; Henness, Sheridan; Brightling, Christopher E.; Burgess, Janette K.; Armour, Carol L.; Ammit, Alaina J.

    2012-01-01

    CXCL10 (IP10) is involved in mast cell migration to airway smooth muscle (ASM) bundles in asthma. We aimed to investigate the role of cytokine-induced MAPK activation in CXCL10 production by ASM cells from people with and without asthma. Confluent growth-arrested ASM cells were treated with inhibitors of the MAPKs ERK, p38, and JNK and transcription factor NF-κB, or vehicle, and stimulated with IL-1β, TNF-α, or IFN-γ, alone or combined (cytomix). CXCL10 mRNA and protein, JNK, NF-κB p65 phosphorylation, and Iκ-Bα protein degradation were assessed using real-time PCR, ELISA, and immunoblotting, respectively. Cytomix, IL-1β, and TNF-α induced CXCL10 mRNA expression more rapidly in asthmatic than nonasthmatic ASM cells. IL-1β and/or TNF-α combined with IFN-γ synergistically increased asthmatic ASM cell CXCL10 release. Inhibitor effects were similar in asthmatic and nonasthmatic cells, but cytomix-induced release was least affected, with only JNK and NF-κB inhibitors halving it. Notably, JNK phosphorylation was markedly less in asthmatic compared with nonasthmatic cells. However, in both, the JNK inhibitor SP600125 reduced JNK phosphorylation and CXCL10 mRNA levels but did not affect CXCL10 mRNA stability or Iκ-Bα degradation. Together, the JNK and NF-κB inhibitors completely inhibited their CXCL10 release. We concluded that, in asthmatic compared with nonasthmatic ASM cells, JNK activation was reduced and CXCL10 gene expression was more rapid following cytomix stimulation. However, in both, JNK activation did not regulate early events leading to NF-κB activation. Thus JNK and NF-κB provide independent therapeutic targets for limiting CXCL10 production and mast cell migration to the ASM in asthma. PMID:22387292

  11. Cigarette smoke causes caspase-independent apoptosis of bronchial epithelial cells from asthmatic donors.

    Directory of Open Access Journals (Sweden)

    Fabio Bucchieri

    Full Text Available Epidemiologic studies have demonstrated important links between air pollution and asthma. Amongst these pollutants, environmental cigarette smoke is a risk factor both for asthma pathogenesis and exacerbation. As the barrier to the inhaled environment, the bronchial epithelium is a key structure that is exposed to cigarette smoke.Since primary bronchial epithelial cells (PBECs from asthmatic donors are more susceptible to oxidant-induced apoptosis, we hypothesized that they would be susceptible to cigarette smoke-induced cell death.PBECs from normal and asthmatic donors were exposed to cigarette smoke extract (CSE; cell survival and apoptosis were assessed by fluorescence-activated cell sorting, and protective effects of antioxidants evaluated. The mechanism of cell death was evaluated using caspase inhibitors and immunofluorescent staining for apoptosis-inducing factor (AIF.Exposure of PBEC cultures to CSE resulted in a dose-dependent increase in cell death. At 20% CSE, PBECs from asthmatic donors exhibited significantly more apoptosis than cells from non-asthmatic controls. Reduced glutathione (GSH, but not ascorbic acid (AA, protected against CSE-induced apoptosis. To investigate mechanisms of CSE-induced apoptosis, caspase-3 or -9 inhibitors were tested, but these failed to prevent apoptosis; in contrast, CSE promoted nuclear translocation of AIF from the mitochondria. GSH reduced the number of nuclear-AIF positive cells whereas AA was ineffective.Our results show that PBECs from asthmatic donors are more susceptible to CSE-induced apoptosis. This response involves AIF, which has been implicated in DNA damage and ROS-mediated cell-death. Epithelial susceptibility to CSE may contribute to the impact of environmental tobacco smoke in asthma.

  12. Regulatory T cells in induced sputum of asthmatic children: association with inflammatory cytokines

    Directory of Open Access Journals (Sweden)

    Hamzaoui Agnès

    2010-02-01

    Full Text Available Abstract Background and objective CD4+CD25+ regulatory T (Treg cells play an essential role in maintaining immune homeostasis. In this study, we investigated whether the induced sputum (IS pool and the function of CD4+CD25+ Treg cells are altered in asthma pediatric patients. Methods Treg activity was studied in the IS of 40 asthmatic children. CD3+ cells were analyzed for the expression of FoxP3 mRNA by real time reverse transcription-polymerase chain reaction (RT-PCR. IS cells from asthmatics and controls were stained for Treg markers and analyzed by flow cytometry. We also studied the ability of Treg cells to differentiate monocytes toward alternatively activated macrophages (AAM, and to suppress proinflammatory cytokines. Results (i Mild and moderate asthmatics had significantly decreased expression of FoxP3/β-actin mRNA and decreased proportions of CD4+CD25highFoxP3+ cells compared to healthy children; (ii patients with moderate asthma had even lower proportions of FoxP3 expression compared to mild asthmatic patients; (iii monocytes cultured with Treg cells displayed typical features of AAM, including up-regulated expression of CD206 (macrophage mannose receptor and CD163 (hemoglobin scavenger receptor, and an increased production of chemokine ligand 18 (CCL18. In addition, Treg cells from asthmatics have a reduced capacity to suppress LPS-proinflammatory cytokine production from monocytes/macrophages (IL-1, IL-6 and TNF-α. Conclusion Asthma pediatric patients display a decreased bronchial Treg population. The impaired bronchial Treg activity is associated with disease severity.

  13. The value of herbal medicines in the treatment of acute non-purulent rhinosinusitis. Results of a double-blind, randomised, controlled trial.

    Science.gov (United States)

    Tesche, Stefan; Metternich, Frank; Sonnemann, Uwe; Engelke, Jan-Christian; Dethlefsen, Uwe

    2008-11-01

    In a prospective, randomised, double-blinded controlled study, we compared the efficacy and safety of two different treatment options with the herbal medicines cineole and a combination of five different components for acute viral rhinosinusitis. One hundred and fifty patients with acute and viral rhinosinusitis (75 patients in each treatment group) were enrolled. The diagnosis rhinosinusitis was made according to a defined symptoms-sum-score which was based on rhinoscopic and clinical signs which are characteristic for rhinosinusitis. The primary endpoint was the amelioration of the symptoms-sum-score, which includes all relevant characteristics for rhinosinusitis as headache on bending, frontal headache, sensitivity of pressure points of trigeminal nerve, impairment of general condition, nasal obstruction, rhino-secretion, secretion quantity, secretion viscosity and fever in a treatment period of 7 days. The mean reduction of the symptoms-sum-score after 4 days was 6.7 (+/-3.4) and after 7 days 11.0 (+/-3.3) in the cineole group and 3.6 (+/-2.8) after 4 days and 8.0 (+/-3.0) after 7 days in the control group. The differences between both groups were clinically relevant and statistically significant after 4 and 7 days (P cineole is clinically relevant and statistically significant, more effective in comparison to the alternative herbal preparation with five different components.

