Allergic rhinitis remains a significant health problem because of the high burden of symptoms and its impact on general well being and HRQoL among patients consulting for this condition. Overall, there was a poor correlation between patients and physicians in the reporting of disease severity.
The delivery of drugs by inhalation is an integral component of asthma and chronic obstructive pulmonary disease (COPD) management. However, even with effective inhaled pharmacological therapies, asthma, particularly, remains poorly controlled around the world. The reasons for this are manifold, but limitations of treatment guidelines in terms of content, implementation and relevance to everyday clinical life, including insufficient patient education, access to health care and cost of medication as well as poor inhaler technique are likely to contribute. Considering that inhalation therapy is a cornerstone in asthma and COPD management, little advice is provided in the guidelines regarding inhaler selection. The pressurised metered dose inhaler (pMDI) is still the most frequently prescribed device worldwide, but even after repeated tuition many patients fail to use it correctly. In addition, the correct technique can be lost over time. Although several improvements in pMDIs such as a change in the propellant and actuation have resulted in improvements in lung deposition, many dry powder inhalers (DPIs) are easier to use. However, these devices also have limitations such as dependency of drug particle size on flow rate and loss of the metered dose if the patient exhales through the device before inhaling. Improvements in using inhalation devices more efficiently, in inhaler design for supporting patient compliance, and advances in inhaler technology to assure drug delivery to the lungs, have the potential to improve asthma and COPD management and control. New and advanced devices are considered being helpful to minimise the most important problems patients have with current DPIs.
The links between asthma and rhinitis are well characterized. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines stress the importance of these links and provide guidance for their prevention and treatment. Despite effective treatments being available, too few patients receive appropriate medical care for both diseases. Most patients with rhinitis and asthma consult primary care physicians and therefore these physicians are encouraged to understand and use ARIA guidelines. Patients should also be informed about these guidelines to raise their awareness of optimal care and increase control of the two related diseases. To apply these guidelines, clinicians and patients need to understand how and why the recommendations were made. The goal of the ARIA guidelines is to provide recommendations about the best management options for most patients in most situations. These recommendations should be based on the best available evidence. Making recommendations requires the assessment of the quality of available evidence, deciding on the balance between benefits and downsides, consideration of patients’ values and preferences, and, if applicable, resource implications. Guidelines must be updated as new management options become available or important new evidence emerges. Transparent reporting of guidelines facilitates understanding and acceptance, but implementation strategies need to be improved.
We investigated the secretion of interleukin (IL)-13 into the airways in 10 mild allergic asthmatics by employing local allergen challenge, and compared the data both to IL-4 levels and eosinophil numbers obtained by bronchoalveolar lavage (BAL).Appropriate allergen or saline were endoscopically instilled into different airway segments, which were lavaged 10 min and 18 h after allergen or sham challenge. IL-4 and IL-13 were measured in unconcentrated BAL fluid using a double sandwich enzymes-linked immunosorbent assay (ELISA).Endobronchial allergen challenge induced a highly significant increase in the numbers of eosinophils after 18 h in the allergen exposed segment. Ten minutes following allergen exposure, low levels of IL-4 and IL-13 could be detected, whilst concentrations of both cytokines were significantly raised 18 h following local allergen exposure. In contrast to IL-4, the concentration of IL-13 strongly correlated with the eosinophil numbers found 18 h post-allergen challenge.The results suggest that interleukin-13 is actively secreted during the late asthmatic response in mild asthmatic subjects. In view of its action on eosinophils and other cell types, we conclude that interleukin-13, in addition to interleukin-4, may play an important role in the pathogenesis of eosinophil-related inflammation, such as bronchial asthma. Eur Respir J., 1996, 9, 899-904
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