O impacto do tratamento fonoaudiológico no controle da asma e da rinite alérgica em crianças e adolescentes respiradores orais

Abstract

Objective: To determine the impact of speech therapy on asthma and allergic rhinitis control in mouth breathing children and adolescents.Methods: This was a quasi-experimental randomized study of 24 mouth breathing patients with asthma and allergic rhinitis, aged from 6 to 15 years. All patients were taking beclomethasone diproprionate through oral inhalation at the start of the study. At enrollment on the study, oral inhalation was substituted with exclusively nasal inhalation and 1 month later half of the patients began speech therapy. They attended 16 speech therapy sessions in 8 weeks and continued taking beclomethasone dipropionate through exclusively nasal inhalation (BDT group). The comparison group received only beclomethasone diproprionate through exclusively nasal inhalation (BDI group). Both groups were assessed five times. Clinical scores were calculated for allergic rhinitis and asthma, an adapted version of the Marchesan orofacial myofunctional assessment protocol was applied, and parents/guardians' observations were recorded, in addition to spirometry measurements of peak inspiratory and peak expiratory flow.Results: There were significant improvements in the BDT group: clinical asthma score at T5 (p = 0.046); peak inspiratory flow at T4 (p = 0.030); peak expiratory flow at T3 (p = 0.008); breathing mode and lip position (p = 0.000) from T3 onwards; and parents/guardians' observations at T2, T4, and T5 (p = 0.010; p = 0.027; p = 0.030).Conclusions: Speech therapy in combination with beclomethasone diproprionate through exclusively nasal inhalation resulted in earlier and longer-lasting clinical and functional control of asthma, allergic rhinitis, and mouth breathing than was achieved in the group that only took beclomethasone diproprionate. The efficacy of treating allergic rhinitis when it is associated with asthma has been widely documented. 5 Recovery of upper airway function contributes to asthma control. 5 For allergic patients and mouth breathers, the objective of speech therapy is to reestablish breathing through the No conflicts of interest declared concerning the publication of this article.Suggested citation: Campanha SM, Fontes MJ, Camargos PA, Freire LM. The impact of speech therapy on asthma and allergic rhinitis control in mouth breathing children and adolescents.

Achados da avaliação multiprofissional de crianças respiradoras orais

“…The last two of those findings are in contrast to the reports in the literature 20 . The literature reports a relationship between abnormal breathing mode and the presence of speech disorders 18,28 . A study showed that 31.2% of mouth breathers have speech disorders, but the significance of that finding was not ascertained 29 .…”

“…Finally, it was found that the most frequent speech-language pathology approach to treatment was an indication to speech therapy-a relevant aspect, since speech therapy can contribute to breathing mode correction, facilitate the control of mouth breathing and of allergic rhinitis, and assist in the management of asthma 28 . The second most frequent approach was postoperative re-evaluation, which is related to the high prevalence of adenotonsillar hypertrophy in our sample.…”

Evidence of orofacial myofunctional therapy patients with asthma and rhinitis: a systematic review

“…After a thorough reading, eight articles were excluded-five due to the research design, two to the outcome, and one to intervention. Finally, one study (8) met the eligibility criteria and was included in our systematic review. Our manual search did not identify any additional studies ( Figure 1).…”

“…Orofacial myofunctional therapy is indicated for mouth breathing patients and aims to raise awareness and establish nasal breathing, based on the improvement of the musculature and orofacial function (7) . Other studies have described speech language disorders in patients with asthma and rhinitis and suggest that orofacial myofunctional therapy may be important in the clinical approach (8,9) . Due to the uncertainty about the beneficial effects of orofacial myofunctional therapy on the clinical parameters of asthma and orofacial function, it is important to search for the scientific evidence available to ensure the efficacy of this treatment.…”

The Mouth Breathing Syndrome: prevalence, causes, consequences and treatments. A Literature Review

“…Regarding to the area of speech-therapy, two studies were conducted; one with 24 children and adolescents with asthma and allergic rhinitis, which was based on the awareness and proprioception mode and respiratory tract, isometric exercises for strengthening the lips, tongue and cheeks, appropriateness of placement of sealing lips, adequacy of habitual tongue position and breathing exercises to stimulate nasal breathing being effective in spacing and reduce allergic crises and exacerbations 42 . The second was an intervention made with 40 children, based miofunctional exercises, workout of the respiratory and miofuncional mode, which resulted in a significant gain in nasal breathing function, improvement of strength and praxis 43 .…”