  14. Oral health status in preschool asthmatic children in Iran.

    OpenAIRE

    Sara Ehsani; Mostafa Moin; Ghasem Meighani; Seyed Jalal Pourhashemi; Hadi Khayatpisheh; Nazli Yarahmadi

    2013-01-01

    Asthma is a chronic inflammatory disorder of the airways, which is diagnosed by periodic symptoms of inflammation, bronchial spasm, and increased mucosal secretions. It has higher incidence among the preschool children. There are many contradictory reports based on the effect of asthma on oral health, however it has been hypothesized that asthma could lead to poor oral health. The objective of the present study was to investigate oral health indices in 44 preschool children of three to six ye...

  15. Impaired glucose metabolism and bronchial hyperresponsiveness in obese prepubertal asthmatic children.

    Science.gov (United States)

    Karampatakis, Nikolaos; Karampatakis, Theodoros; Galli-Tsinopoulou, Assimina; Kotanidou, Eleni P; Tsergouli, Katerina; Eboriadou-Petikopoulou, Maria; Haidopoulou, Katerina

    2017-02-01

    The prevalence of asthma and obesity has risen in parallel over the last decades, but the exact mechanisms linking these two diseases still remain unclear. The aim of the present study was to investigate the associations between bronchial hyperresponsiveness (BHR), impaired glucose metabolism, obesity, and asthma in prepubertal children. A total of 71 prepubertal children were included in the study and divided in four groups according to the presence of asthma and their Body Mass Index (BMI): Group 1-Healthy Controls (HC), Group 2-Non Obese Asthmatics (NOA), Group 3-Obese Non Asthmatics (ONA), Group 4-Obese Asthmatics (OA) Αll children underwent spirometry and bronchial hyperresponsiveness testing by using the cumulative Provoking Dose of mannitol (PD 15, primary study variable); homeostasis model assessment-estimated insulin resistance (HOMA-IR) index was calculated in order to evaluate insulin resistance. Obese children also underwent an oral glucose tolerance testing (OGTT). A statistically significant difference in bronchial hyperreactivity (mean ± SD) was detected in the group of obese asthmatic children who had lower values ​​of PD 15 , (174.16 ± 126.42) as compared to normal weight asthmatic children (453.93 ± 110.27), (P HOMA-IR ≥2.5), had significantly lower PD 15 values (89.05 ± 42.75) as ​​compared to those with HOMA-IR <2.5 (259.27 ± 125.75), (P = 0.006). Finally, obese asthmatic children with impaired OGTT had likewise significantly lower PD 15 (81.02 ± 42.16) measurements as compared to children with normal OGTT (267.3 ± 112.62), (P = 0.001). Our findings suggest that obesity per se does not correlate to airway hyperreactivity unless it is accompanied by glucose intolerance and insulin resistance. Pediatr Pulmonol. 2017;52:160-166. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  16. Relationship of Circulating Hyaluronic Acid Levels to Disease Control in Asthma and Asthmatic Pregnancy

    Science.gov (United States)

    Eszes, Noémi; Toldi, Gergely; Bohács, Anikó; Ivancsó, István; Müller, Veronika; Rigó Jr., János; Losonczy, György; Vásárhelyi, Barna; Tamási, Lilla

    2014-01-01

    Uncontrolled asthma is a risk factor for pregnancy-related complications. Hyaluronic acid (HA), a potential peripheral blood marker of tissue fibrosis in various diseases, promotes eosinophil survival and plays a role in asthmatic airway inflammation as well as in physiological processes necessary to maintain normal pregnancy; however the level of circulating HA in asthma and asthmatic pregnancy is unknown. We investigated HA levels in asthmatic patients (N = 52; asthmatic pregnant (AP) N = 16; asthmatic non-pregnant (ANP) N = 36) and tested their relationship to asthma control. Serum HA level was lower in AP than in ANP patients (27 [24.7–31.55] vs. 37.4 [30.1–66.55] ng/mL, p = 0.006); the difference attenuated to a trend after its adjustment for patients’ age (p = 0.056). HA levels and airway resistance were positively (r = 0.467, p = 0.004), HA levels and Asthma Control Test (ACT) total score inversely (r = −0.437, p = 0.01) associated in ANP patients; these relationships remained significant even after their adjustments for age. The potential value of HA in the determination of asthma control was analyzed using ROC analysis which revealed that HA values discriminate patients with ACT total score ≥20 (controlled patients) and <20 (uncontrolled patients) with a 0.826 efficacy (AUC, 95% CI: 0.69–0.97, p = 0.001) when 37.4 ng/mL is used as cut-off value in ANP group, and with 0.78 efficacy (AUC, 95% CI: 0.65–0.92, p = 0.0009) in the whole asthmatic cohort. In conclusion circulating HA might be a marker of asthma control, as it correlates with airway resistance and has good sensitivity in the detection of impaired asthma control. Decrease of HA level in pregnancy may be the consequence of pregnancy induced immune tolerance. PMID:24736408

  17. The preventive effect of Brassica napus L. oil on pathophysiological changes of respiratory system in experimental asthmatic rat

    Directory of Open Access Journals (Sweden)

    Mehdi Kabiri rad

    2012-12-01

    Results: Eosinophil numbers in the submucosal layer, as well as smooth muscle layer thicknesses were significantly lower in the rat group treated with 0.75 mg/kg B. napus oil as compared with asthmatic group (p

  18. Rhinovirus infection results in stronger and more persistent genomic dysregulation: Evidence for altered innate immune response in asthmatics at baseline, early in infection, and during convalescence.

    Directory of Open Access Journals (Sweden)

    Peter W Heymann

    Full Text Available Rhinovirus (HRV is associated with the large majority of virus-induced asthma exacerbations in children and young adults, but the mechanisms remain poorly defined.Asthmatics and non-asthmatic controls were inoculated with HRV-A16, and nasal epithelial samples were obtained 7 days before, 36 hours after, and 7 days after viral inoculation. RNA was extracted and subjected to RNA-seq analysis.At baseline, 57 genes were differentially expressed between asthmatics and controls, and the asthmatics had decreased expression of viral replication inhibitors and increased expression of genes involved in inflammation. At 36 hours (before the emergence of peak symptoms, 1329 genes were significantly altered from baseline in the asthmatics compared to 62 genes in the controls. At this time point, asthmatics lacked an increase in IL-10 signaling observed in the controls. At 7 days following HRV inoculation, 222 genes were significantly dysregulated in the asthmatics, whereas only 4 genes were dysregulated among controls. At this time point, the controls but not asthmatics demonstrated upregulation of SPINK5.As judged by the magnitude and persistence of dysregulated genes, asthmatics have a substantially different host response to HRV-A16 infection compared with non-asthmatic controls. Gene expression differences illuminate biologically plausible mechanisms that contribute to a better understanding of the pathogenesis of HRV-induced asthma exacerbations.

