Asthma and allergic rhinitis (AR) form a well-recognized comorbidity. This study aims at assessing the efficacy of nasally inhaled beclomethasone dipropionate (BDP) in their simultaneous treatment. A randomized controlled trial was conducted with 78 allergic rhinitis and asthma patients aged 5-17 years. Seventy-five individuals completed the study. During 8 weeks, 38 subjects received BDP-CFC aerosol (>or= 500 mcg/day) exclusively via nasal inhalation through a facemask attached to a plastic valved spacer. The control group (37 patients) received 200 mcg/day of aqueous intranasal beclomethasone plus oral inhalation of BDP-CFC (>or= 500 mcg/day) through a mouthpiece connected to the same spacer. Primary outcomes analyzed in order to assess the response to treatment were clinical scoring for allergic rhinitis and measurements of nasal inspiratory peak flow (NIPF). AR clinical scoring and NIPF did not differ in the two groups at admission or at nearly all follow-up visits. Nasal inhalation of beclomethasone dipropionate provides AR symptom relief while maintaining control of asthma by delivering it to the lungs. Therefore, this therapeutic strategy might be considered for patients suffering from this comorbidity, especially in low-resource countries, since it is less expensive than the conventional treatment.
Objective: to describe current ideas about the relation between upper and lower respiratory tract and to review the epidemiological, immunological, and pathological aspects that support the paradigm of united airways disease.Sources: literature review using the Medline, MD Consult, HighWire, Medscape and Lilacs databases. We used allergic rhinitis and asthma as keywords, and searched articles published in the past 20 years.Summary of the findings: epidemiological evidence includes prevalence of allergic rhinitis in asthmatic patients and vice-versa, results of cross-sectional studies, bronchial hyperresponsiveness in patients with allergic rhinitis, importance of genetic and environmental factors, and the age of onset of atopic disease. Morphological and physiological aspects show structural differences between the nasal and bronchial mucosa, and the mechanisms that could explain the effect of rhinitis on asthma. Immunological aspects including the participation of bone marrow in the production of inflammatory cells and allergic reactions after allergen challenge are the same in allergic rhinitis and asthma. Finally, the results of the therapy for allergic rhinitis in bronchial hyperresponsiveness and in clinical and functional control of asthma are also reported.Conclusions: epidemiological evidence and immunological and pathological aspects suggest that there is a relation between allergic rhinitis and asthma. The paradigm of united airways disease suggests the implementation of an integrated therapeutic approach.
Objective: To correlate forced expiratory volume in 1 second (VEF 1 ) and peak expiratory flow (PEF) with clinical parameters in children with moderate and severe asthma.Methods: This was a non-concurrent cohort study, carried out at a pediatric pneumology clinic, in Belo Horizonte, MG, Brazil, between March and October 2002. The study enrolled children aged 5 to 16 years, with persistent asthma, being treated with a minimum of 500 µg/ day beclomethasone, and with symptoms under control for at least 3 months. Seventy-five patients (96.1%) were selected by simple randomization and monitored for 3 months, via a clinical severity scale and pulmonary function tests (PEF and VEF 1 ). Results were analyzed using Pearson s coefficient.Results: Correlations between absolute and percentage PEF figures and clinical severity score, were negative and very close to zero, signifying a weak correlation with no statistical significance. The same relationship was observed between VEF 1 and clinical severity score. The correlation between VEF 1 and PEF had a positive value with statistical significance (p = 0.000). Conclusions:Since the best parameter for evaluating airway obstruction is VEF 1 , the finding that there is a positive correlation between this measure and absolute PEF reinforces the importance of its use and allows for the recommendation that PEF be measured as part of the management of asthmatic children, particularly in severe cases.J Pediatr (Rio J). 