A Comparative Study of Symptoms, Nasal Eosinophilia and Pulmonary Function Tests Before and After Short Term Treatment w
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ORIGINAL ARTICLE
A Comparative Study of Symptoms, Nasal Eosinophilia and Pulmonary Function Tests Before and After Short Term Treatment with Corticosteroid Nasal Spray in Patients with Allergic Rhinitis Keshav Mangalore Pai1 • Suresh Pillai2 • Harshita Sabhahit Pai3 • Shama Shetty2
Received: 9 July 2020 / Accepted: 3 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Allergic rhinitis has been on the rise because of urbanization and major population shift in addition to changes in the particulate matter in the atmosphere. Intranasal corticosteroid sprays are recommended as first-line prescription treatment in all cases of allergic rhinitis. The propensity of co-existing non-apparent lower airway hyperresponsiveness is also on the rise and must be evaluated. The aim of this study is to compare the symptomatic improvement, changes in nasal eosinophilia and asymptomatic airway hyper responsiveness before and after short term treatment with steroid nasal spray. Fifty patients meeting the inclusion criteria for allergic rhinitis with no symptoms of asthma underwent pulmonary function tests and assessment of symptoms before and after one-month treatment with inhalational steroid nasal spray (Fluticasone Furoate), in the standard adult dosage. Based on TNSS (Total nasal symptom score) and TOSS (Total ocular symptom score), all 50 patients showed significant improvement after treatment. Among 20 patients with[ 50 eosinophils per high power field, 80% had 0–10 eosinophils per high power field on nasal smear after treatment. Among 40 patients with mild large airway obstruction, 37 showed significant improvement in FEV1 data. Also FEV1/ FVC data showed significant improvement. Significant improvement (FEF25–75 [ 50%) was also noticed in small airway disease after treatment among the 5 patients. The & Shama Shetty [email protected] 1
St Helens and Knowsley Teaching Hospitals, St Helens, Merseyside, UK
2
Dept of Otorhinolaryngolgy- Head & Neck Surgery, Kasturba Medical College Hospital, MAHE, Manipal, Karnataka, India
3
Merseyside, UK
study showed that lower airway hyper responsiveness coexists with allergic rhinitis and treating allergic rhinitis with just steroid nasal spray assists in reducing the former, supporting the concept of Unified Airway Disease (UAD). Keywords Allergic rhinitis Pulmonary function tests Unified airway disease Nasal eosinophilia Intranasal corticosteroid Fluticasone furoate
Introduction Allergic rhinitis (AR), a global health problem, is a chronic inflammatory respiratory disease, typically IgE-mediated and is characterized by one or more symptoms, including sneezing, itching, nasal congestion and rhinorrhea affecting 5–50% of the worldwide population and its prevalence is increasing [1, 2]. In accordance with ARIA guidelines (ARIA 2019), therapy with intranasal corticosteroid is recommended as first-line prescription treatment in all cases of AR with the exception of mild intermittent type [3]. During the second century, Claudius Galenus in his work ‘‘De u
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