  19. Short-term heart rate variability in asthmatic obese children: effect of exhaustive exercise and different humidity conditions.

    Science.gov (United States)

    Rezvan, K; Dabidi Roshan, V; Mahmudi, S A

    2015-11-01

    Asthmatic obese children experience changes in functional capacity and autonomic control. Previous heart rate variability (HRV) studies were based on 24-hour recordings, little research has been conducted on the short-term HRV in asthmatic obese children, primarily during physical effort indifferent environmental humidity conditions. The aim of this study was to evaluate the effect of aerobic activity on short-term HRV in asthmatic obese children under two different environmental humidity conditions. Ten obese boys with mild asthma as experimental group and 15 obese healthy boys with the same conditions were involved as a control group. Protocol included progressive and exhaustive aerobic activities on a calibrated ergometer pedal bicycle in two various environmental humidity 35±5% and 65±5%. HRV was measured by PADSY MEDSET Holter monitoring device during three phases; pre-test, mid-test and post-test. Then, short-term HRV was assessed from calculation of the mean R-R interval measured on HRV at each phases. HRV significantly decreased at mid-test and post-test among asthmatic and health children. However, the aforesaid changes were significantly higher in the asthmatic than health children following. Moreover, decrease of short-term HRV was significantly greater in the 35±5% than 65±5% environmental humidity. Our findings suggest from the autonomic standpoint, asthmatic and non-asthmatic children respond differently to exhaustive exercise induced stress. Aerobic exercise at an environment with high humidity compared with the low humidity appears to have additional benefits on short-term HRV in that it enhances the parasympathetic and autonomic modulation of the heart in asthmatic obese children.

  20. Rinitis alérgica y rinosinusitis: Una revisión necesaria Allergic rhinitis and rhinosinusitis: A necessary review

    Directory of Open Access Journals (Sweden)

    Mirta Álvarez Castelló

    2004-02-01

    Full Text Available La importancia de las enfermedades alérgicas, y entre ellas de la rinitis alérgica, así como su costo económico y de recursos humanos, tanto como su prevalencia, está fuera de toda duda. Esta entidad representa la sexta causa de enfermedad crónica en EE.UU. y tiene un gran impacto en la calidad de vida de los pacientes que la padecen. La rinitis alérgica es un desorden heterogéneo y su alta prevalencia es aún subdiagnosticada. Está caracterizada por uno o más de los siguientes síntomas: estornudos, picor nasal, secreción y congestión nasal. Muchos agentes están involucrados con esta entidad, entre ellos, pólenes, hongos, ácaros y animales domésticos. Atendiendo a que la rinitis y la sinusitis mantienen síntomas en común como la pérdida del olfato y la obstrucción y el drenaje nasal, se prefiere denominarla como rinosinusitis. Muchos estudios han identificado a la rinitis como un factor de riesgo para el asma, con una prevalencia entre 80 y 90 %. Esta revisión pretende repasar aspectos fundamentales de estas entidades como definición, etiología, clasificación, síntomas y tratamiento, y servir de guía para aquellos médicos que de una forma u otra tratan ambas afecciones con un impacto demostrado en la calidad de vida de los que las padecen.The importance of the allergic diseases and, among them, of allergic rhinits, as well as its economic cost, human resources involved and prevalence, is out of doubt. This entity represents the sixth cause of chronic disease in the United States and it has a great impact on the quality of life of those patients suffering from it. Allergic rhinits is a heterogenous disorder and its high prevalence is still underdiagnosed. It is characterized by one or more of the following symptoms that include sneezes, nasal itching, nasal secretion and congestion. Many agents are involved in this entity, among them, pollens, fungi, mites and domestic animals. Taking into account that rhinitis and

  1. Abnormalities of the airways and lung parenchyma in asthmatics: CT observations in 50 patients and inter- and intraobserver variability

    International Nuclear Information System (INIS)

    Grenier, P.; Mourey-Gerosa, I.; Benali, K.; Brauner, M.W.; Leung, A.N.; Lenoir, S..; Cordeau, M.P.; Mazoyer, B.

    1996-01-01

    The purpose of the study was to evaluate the CT abnormalities of airways and lung parenchyma in asthmatic patients and to assess inter- and intraobserver variability for these abnormalities. The CT scans of 50 asthmatic patients and 10 healthy volunteers were assessed independently by four independent chest radiologists who were masked with respect to the clinical informations. Bronchiectasis involving mostly subsegmental and destal bronchi was noted in 28.5% of the asthmatic subjects and none of the non-asthmatics. Bronchial wall thickening, small centrilobular opacities and decreased lung attenuation were observed in 82%, 21% and 31% of asthmatic patients respectively, compared with 7%, 5% and 7% of healthy subjects. The intra- and interobserver agreements for these four CT abnormalities were measured by the kappa statistic and ranged from 0.60 to 0.79 and from 0.40 to 0.64, respectively. It is concluded that asthmatic patients may exhibit bronchial wall thickening, bronchiectasis and morphological abnormalities suggestive of distal airways disease that can be assessed on CT scans with a clinically acceptable observer variability. (orig.)

  2. Differing response of asthmatics to sulfur dioxide exposure with continuous and intermittent exercise

    Energy Technology Data Exchange (ETDEWEB)

    Kehrl, H.R.; Roger, L.J.; Hazucha, M.J.; Horstman, D.H.

    1986-08-29

    Ten mild asthmatics were initially exposed in an environmental chamber (26 C, 70% RH) to clean air and 1.0 ppm sulfur dioxide while performing three sets of 10 minutes treadmill exercise (ventilation = 41 1/min) and 15 minutes rest. To evaluate the effects of the pattern and duration of exercise on the response to sulfur dioxide exposure, the subjects were then exposed to the same environmental conditions, while exercising continuously for 30 minutes. Specific airways resistance (SRaw) was measured by body plethysmography prior to exposures and after each exercise. All SRaw responses with sulfur dioxide exposure were significantly different than the clean air responses. It appears that asthmatics show an attenuated response to repetitive exercise in a 1.00 ppm sulfur dioxide atmosphere and that the response to sulfur dioxide exposure develops rapidly and is maintained during 30 minutes continuous exercise.

