The correlation between allergic rhinitis with hyperactive lower airway disorders and effect of management of allergic rhinitis on lower airway
Keywords:Allergic rhinitis, Asthma, Intranasal corticosteroids, Fluticasone furoate
Background: Allergic rhinitis and brochial asthma are interrelated diseases because of the shared respiratory epithelium and the common allergens affecting both the areas. The treatment of both these conditions is often overlapping. Although no treatment modality is perfect in treating the disease, corticosteroids are the mainstay of the treatment for both the conditions. This study was conducted to quantify strength of association between allergic rhinitis and hyperactive lower airway disorders and to study the effect of topical intranasal steroid Fluticasone on Bronchial hyperactivity in patients with allergic rhinitis.
Methods: Patient with moderate to severe allergic rhinitis presenting to ENT OPD with symptoms of lower airway hyperactivity were subjected to pulmonary function tests. After all routine investigations, the patients were started on fixed dose of intranasal fluticasone furoate nasal spray for a period of 2 months and the pretreatment and post treatment FEV1 and PEFR were compared and statistically analysed for the effect.
Results: Approximately 50% of patients with allergic rhinitis showed associated lower airway hyperreactivity. There was statistically significant improvement in pulmonary function test readings after 2 months therapy with intranasal fluticasone spray.
Conclusions: The study showed that the treatment of inflammation in the upper airways indirectly improves the symptoms of hyperactive lower airway disorders and decreased bronchial hyperactivity.
Izquierdo-Domínguez A, Valero AL, Mullol J. Comparative Analysis of Allergic Rhinitis in Children and Adults. Cur Allergy Asthma Rep. 2013;13:142–51.
Bergeron C, Hamid Q. Relationship between Asthma and Rhinitis: Epidemiologic, Patho-physiologic, and Therapeutic Aspects. Allergy Asthma Clin Immunol. 2005;1(2):81–7.
Dahl R, Nielsen LP, Kips J, Foresi A, van Cauwenberge P, Tudoric N, et al. Intranasal and inhaled fluticasone propionate for pollen-induced rhinitis and asthma. Allergy. 2005;60:875–81.
Pauwels RA, Pedersen S, Busse WW, Tan WC, Chen YZ, Ohlsson SV, et al. Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial. Lancet. 2003;361:1071–6.
Cruz AA. Obtaining concomitant control of allergic rhinitis and asthma with a nasally inhaled corticosteroid. Allergy. 2007;62(3):871–4.
Lohia S, Schlosser RJ, Soler ZM. Impact of intranasal corticosteroids on asthma outcomes in allergic rhinitis: A meta-analysis. Allergy. 2013;68(5):569-79.
Taramarcaz P, Gibson PG. Intranasal corticosteroids for asthma control in people with co-existing asthma and rhinitis. Cochrane Database of Systematic Reviews. 2003:3:CD003570.