One of the most common chronic upper respiratory diseases worldwide is allergic rhinitis (AR). Despite advances in understanding the mechanisms of allergic inflammation, the symptoms of AR in most cases are not completely controlled by modern treatment methods. Allergic rhinitis is a precursor and predisposing factor for the development of other respiratory diseases, one of which is asthma. Diagnosis of AR is being actively conducted, but there is still a serious problem of uncontrolled and chaotic treatment of patients, so it is necessary to provide comprehensive medical care within the national health system. ARIA aims to develop and apply internationally recommendations for the management of patients with allergic respiratory diseases. In collaboration with other international associations that deal with the treatment and diagnosis of allergies and respiratory diseases, regulations and programs have been developed for the treatment of patients with AR, as well as when it is combined with asthma, which form the basis of ARIA. This document has been adapted for use in the field of healthcare in the Russian Federation and covers key issues related to the management of patients with AR and in combination with AR and asthma.
Background. The combination of chronic rhinosinusitis with nasal polyps (CRSwNP) and bronchial asthma (BA) is currently considered as a separate phenotype characterized by similar features of inflammatory changes leading to an increase in the clinical course of both CRSwNP and BA. The aim of the study was to investigate the clinical features and characteristics of the local and systemic inflammatory process in patients having a combination of CRSwNP and BA. Materials and methods. The study included 96 volunteers, who were divided into 4 groups: group 1 consisted of healthy volunteers (Normal); group 2 consisted of volunteers with CRSwNP in combination with allergic BA (CRSwNP + aBA); group 3 - volunteers with PRS in combination with non-allergic BA (CRSwNP + nBA); and group 4 - CRSwNP without BA. Clinical, laboratory, instrumental and allergology examination methods were applied for all participants of the study. BA control status was determined using the asthma control questionnaire (ACQ-7), and CRSwNP control status was determined using the nasal and paranasal sinus clinical outcome control questionnaire (SNOT-22). At the same time, the quality of life of the patients was also evaluated using AQLQ (Asthma Quality of Life Questionnaire). Results. The results confirmed the interaction of BA and CRSwNP, where the combination of these diseases led to a more severe and uncontrolled clinical course of BA and CRSwNP based on the assessment using SNOT-22, ACQ-7 and AQLQ questionnaires. These results correlated with an increase in the absolute number of eosinophils in peripheral blood and pronounced eosinophilic cell infiltration of nasal polyp stroma. Data processing demonstrated that the combination of CRSwNP and nBA showed signs of more pronounced eosinophilic inflammation, which is an unfavorable prognostic factor. Conclusions. The comparison of the cellular characteristics of the local and systemic inflammatory process in patients with CRSwNP in combination with BA allowed us to conclude that polyp development follows a local inflammatory process. Further study of the pathogenesis of CRSwNP and BA will help to understand the mechanisms that connect these diseases and consider possible target molecules for biological therapy.
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