  3. Increased use of inhaled corticosteroids among young Danish adult asthmatics: An observational study

    DEFF Research Database (Denmark)

    Davidsen, Jesper Rømhild; Søndergaard, Jens; Hallas, Jesper

    2010-01-01

    OBJECTIVE: This population-based longitudinal study aimed to investigate trends in use of inhaled corticosteroids (ICS) and determinants of ICS use in young Danish adults with asthma. METHODS: 106 757 users, aged 18-44 years, of anti-asthmatic drugs were identified in the Danish Register of Medical...... prescriptions in 2006. CONCLUSION: Treatment with ICS among young Danish adult asthmatics has increased since 2001. This apparent improvement was associated with the introduction of fixed dose combination inhalers with ICS and inhaled long-acting beta-2-agonists. However, there is still room for improvement....... Product Statistics during 1997-2006. One year prevalences of ICS use were calculated in categories of gender, age, and annual consumption of inhaled beta-2-agonists (IBA) in defined daily doses (DDD) per year. Determinants of ICS use were estimated by logistic regression models. RESULTS: The one year...

  4. The effects of ketotifen on beta-adrenergic activity in asthmatics.

    Science.gov (United States)

    Gove, R I; Burge, P S; Stableforth, D E; Skinner, C

    1988-01-01

    In order to examine a possible mechanism of action of ketotifen in asthma, a double-blind study was undertaken to determine whether ketotifen showed any effects on the beta-adrenergic system in asthmatic patients. The effects of ketotifen 1 mg b.i.d. for one month on the changes in spirometry, plasma potassium and serum glucose nebulized salbutamol was compared with placebo. In addition the degree of inhibition caused by local salbutamol on the wheal volume due to intradermal prostaglandin E and bradykinin, was compared following ketotifen and placebo. Nebulized salbutamol produced consistent improvements in spirometry and changes in potassium and glucose levels. Local salbutamol significantly decreased the wheal volume induced by intradermal prostaglandin E and bradykinin. However, none of these salbutamol-induced effects were altered following ketotifen or placebo. Ketotifen, in the doses used, has no demonstrable effect on the beta-adrenergic system in asthmatic patients.

  5. Right ventricular function in asthmatic children determined with PW-TDI

    International Nuclear Information System (INIS)

    Wang Shaona; Song Lili; Cong Lin; Li Liping; Huang Yanxia

    2007-01-01

    Objective: To assess the right ventricular function of asthmatic children in onset period or remission period by using PW-TDI. Method: 36 children with confirmed asthma were enrolled. In tricuspid annular, the ECHO were recorded with PW-PDI pattern to obtain fight ventricular function (Sm, e-peak, Vmax for a-peak, and e/a), ICT, ET, IRT and Tei-Index. These were carried out in acute attack period and stable period. Result: Right ventficular function parameter (Sm, Vmax for e-peak, Vmax for a-peak, e/a and Tei-Index) in acute attack period were significant different compared to those in stable period (P<0.05). Conclusions: The fight ventricular function was impaired in patients with asthma in acute attack period. PW-TDI is helpful for assessing right ventricular function to asthmatic children. (authors)

  6. Eosinophilic airway inflammation in asthmatic patients is associated with an altered airway microbiome

    DEFF Research Database (Denmark)

    Sverrild, Asger; Kiilerich, Pia; Brejnrod, Asker Daniel

    2017-01-01

    of eosinophilic airway inflammation correlates with variations in the microbiome across asthmatic patients, whereas neutrophilic airway inflammation does not. This warrants further investigation on molecular pathways involved in both patients with eosinophilic and those with noneosinophilic asthma.......BACKGROUND: Asthmatic patients have higher microbiome diversity and an altered composition, with more Proteobacteria and less Bacteroidetes compared with healthy control subjects. Studies comparing airway inflammation and the airway microbiome are sparse, especially in subjects not receiving anti......-inflammatory treatment. OBJECTIVE: We sought to describe the relationship between the airway microbiome and patterns of airway inflammation in steroid-free patients with asthma and healthy control subjects. METHODS: Bronchoalveolar lavage fluid was collected from 23 steroid-free nonsmoking patients with asthma and 10...

  7. [Severe asthmatic crisis during general anesthesia in a patient with IgG4 related disease].

    Science.gov (United States)

    Moriya, Machika; Oda, Shinya; Nakane, Masaki; Kawamae, Kaneyuki

    2014-04-01

    We experienced severe asthmatic crisis during general anesthesia in a 45-year-old man with IgG4-related disease, COPD and athma undergoing removal of submandibular gland. The ventilatiory failure was caused by the stimulation of the operation, sputum, and neostigmine. His serum IgG4 level was extremely high. IgG4 related disease is a recently emerging entity characterized by a diffuse or mass forming inflammatory reaction rich in IgG4-positive plasma cells associated with fibrosclerosis and obliterative phlebitis. It is associated with an elevated serum level of IgG4 and an allergic disease. We must be careful in perioperative management of the patients with IgG4-related disease because general anesthesia can induce asthmatic crisis.

  8. Clinical Characteristics of Exacerbation-Prone Adult Asthmatics Identified by Cluster Analysis.

    Science.gov (United States)

    Kim, Mi Ae; Shin, Seung Woo; Park, Jong Sook; Uh, Soo Taek; Chang, Hun Soo; Bae, Da Jeong; Cho, You Sook; Park, Hae Sim; Yoon, Ho Joo; Choi, Byoung Whui; Kim, Yong Hoon; Park, Choon Sik

    2017-11-01

    Asthma is a heterogeneous disease characterized by various types of airway inflammation and obstruction. Therefore, it is classified into several subphenotypes, such as early-onset atopic, obese non-eosinophilic, benign, and eosinophilic asthma, using cluster analysis. A number of asthmatics frequently experience exacerbation over a long-term follow-up period, but the exacerbation-prone subphenotype has rarely been evaluated by cluster analysis. This prompted us to identify clusters reflecting asthma exacerbation. A uniform cluster analysis method was applied to 259 adult asthmatics who were regularly followed-up for over 1 year using 12 variables, selected on the basis of their contribution to asthma phenotypes. After clustering, clinical profiles and exacerbation rates during follow-up were compared among the clusters. Four subphenotypes were identified: cluster 1 was comprised of patients with early-onset atopic asthma with preserved lung function, cluster 2 late-onset non-atopic asthma with impaired lung function, cluster 3 early-onset atopic asthma with severely impaired lung function, and cluster 4 late-onset non-atopic asthma with well-preserved lung function. The patients in clusters 2 and 3 were identified as exacerbation-prone asthmatics, showing a higher risk of asthma exacerbation. Two different phenotypes of exacerbation-prone asthma were identified among Korean asthmatics using cluster analysis; both were characterized by impaired lung function, but the age at asthma onset and atopic status were different between the two. Copyright © 2017 The Korean Academy of Asthma, Allergy and Clinical Immunology · The Korean Academy of Pediatric Allergy and Respiratory Disease

  9. Information and communication technology use in asthmatic patients: a cross-sectional study in Latin America

    Directory of Open Access Journals (Sweden)