2006;82(6):465-9: Asthma, monitoring, peak expiratory flow. ResumoObjetivo: Correlacionar as medidas de volume expiratório forçado no primeiro segundo (VEF 1 ), pico do fluxo expiratório (PFE) e parâme-tros clínicos em crianças com asma moderada a grave.Métodos: Trata-se de um estudo de coorte não concorrente, realizado em ambulatório de pneumologia pediátrica, em Belo Horizonte, MG, de março a outubro de 2002. Participaram do estudo crianças entre 5 e 16 anos, com asma persistente, em uso de beclometasona na dosagem mínima de 500 µg/dia, com sintomas controlados há pelo menos 3 meses. Foram selecionados 75 pacientes (96,1%) de forma aleatória simples, os quais foram acompanhados durante 3 meses, sendo avaliados o escore clínico e as provas de função pulmonar (PFE e VEF 1 ). Os resultados foram analisados através da regressão linear de Pearson.Resultados: Entre os valores absolutos e percentuais do PFE e o escore clínico, a correlação foi negativa e muito próxima a zero, o que significa uma correlação fraca, sem significância estatística. O mesmo se observa entre VEF 1 e escore clínico. A correlação entre VEF 1 e PFE apresentou valor positivo e com significância estatística (p = 0,000). Conclusões:Como o melhor parâmetro para avaliar obstrução de vias aéreas é o VEF 1 , o encontro de correlação positiva entre este e os valores absolutos do PFE reforça a importância do seu uso e permite recomendar a mensuração do PFE no manejo das crianças asmáticas, sobretudo nos casos graves.J Pediatr (Rio J). 2006;82(6):465-9: Asma, monitoramento, pico do fluxo expiratório. ...
Objective: To correlate forced expiratory volume in 1 second (VEF 1 ) and peak expiratory flow (PEF) with clinical parameters in children with moderate and severe asthma.Methods: This was a non-concurrent cohort study, carried out at a pediatric pneumology clinic, in Belo Horizonte, MG, Brazil, between March and October 2002. The study enrolled children aged 5 to 16 years, with persistent asthma, being treated with a minimum of 500 µg/day beclomethasone, and with symptoms under control for at least 3 months. Seventy-five patients (96.1%) were selected by simple randomization and monitored for 3 months, via a clinical severity scale and pulmonary function tests (PEF and VEF 1 ). Results were analyzed using Pearson s coefficient.Results: Correlations between absolute and percentage PEF figures and clinical severity score, were negative and very close to zero, signifying a weak correlation with no statistical significance. The same relationship was observed between VEF 1 and clinical severity score. The correlation between VEF 1 and PEF had a positive value with statistical significance (p = 0.000).Conclusions: Since the best parameter for evaluating airway obstruction is VEF 1 , the finding that there is a positive correlation between this measure and absolute PEF reinforces the importance of its use and allows for the recommendation that PEF be measured as part of the management of asthmatic children, particularly in severe cases.J Pediatr (Rio J). 2006;82(6):465-9: Asthma, monitoring, peak expiratory flow.
Objective: to describe current ideas about the relation between upper and lower respiratory tract and to review the epidemiological, immunological, and pathological aspects that support the paradigm of united airways disease.Sources: literature review using the Medline, MD Consult, HighWire, Medscape and Lilacs databases. We used allergic rhinitis and asthma as keywords, and searched articles published in the past 20 years.Summary of the findings: epidemiological evidence includes prevalence of allergic rhinitis in asthmatic patients and vice-versa, results of cross-sectional studies, bronchial hyperresponsiveness in patients with allergic rhinitis, importance of genetic and environmental factors, and the age of onset of atopic disease. Morphological and physiological aspects show structural differences between the nasal and bronchial mucosa, and the mechanisms that could explain the effect of rhinitis on asthma. Immunological aspects including the participation of bone marrow in the production of inflammatory cells and allergic reactions after allergen challenge are the same in allergic rhinitis and asthma. Finally, the results of the therapy for allergic rhinitis in bronchial hyperresponsiveness and in clinical and functional control of asthma are also reported.Conclusions: epidemiological evidence and immunological and pathological aspects suggest that there is a relation between allergic rhinitis and asthma. The paradigm of united airways disease suggests the implementation of an integrated therapeutic approach.
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