过敏性鼻炎与哮喘分析报告

过敏性鼻炎与哮喘青岛市儿童医院孙广荣病例简介患儿男，4岁，17kg,鼻塞流涕3天咳喘1天来诊3天前患儿始鼻塞流清涕，喷嚏不止，经常揉鼻子搓眼睛，无发热，1天前咳嗽，单声痰较多，伴喘息，夜较剧，未服药治疗，今来就诊。食欲欠佳，二便无异常。既往已确诊为支气管哮喘，有湿疹史PE：一般尚可，气平，鼻粘膜苍白水肿，见多量清涕，咽（-），心（-），双肺野闻及少许哮鸣音，呼气相为主，腹（-）病例简介辅助检查：血MP-IgM（-）肺功能 pred67%诊断：支气管哮喘急性发作过敏性鼻炎病例简介处理：开瑞坦糖浆5mlqN氨茶碱50mgq8h顺尔宁4mgqN普米克气雾剂200μgtidLink

Between

Allergic

Rhinitis

and

Asthma,

Sinusitis,

and

Otitis

MediaAllergic

rhinitis

has

important

links

to

other

chronic

diseases

that

cause

significant

morbidity,

includingasthma,

sinusitis,

and

otitismedia.

Substantial

evidence

indicates

that

allergic

rhinitis

frequently

coexists

withasthma

and

sinusitis

and

may

beapredisposing

factor

forboth.

The

allergic

response

appearsto

be

the

link

between

allergic

rhinitis

and

otitis

media.

The

timely

treatment

of

allergic

rhinitis

maybenefitthese

closelyassociated

conditions.Corren

J.

The

link

between

allergic

rhinitis

and

asthma,

otitis

media,

sinusitis,

and

nasal

polyps.

Immunol

Allergy

Clin

NorthAm.

2000;20:445-460.Fireman

P.

Otitis

media

and

eustachian

tube

dysfunction:

connection

to

allergic

rhinitis.

JAllergy

Clin

Immunol.

1997(suppl);99:S787-S797.Rachelefsky

GS.

National

guidelines

needed

to

manage

rhinitis

and

prevent

complications.

Ann

Allergy

Asthma

Immunol.

1999;82:1-10.过敏性疾病存在着共患疾病哮喘过敏性鼻炎(AR)中耳炎(OM)上呼吸道感染上呼吸道感染Si鼻nu窦si炎i炎tis细支气管炎ContentsSlide

1

Asthma

and

Allergic

Rhinitis

Are

Both

Inflammatory

ConditionsEpidemiologic

Links

Between

Allergic

Rhinitis

and

AsthmaSlide

2

Allergic

Rhinitis

and

Asthma

Have

Similar

PrevalencePatternsSlide3

Allergic

Rhinitis

Is

a

Risk

Factor

for

AsthmaSlide

4

Most

Patients

withAsthma

Have

Allergic

RhinitisSlide

5

Patients

with

Allergic

Rhinitis

and

Asthma

Experience

Physical

and

Mental

ImpairmentSlide

6

Patients

withAllergic

Rhinitis

and

Asthma

Incur

Greater

CostsSlide

7

Treating

Allergic

Rhinitis

Decreased

Asthma-Related

Resource

UtilizationSlide

8

SummaryShared

Pathophysiology

of

Allergic

Rhinitis

and

AsthmaSlide

9

Allergic

Rhinitis

and

Asthma

Share

Common

TriggersSlide

10

Allergic

Rhinitis

and

Asthma

Sharea

Common

ImmunopathologySlide

11

Allergic

Rhinitis

and

Asthma

Have

Similar

Early-

and

Late-Phase

ResponsesSlide

12

Eosinophils

Characterize

Inflammation

in

Allergic

Rhinitis

and

AsthmaSlide

13

Allergic

Rhinitis

and

Asthma:Proposed

Interactive

MechanismsSlide

14

SummaryClinical

Links

Between

Allergic

Rhinitis

and

AsthmaSlide

15

Allergic

Rhinitis

Patients

Experience

Increased

BronchialHyperresponsiveness

inthe

Pollen

SeasonSlide

16

Allergen

Challenge

to

the

Nose

Increases

Bronchial

HyperresponsivenessSlide

17

Patients

withAsthma

Have

Nasal

InflammationSlide

18

Inflammatory

Changes

in

the

Nasal

and

Bronchial

Mucosa

Are

CorrelatedSlide

19

Bronchial

Allergen

Challenge

Increases

a

Marker

of

Inflammation

(Eosinophils)