    Juan Calderón

    2017-07-01

    Full Text Available Rapid diffusion, low cost and broad availability of information and communication technologies (ICTs make them an attractive platform for managing care, communication and interventions in asthma. There is little information in Latin America about usage frequency of ICTs in asthmatic patients. The analysis undertaken consisted of an observational, cross-sectional study that aimed to identify the frequency and type of ICTs most often used by asthmatics. The Spanish version of the Michigan questionnaire was employed in five Latin American countries. Age and educational level was categorised. Logistic regression was performed among these groups concerning the frequency of ICT usage and the level of interest shown in seeking and receiving information about asthma. In total, 673 asthma patients were surveyed. The mean age was 43.44 years. Over two-thirds of the participants were female (68.4%. The most used ICT was the short message service (SMS (69.9%. SMS and E-mail are useful tools for communicating (i.e. receiving and seeking information with all asthma patients, irrespective of their age. WhatsApp (61.5% and Facebook (32.0% were rated as being the most interesting channels of communication for receiving information. Regression analysis showed that younger asthmatics and asthmatics with higher educational levels were most likely to use almost all forms of ICTs. ICTs are generally an attractive platform for managing care, communication and interventions to improve asthma care. SMS and E-mail were found to be the preferred ICT forms among users. However, social media forms such as WhatsApp and Facebook may also be appropriate for certain types of patient.

  10. Antipyretic and anti-asthmatic activities of traditional Chinese herb-pairs, Ephedra and Gypsum.

    Science.gov (United States)

    Mei, Fen; Xing, Xue-Feng; Tang, Qing-Fa; Chen, Fei-Long; Guo, Yang; Song, Shuai; Tan, Xiao-Mei; Luo, Jia-Bo

    2016-06-01

    Mahuang-Shigao herb-pair is a famous formula composed of Ephedra and Gypsum. The herb-pair is frequently used for treating cold symptoms and bronchial asthma in the clinical practice of Chinese medicine (CM). In the present study, we evaluated evidence for the benefit of combined use of Ephedra and Gypsum by analyzing the antipyretic and anti-asthmatic activities of Ephedra-Gypsum. The antipyretic effects of Ephedra-Gypsum were evaluated in yeast-induced hyperthermia test. Thirty male Wistar rats were randomly divided into 5 groups, including control group, standard aspirin group, and 3 Ephedra- Gypsum groups of different doses (6, 12, 24 g/kg). Ephedra-Gypsum extract and asprin were administered orally 6 h after the injection of yeast solution and body temperature was measured every 1 h for 8 h. The antiasthmatic effects of Ephedra-Gypsum were evaluated using an ovalbumin (OVA)-induced asthmatic rat model. Thirty-six male SD rats were randomly divided into 6 groups. Rats were alternately sensitized and OVA+Al(OH) challenged by exposure to mists of ovalbumin. Ephedra-Gypsum extracts (6, 12, 24 g/kg) or dexamethasone were administered 45 min prior to the allergen challenge for 8 days. Latent period and the weight of wet to dry ratio of lung were determined. In addition, the eosinophils in blood and white blood cell (WBC) were counted by an YZ-Hemavet Analyzer. The Ephedra-Gypsum extracts at test dose (6, 12, 24 g/kg) significantly and dose-dependently attenuated yeast-induced fever in rats. The Ephedra-Gypsum extracts also prolonged the latent period, reduced OVA-induced increases in eosinophils and WBC, and decreased the wet and dry weight ratio of the lungs in the anti-asthmatic test. These findings indicate that the Ephedra-Gypsum extract has antipyretic and anti-asthmatic properties. Hence, the results support additional scientific evidence in prescriptions.

  11. Spontaneous epidural emphysema and pneumomediastinum during an asthmatic attack in a child

    International Nuclear Information System (INIS)

    Caramella, D.; Bulleri, A.; Battolla, L.; Bartolozzi, C.; Pifferi, M.; Baldini, G.

    1997-01-01

    CT revealed the presence of epidural emphysema as an incidental finding in a 13-year-old boy in whom mild infrequent coughing during an asthmatic attack resulted in a pneumomediastinum and subcutaneous emphysema. Epidural emphysema was not associated with neurological symptoms. The CT images demonstrated the pathway of air leakage from the posterior mediastinum through the intervertebral foramina into the epidural space. Repeat CT showed spontaneous resolution of the epidural emphysema. (orig.)

  12. Spontaneous epidural emphysema and pneumomediastinum during an asthmatic attack in a child

    Energy Technology Data Exchange (ETDEWEB)

    Caramella, D.; Bulleri, A.; Battolla, L.; Bartolozzi, C. [Department of Radiology, University of Pisa, Via Roma 67, I-56 100 Pisa (Italy); Pifferi, M.; Baldini, G. [Department of Pediatrics, University of Pisa, Pisa (Italy)

    1997-12-01

    CT revealed the presence of epidural emphysema as an incidental finding in a 13-year-old boy in whom mild infrequent coughing during an asthmatic attack resulted in a pneumomediastinum and subcutaneous emphysema. Epidural emphysema was not associated with neurological symptoms. The CT images demonstrated the pathway of air leakage from the posterior mediastinum through the intervertebral foramina into the epidural space. Repeat CT showed spontaneous resolution of the epidural emphysema. (orig.) With 2 figs., 9 refs.

  13. In vitro histamine release from basophils of asthmatic and atopic individuals in D2O

    International Nuclear Information System (INIS)

    Tung, R.; Lichtenstein, L.M.

    1982-01-01

    It was found that spontaneous histamine release from human basophils in H 2 O-based buffers is negligible; in D 2 O-based buffers, however, release is observed with the cells of some donors. Analysis of this phenomenon revealed release from the basophils of 1 of 22 control individuals (5%), 15 of 47 patients with allergic rhinitis (32%), and 14 of 20 asthmatic patients (70%). The difference between both patient groups and controls and between atopics and asthmatics was highly significant. That D 2 O release was not cytotoxic is suggested by the finding that 37 0 was optimal, with inhibition at 4 0 C or 46 0 C as well as by EDTA, 2-deoxyglucose, and dibromoacetophenone, an inhibitor of phospholipase A 2 . The release mechanism was unusual in that dibutyryl cAMP and agonists that cause an increase in cAMP lead to no inhibition. No correlation was noted between the total serum IgE level (and thus the number of IgE receptors on the basophil surface) and the magnitude of D 2 O release. No increase in D 2 O release was observed in 17 ragweed-sensitive patients through a ragweed season. A unique property of D 2 O release was the loss of reactivity by preincubating cells at 37 0 C for 30 min before adding D 2 O. Non-D 2 O-reactive cells could be ''converted'' to D 2 O-reactive cells by incubation with antigen in the whole blood phase during leukocyte isolation; these cells showed the same loss of releaseability at 37 0 C and an inhibitor profile similar to D 2 O-responsive cells from ragweed allergic or asthmatic patients. We suggest that D 2 O-based buffers reveal, in atopic and asthmatic patients, in vivo basophil activation; whether this is due to IgE cross-links, to C split products, or to other stimuli is not yet clear

  14. Facilitating Learning among Nursing Students -Safe Administration of Asthmatic Children’s Medication.

    OpenAIRE

    Mohammed, Amida Abdul; Antniemi, Anna-Lotta; Väänänen, Sarah; Chinatou, Cynthia Eyong

    2012-01-01

    The aim of this thesis is to describe how learning of safe administration of asthmatic children’s medication can be facilitated amongst nursing students through planning, implementing, and evaluating learning sessions. This thesis was an action based research which was carried out in collaboration with Laura University of Applied Sciences, Otaniemi. The thesis aimed to find out how students learning can be facilitated therefore playing the role of facilitators during two (2) interaction ...

  15. Stereoselective total synthesis of the potent anti-asthmatic compound CMI-977 (LDP-977)

    Energy Technology Data Exchange (ETDEWEB)

    Dias, Luiz Carlos; Farina, Lui Strambi; Ferreira, Marco Antonio Barbosa, E-mail: ldias@iqm.unicamp.br [Universidade de Campinas (UNICAMP), SP (Brazil). Instituto de Quimica

    2013-02-15

    A short and efficient stereoselective total synthesis of CMI-977 (LDP-977), a potent and orally active anti-asthmatic compound, was developed. The key steps involve a highly diastereoselective Mukaiyama oxidative cyclization, which provides the trans-THF (tetrahydrofuran) unit and a Seyferth-Gilbert homologation to construct the triple bond in the target molecule. The synthesis of the key chiral building block was performed using Jacobsen hydrolytic kinetic resolution. (author)

  16. Heterogeneity of FeNO response to inhaled steroid in asthmatic children

    DEFF Research Database (Denmark)

    Buchvald, F; Eiberg, H; Bisgaard, H

    2003-01-01

    variables associated with the heterogeneity in the response of exhaled nitric oxide to ICSs. METHODS: Exhaled nitric oxide (FeNO), lung function, bronchial hyper-responsiveness (BHR), specific IgE to common inhalant allergens, blood eosinophils, other atopic manifestations and variants in nitric oxide...... of high-dose steroid treatment. This should be considered when using FeNO for steroid dose titration and monitoring of ICS anti-inflammatory control in asthmatic children....

  17. Information and communication technology use in asthmatic patients: a cross-sectional study in Latin America.

    Science.gov (United States)

    Calderón, Juan; Cherrez, Annia; Ramón, Germán Darío; Lopez Jove, Orlando; Baptist, Alan; Matos, Edgar; Morfín Maciel, Blanca; Calero, Erick; Sanchez-Borges, Mario; Cherrez, Sofia; Simancas-Racines, Daniel; Cherrez Ojeda, Ivan

    2017-07-01

    Rapid diffusion, low cost and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, communication and interventions in asthma. There is little information in Latin America about usage frequency of ICTs in asthmatic patients. The analysis undertaken consisted of an observational, cross-sectional study that aimed to identify the frequency and type of ICTs most often used by asthmatics. The Spanish version of the Michigan questionnaire was employed in five Latin American countries. Age and educational level was categorised. Logistic regression was performed among these groups concerning the frequency of ICT usage and the level of interest shown in seeking and receiving information about asthma. In total, 673 asthma patients were surveyed. The mean age was 43.44 years. Over two-thirds of the participants were female (68.4%). The most used ICT was the short message service (SMS) (69.9%). SMS and E-mail are useful tools for communicating ( i.e. receiving and seeking information) with all asthma patients, irrespective of their age. WhatsApp (61.5%) and Facebook (32.0%) were rated as being the most interesting channels of communication for receiving information. Regression analysis showed that younger asthmatics and asthmatics with higher educational levels were most likely to use almost all forms of ICTs. ICTs are generally an attractive platform for managing care, communication and interventions to improve asthma care. SMS and E-mail were found to be the preferred ICT forms among users. However, social media forms such as WhatsApp and Facebook may also be appropriate for certain types of patient.

  18. Therapy for acute nonpurulent rhinosinusitis with cineole: results of a double-blind, randomized, placebo-controlled trial.

    Science.gov (United States)

    Kehrl, Wolfgang; Sonnemann, Uwe; Dethlefsen, Uwe

    2004-04-01

    Nonpurulent rhinosinusitis can be treated successfully with cineole. Prospective, randomized, double-blinded, placebo-controlled study. We compared efficacy and safety of cineole capsules with placebo capsules in 152 patients with acute rhinosinusitis (76 patients in each treatment group). The dosage of the active ingredient was two 100-mg capsules of cineole three times daily. The primary end point was the reduction of a defined symptoms-sum-score based on symptoms and signs comparing baseline therapy difference from the beginning to the end of the 7-day treatment. All randomly selected patients were assigned to the intention-to-treat-population. At the beginning, the mean symptoms-sum-score was 15.6 in both treatment groups. The mean values for the symptoms-sum-scores in the cineole group were 6.9 +/- 2.9 after 4 days and 3.0 +/- 2.8 after 7 days, and in the placebo group, 12.2 +/- 2.5 after 4 days and 9.2 +/- 3.0 after 7 days. The differences between both groups were clinically relevant and statistically significant after 4 and 7 days. The result for the primary end point was validated by the amelioration of the following secondary end points: headache on bending, frontal headache, sensitivity of pressure points of trigeminal nerve, impairment of general condition, nasal obstruction, and rhinological secretion. Mild side effects, possibly associated with medication, were observed in two patients as heartburn and exanthema after treatment with cineole. In patients with acute nonpurulent rhinosinusitis, timely treatment with cineole is effective and safe before antibiotics are indicated.

  19. A retrospective comparison of acute rhinosinusitis outcomes in patients prescribed antibiotics, mometasone furoate nasal spray, or both.