in

Nasal

and

Bronchial

TissuesSlide

20

Bronchial

Allergen

Challenge

Increases

Systemic

Markers

of

InflammationSlide

21

Treatment

of

SeasonalAllergy

with

Nasal

Steroids

Reduced

Asthma

SymptomsSlide

22

Antileukotriene

TherapyImproves

Endpoints

in

Allergic

Rhinitis

and

AsthmaSlide

23

SummaryThe

Allergic

Rhinitis

and

its

Impact

on

Asthma

(ARIA)

InitiativeSlide

24

Aims

of

the

ARIA

InitiativeSlide

25

ARIA

Guidelines

Recommend

a

Combined

Approach

to

Managing

Upper

and

Lower

AirwaysSummarySlide

26

SummaryReferences过敏性鼻炎和哮喘：同一气道,同一疾病变应性鼻炎和哮喘的临床平行关系慢性变应性呼吸道综合征（chronic

allergic

respiratosyndrome）在上、下呼吸道的不同表现如果疾病不严重，尽管下呼吸道的病理表现已经存在，但是疾病的惟一表现就是鼻炎，随着鼻炎的加重，下呼吸道的症状可能变得明显一旦症状同时表现，上下呼吸道症状的严重程度平行，这种平行关系受鼻腔和下呼吸道的多种因素制约包括鼻腔对吸入空气的温度、湿度的调节作用，以及局部变应性反应与系统性变应反应双向相互作用的表现变应性鼻炎与哮喘密切相关：1998年的一项研究表明哮喘患者中变应性鼻炎的发病率为78%,而哮喘在普通人群中的发病率为5~20%。哮喘患者中过敏性鼻炎的发病率敏性鼻炎的发病率%Corren

J.

J

Allergy

Clin

Immunology.

1998;

101:

S352-356

AAAAI

data.5-20%78%变应性鼻炎与哮喘密切相关：1998年的一项研究表明哮喘患者中变应性鼻炎的发病率为78%,而哮喘在普通人群中的发病率为5~20%。过敏性鼻炎患者中支气管哮喘的发病率哮喘的发病率%Corren

J.

J

Allergy

Clin

Immunology.

1998;

101:

S352-356

AAAAI

data.3－5%38%Slide

3Allergic

rhinitis

is

an

important

risk

factor

for

asthma.

In

one

long-term

follow-up

study,

college

freshmenwith

allergic

rhinitis

were

approximatelythree

times

more

likely

to

develop

asthma

over

the

ensuing

23

years

than

individuals

without

allergic

rhinitis.

This

observed

difference

in

the

relative

risk

of

developing

asthma

was

significant

between

the

two

groups

(p<0.002).12In

fact,

allergic

rhinitis

frequently

precedes

development

of

asthma.2

One

large

population-based

study

of

11,540

adult

twin

pairs

in

Finlandshowed

that

the

diagnosis

of

“hay

fever”

was

almost

always

made

before

or

concurrently

withadiagnosis

of

asthma,

but

rarely

afterward;

hayfever

was

a

strong

predictorof

newasthma.13These

associations

may

reflect

the

shared

atopy

that

underlies

allergic

rhinitis

and

asthma,

thus

explaining,

at

least

in

part,

the

frequent

coexistenceof

these

disorders.14过敏性鼻炎能增加哮喘的危险约3倍23-year

follow-up

of

college

freshmen

undergoing

allergy

testing; data

based

on

7individuals

(69%

male)

with

average

age

of

40

years.Adapted

from

Settipane

RJ

et

al

Allergy

Proc

1994;15:21-25.12108010.5过敏性鼻炎患者(n=162)3.6不罹患过敏性鼻炎的人群(n=528)P

<

0.0026展成为哮喘患者4

的百分比%2过敏性鼻炎常见症状鼻痒：包括鼻部和非鼻部的（眼、耳、上腭等）喷嚏鼻涕鼻塞Reference:《实用耳鼻喉科学》人民卫生出版社1998是过敏性鼻炎还是感冒？Reference:《变态反应并诊断治疗学》北京协和医院1998过敏性鼻炎和哮喘有相似的发病诱因鼻炎和哮喘的诱因吸入性过敏原与鼻炎和哮喘均相关室内过敏原(尘螨等)主要引起哮喘室外过敏原(花粉等)主要引起鼻炎In

practical

terms,

a

patient

withcomplete

nasal

blockage

resulting

fromsevere

allergic

rhinitis

must

resort

to

mouthbreathing,

and

this

mayadversely

affect

the

lower

airways

because

of

a

lack

of

nasal

“air

conditioning”

and

warming,

humidification,

and

filtration

of

inspired

air.