    Science.gov (United States)

    de Moor, Carl; Reardon, Gregory; McLaughlin, John; Maiese, Eric M; Navaratnam, Prakash

    2012-01-01

    Antibiotics are frequently used to treat acute rhinosinusitis (ARS; acute sinusitis), although many episodes are viral. Because of community resistance concerns, current evidence provides limited support for the use of antibiotics in ARS. We conducted a retrospective comparative effectiveness outcomes assessment of the nasal steroid mometasone furoate nasal spray (MFNS) versus antibiotics among ARS patients in clinical practice. Using the General Practice Research Database (United Kingdom), the earliest ARS event between January 1, 2005 and December 31, 2008 (index event) for patients aged 12-75 years and an antibiotic or MFNS prescription ±2 days was identified. Treatment cohorts were MFNS monotherapy (MM), MFNS + antibiotic (MAT), and antibiotic monotherapy (AM). Logistic regression adjusted for potential confounders and compared odds of rhinosinusitis-related medical encounters and related prescriptions in the 3- to 30-day postindex period. There were 12,679 eligible patients (651 MM; 2285 MAT; 9743 AM). Compared with the reference cohort AM, during the 3- to 30-day postindex period, lower adjusted odds (p prescriptions for MM (OR = 0.51; 95% CI, 0.42-0.63) and MAT (OR = 0.58; 95% CI, 0.52-0.65); having one or more antibiotic, nasal steroid, or oral steroid prescriptions for MM (OR = 0.36; 95% CI, 0.28-0.46) and MAT (OR = 0.51; 95% CI, 0.46-0.58); and having one or more antibiotic prescriptions for MM (OR = 0.43; 95% CI, 0.33-0.58) and MAT (OR = 0.63; 95% CI, (0.55-0.72). Compared with AM, using MFNS for initial ARS treatment, alone or with an antibiotic, is associated with a decreased likelihood of both subsequent rhinosinusitis-related medical encounters and use of related prescriptions.

  20. Effects of Ramadan fasting on spirometric values and clinical symptoms in asthmatic patients

    Directory of Open Access Journals (Sweden)

    Abdolreza Norouzy

    2013-03-01

    Full Text Available Introduction: Ramadan is the 9th  Islamic lunar month during which Muslims avoid eating and drinking from sunrise to sunset.  The effect of Ramadan intermittent fasting on asthma control is controversial.  The aim of this study was to investigate the effects of Ramadan fasting on the spirometric variables and clinical symptoms on well-controlled asthmatic patients during Ramadan. Material and Methods: a cohort study was conducted in Mashhad, Khorasan Razavi, Iran. Twenty-nine (19 females and 10 males well-controlled asthmatic patients aged 47 (12 years completed the study.  The average duration of fasting was 26.5 days. Assessment of spirometric variables (daily peak expiratory flow, peak expiratory flow variability, peak expiratory flow home monitoring as well as asthma clinical symptoms including dyspnea, cough, wheezing, and chest tightness were carried out. Results: No significant changes in clinical symptoms were reported in asthmatic patients at the end of Ramadan fasting.  Among spirometric variables, only peak expiratory flow improved after Ramadan (p

  1. Characterisation of patients receiving moxifloxacin for acute bacterial rhinosinusitis in clinical practice: results from an international, observational cohort study.

    Directory of Open Access Journals (Sweden)

    Ralph Mösges

    Full Text Available We conducted a prospective, non-controlled, multi-centre Phase IV observational cohort study of patients with acute bacterial rhinosinusitis who were treated with moxifloxacin in clinical practice in 19 countries in Asia Pacific, Europe and the Middle East. With the data collected we evaluated the presentation and course of the current disease episode, particularly in terms of the principal clinical signs and symptoms of acute rhinosinusitis and diagnostic procedures. A final assessment of moxifloxacin therapy was made to evaluate the impact of the sinusitis episode on activities of daily life and on sleep disturbance, and to evaluate the clinical outcome of treatment. A total of 7,090 patients were enrolled, of whom 3909 (57.6% were included in the valid for clinical outcome and safety population. Regional differences were observed in the main symptoms of acute rhinosinusitis and, according to several characteristics, disease episodes appeared to be more severe in patients in Europe than in the Asia Pacific or Middle East regions. The sinusitis episode impacted on daily living for mean (SD periods of 3.6 (3.2, 4.6 (3.9 and 3.1 (3.0 days and disturbed sleep for 3.6 (3.2, 4.6 (3.9 and 3.1 (3.0 nights in the Asia Pacific, Europe and Middle East regions, respectively. With moxifloxacin treatment, the mean (SD time to improvement of symptoms was 3.0 (1.5, 3.4 (1.6 and 3.2 (1.5 days, and the time to resolution of symptoms was 4.8 (2.6 days, 5.7 (2.4 days and 5.5 (2.5 days, in the Asia Pacific, Europe and Middle East regions, respectively. In conclusion, acute rhinosinusitis remains a substantial health burden with significant impact on patients' quality of life, and there are differences between global regions in the clinical presentation, diagnosis and clinical course of disease episodes. Moxifloxacin was an effective and well-tolerated treatment option in the overall population.ClinicalTrials.gov Identifier: NCT00930488.

  2. Cost-effectiveness of a nurse-led telemonitoring intervention based on peak expiratory flow measurements in asthmatics: results of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Wouters Emiel FM

    2007-07-01

    Full Text Available Abstract Background Asthma is a chronic lung disease in which recurrent asthma symptoms create a substantial burden to individuals and their families. At the same time the economic burden associated with asthma is considerable. Methods The cost-effectiveness study was part of a single centre prospective randomised controlled trial comparing a nurse-led telemonitoring programme to usual care in a population of asthmatic outpatients. The study included 109 asthmatic outpatients (56 children; 53 adults. The duration of follow-up was 12 months, and measurements were performed at baseline, 4, 8, and 12 months. Patients were asked to transfer their monitor data at least twice daily and by judging the received data and following a stepwise intervention protocol a nurse was able to act as the main caregiver in the intervention group. In both groups the EQ-5D and the SF-6D were used to obtain estimates of health state utilities. One year health care costs, patient and family costs, and productivity losses were calculated. The mean incremental costs were weighted against the mean incremental effect in terms of QALY. Results The study population generally represented mild to moderate asthmatics. No significant differences were found between the groups with regard to the generic quality of life. Overall, the mean health care costs per patient were higher in the intervention group than in the control group. The intervention costs mainly caused the cost difference between the groups. The intervention costs the society € 31,035/QALY gained with regard to adults and with regard to children € 59,071/QALY gained. Conclusion If the outcome is measured by generic quality of life the nurse-led telemonitoring programme is of limited cost-effectiveness in the study population. From the societal perspective the probability of the programme being cost-effective compared to regular care was 85% at a ceiling ratio of € 80,000/QALY gained among the adults and 68

  3. Investigation into the use of complementary and alternative medicine and affecting factors in Turkish asthmatic patients.

    Science.gov (United States)

    Tokem, Yasemin; Aytemur, Zeynep Ayfer; Yildirim, Yasemin; Fadiloglu, Cicek

    2012-03-01

    The purpose of this study was to examine the frequency of complementary and alternative medicine usage in asthmatic patients living in the west of Turkey, the most frequently used complementary and alternative medicine methods and socio-demographic factors affecting this and factors related to the disease. While the rate of complementary and alternative medicine usage in asthmatic patients and the reasons for using it vary, practices specific to different countries and regions are of interest. Differing cultural and social factors even in geographically similar regions can affect the type of complementary and alternative medicine used. Two hundred asthmatic patients registered in the asthma outpatient clinic of a large hospital in Turkey and who had undergone pulmonary function tests within the previous six months were included in this study, which was planned according to a descriptive design. The patients filled out a questionnaire on their demographic characteristics and complementary and alternative medicine usage. The proportion of patients who reported using one or more of the complementary and alternative medicine methods was 63·0%. Of these patients, 61·9% were using plants and herbal treatments, 53·2% were doing exercises and 36·5% said that they prayed. The objectives of their use of complementary and alternative medicine were to reduce asthma-related complaints (58%) and to feel better (37·8%). The proportion of people experiencing adverse effects was 3·3% (n = 4). Factors motivating asthmatic patients to use complementary and alternative medicine were the existence of comorbid diseases and a long period since diagnosis (p complementary and alternative medicine and the severity of the disease, pulmonary function test parameters, the number of asthma attacks or hospitalisations because of asthma within the last year (p > 0·05). Understanding by nurses of the causes and patterns of the use of complementary and alternative medicine in asthmatic

  4. Ethnic and migrant differences in the use of anti-asthmatic medication for children: the effect of place of residence.

    Science.gov (United States)

    Cantarero-Arévalo, Lourdes; Ersbøll, Annette Kjaer; Holstein, Bjørn E; Andersen, Anette; Kaae, Susanne; Hansen, Ebba Holme

    2014-01-01

    Ethnic differences in the use of anti-asthmatic medication have been reported, with ethnic minorities being at a higher risk of suboptimal asthma control. As contextual socioeconomic characteristics may play a role, we analysed whether ethnic differences in the use of anti-asthmatic medication among children residing in the Capital Region of Denmark varied by place of residence. Data were obtained from the Danish Civil Registration System, the Central Taxpayers' Register and the Danish National Prescription Register and were linked at the individual level. Population used was the entire child population in the Capital Region from 0 to 17 years old in 2008 (n = 342,403). Use of anti-asthma medicine was defined as at least one prescription having been filled in 2008. The analyses included multiple multilevel logistic regression models. Children living in low-income places of residence had lower odds of being prescribed preventive anti-asthmatics compared with children living in higher-income places of residence [odds ratio (OR) = 0.87, 95% confidence interval (CI) 0.84-0.91]. Immigrant children had the lowest OR of being prescribed anti-asthmatics medication, both relief (OR = 0.50, 95% CI 0.20-0.77) and preventive (OR = 0.47, 95% CI 0.24-0.82) compared with ethnic Danes. Similar associations were found among descendants of immigrant children (OR for preventive medication = 0.70, 95% CI 0.62-0.78). Place of residence contributed to but did not account for the ethnic differences in the use of anti-asthmatic medication. Ethnic differences in the use of anti-asthmatic medication were documented, and they cannot be explained by socioeconomic characteristics of place of residence. The lower prevalence of anti-asthmatic medication among ethnic minority children suggests poor asthma management control. Copyright © 2013 John Wiley & Sons, Ltd.

  5. Absence of evidence for enhanced benefit of antibiotic therapy on recurrent acute rhinosinusitis episodes: a systematic review of the evidence base

    NARCIS (Netherlands)

    Kaper, N.M.; Breukel, L.; Venekamp, R.P.; Grolman, W.; van der Heijden, G.J.M.G.

    2013-01-01

    Objective To systematically review the evidence base on the effectiveness of short-course antibiotic therapy in adult patients with a recurrent episode of acute rhinosinusitis as part of a disease pattern on severity and duration of symptoms and recurrences. Data Sources PubMed, EMBASE, and the

  6. EPOS Primary Care Guidelines: European Position Paper on the Primary Care Diagnosis and Management of Rhinosinusitis and Nasal Polyps 2007 - a summary

    NARCIS (Netherlands)

    Thomas, Mike; Yawn, Barbara P.; Price, David; Lund, Valerie; Mullol, Jocquim; Fokkens, Wytske

    2008-01-01

    This paper is a summary of the 2007 European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS)1 which was published in Rhinology in 2007. In order to widen dissemination of the EP3OS paper, the editors of Rhinology and the Primary Care Respiratory Journal (PCRJ) have agreed to publish this

  7. Omalizumab therapy for refractory allergic fungal rhinosinusitis patients with moderate or severe asthma.

    Science.gov (United States)

    Gan, Eng Cern; Habib, Al-Rahim R; Rajwani, Alykhan; Javer, Amin R

    2015-01-01

    1. To assess the efficacy of omalizumab therapy in improving sinonasal outcomes in refractory allergic fungal rhinosinusitis (AFRS) patients with moderate or severe asthma. 2. To determine if omalizumab therapy reduces the usage of corticosteroids or antifungal therapy in AFRS patients The clinical charts of patients with AFRS with moderate or severe asthma who received at least three subcutaneous injections of omalizumab therapy between 1st January 2012 and 1st May 2014 were retrospectively reviewed. These patients had undergone bilateral functional endoscopic sinus surgery (FESS) and failed adjunct medical treatments (oral or topical corticosteroids and/or antifungal therapy) prior to omalizumab therapy. Seven patients met the inclusion criteria and were included in this study. The mean age of the patients was 48.14. The average number of subcutaneous omalizumab injections was 7.57 (range 6-11) with a mean dosage of 287mg (range 225-375mg). The mean pre-omalizumab treatment Sino-Nasal Outcome Test-22 (SNOT-22) score was 52.14 while the mean post-omalizumab treatment SNOT-22 score was 35.86 (31% improvement). The mean pre-omalizumab therapy Phillpott-Javer endoscopic score (over the last one year before omalizumab therapy) was 36 while the mean post-omalizumab therapy endoscopic score (from the last clinic visit) was 14 (61% improvement). Omalizumab therapy reduced the dependence of AFRS patients on corticosteroid and antifungal treatments. Omalizumab therapy can be considered as a potential adjunct for the treatment for patients with refractory AFRS with moderate or severe asthma. However, larger prospective studies to confirm the findings of this study will be required. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

  8. The role of microbes in the pathogenesis of acute rhinosinusitis in young adults.

    Science.gov (United States)

    Autio, Timo J; Tapiainen, Terhi; Koskenkorva, Timo; Närkiö, Mervi; Lappalainen, Maija; Nikkari, Simo; Hemmilä, Heidi; Koskela, Katja A; Koskela, Markku; Koivunen, Petri; Alho, Olli-Pekka

    2015-01-01

    To provide information on the course of acute rhinosinusitis (ARS) with sequential nasal and paranasal microbiological data and their correlation with clinical outcomes. We conducted a prospective cohort study among 50 Finnish military recruits with clinically diagnosed ARS in spring 2012. We collected symptom, nasal end