Ref

16:

Simons,

ER.

“Allergic

rhinobronchitis:

The

asthma-allergic

rhinitis

link,”

Journal

of

Allergy

and

Clinical

Immunology1999Sep;

104(3):

534-40.

Mouth

Breathing

Caused

by

Nasal

Obstruction

worsens

exercise-induced

bronchospasm(REF

11)Study

of

9

asymptomatic

asthmatics

and

5

normal

subjects

who

inhaled

subfreezingair

througheither

nose

or

mouth

randomly,

showed

that

nasalventilation

minimizes

airwaycooling

in

both

normal

and

asthmatic

individuals

through

more

efficient

conditioning

of

inspired

air,

and

it

is

through

this

mechanismthat

this

formof

respiration

protects

against

exercise-induced

bronchospasm.

Reference

14:

Griffin

MP,

McFadden

ER

Jr,IngramRH

Jr.

“Airway

cooling

in

asthmatic

and

nonasthmatic

subjects

during

nasal

and

oral

breathing,”

Journal

of

Allergy

and

Clinical

Immunology

1982Apr;

69(4):354-9.Improvements

in

asthma

associated

with

nasal

breathing

may

be

the

result

ofsuperior

humidification

and

warming

of

inspired

air(REF

11)Similarly,

it

would

be

expected

that

airborne

allergens

and

pollutants

would

also

be

less

likely

to

enter

the

lungs

during

periods

of

normal

nasalfunction

(REF

11)Reference

11:

Corren,

J.

“The

impact

of

allergic

rhinitis

on

bronchial

asthma,”

Journal

ofAllergy

and

Clinical

Immunology

1998

Feb;

101(2

Pt

2):S352-6.哮喘和过敏性鼻炎临床上的联系鼻塞引起的张口呼吸加重运动诱导的支气管收缩哮喘症状的改善与鼻部症状的改善相关，可能是由于鼻部对于吸入空气的加温、加湿作用的恢复Corren,

J.

“The

impact

of

allergic

rhinitis

on

bronchial

asthma,”Journal

of

Allergy

and

Clinical

Immunology

1998

Feb;

101(2

Pt

2):

S352-6.Slide

15Many

examples

of

“communication”

between

the

nose

and

lungs

link

allergic

rhinitis

and

asthma.

One

such

example

is

the

bronchialhyperresponsiveness

(BHR)

observed

in

patients

with

allergic

rhinitis.

The

prevalence

of

BHR(defined

as

PD20

<1

mg*

after

carbacholchallenge)

was

evaluated

during

and

outof

pollen

season

in

27

nonasthmatic

patients

with

hay

fever.

BHR

increased

significantly

from

11%

out

ofpollen

season

to

48%

during

pollen

season

(p<0.02).

Thus,

the

expression

of

allergic

symptoms,

even

when

confined

to

the

nose,

is

associatedwith

aspecific

bronchial

hyperactivityinthe

lungs.32*PD20

refers

to

the

provocative

dose

of

a

substance,

such

as

carbachol

in

this

study,

resulting

in

a

20%

fall

in

lung

function

(FEV1).哮喘和过敏性鼻炎临床上的联系平均年龄20岁的枯草热患者;激发试验在秋季以及季节后6个月进行*激发剂量<1

mg引起FEV

20%下降Adapted

from

Madonini

E

et

al

J

Allergy

Clin

Immunol

1987;79:358-363.6050403020100病人%(n=27)11非花粉季节

花粉季节48p<0.02过敏性鼻炎的患者在花粉季节会有更多的气道高反应气道高反应的发生率*Slide

17In

a

recent

study

of

27

non-atopic

patients,

eosinophil

counts

in

nasal

biopsyspecimens

from

asthmatic

patients

(with

or

without

rhinitissymptoms)

were

consistently

and

significantly

greater

than

those

in

normal

controls

(p<0.001).

Of

the

27

subjects

who

participated,

nine

patientshad

both

asthma

and

allergic

rhinitis,

eight