Oztürk Fadil, Türktaş Ipek, Asal Korhan, Ileri Fikret, Münevver Pinar N
Department of Pediatrics, Division of Pediatric Allergy and Asthma, Gazi University Faculty of Medicine, Ankara, Turkey.
Int J Pediatr Otorhinolaryngol. 2004 Aug;68(8):1007-15. doi: 10.1016/j.ijporl.2004.03.006.
Many patients with allergic rhinitis (AR) have bronchial hyper-responsiveness (BHR), and seasonal variation of BHR has been demonstrated in these patients. We aimed to investigate how BHR in children with seasonal AR is modified by triamcinolone acetonide aqueous nasal spray (TANS) therapy during the pollen season. A secondary aim was to assess the efficacy of TANS on nasal congestion by acoustic rhinometry and symptom scores.
A total of 34 children aged 7-18 years with grass pollen-induced AR and 18 age and sex-matched healthy controls were included in study. The patients were divided into the following two subgroups: 22 patients who had AR only; and 12 patients who had AR and asthma. All of them had a baseline BHR (PC20FEV1 methacholine < 8mg/ml). All patients received 220 microg TANS once daily for 4 weeks following a 1-week run-in period. Nasal patency was measured by acoustic rhinometry and patients recorded their nasal obstruction scores in a diary.
There was no significant difference at baseline pulmonary function test parameters between the patients and the healthy control children. None of the control subjects had BHR. Asthmatic children with AR had significantly reduced baseline PC20FEV1 when compared with the AR only group [mean +/- S.E.M., (1.60 +/- 0.57 mg/ml versus 2.93 +/- 0.42 mg/ml, P = 0.021)]. The mean PC20FEV1 values increased slightly at the end of treatment in both group (from 1.60 +/- 0.57 mg/ml to 3.25 +/- 1.11 and from 2.93 +/- 0.42 mg/ml to 3.93 +/- 1.41 mg/ml), but the change was not statistically significant. TANS produced substantial symptomatic recovery in nasal obstruction according to patients' daily diary assessments, and significantly improved all objective acoustic rhinometry parameters.
Once-daily intranasal TANS 220 microg effectively controlled nasal obstruction in children with seasonal AR according to subjective and objective assessments, and blocked the increase in BHR to methacholine after high-load natural pollen exposure. There was no correlation between patients' own subjective assessment of nasal obstruction and objective acoustic rhinometric assessment.
许多变应性鼻炎（AR）患者存在支气管高反应性（BHR），且已证实这些患者的BHR存在季节性变化。我们旨在研究在花粉季节，曲安奈德鼻喷雾剂（TANS）治疗对季节性AR儿童BHR的影响。次要目的是通过鼻声反射和症状评分评估TANS对鼻充血的疗效。
本研究纳入了34名7-18岁的草花粉诱导的AR儿童以及18名年龄和性别匹配的健康对照。患者被分为以下两个亚组：仅患有AR的22名患者；以及患有AR和哮喘的12名患者。所有患者的基线BHR（乙酰甲胆碱激发试验的PC20FEV1<8mg/ml）。所有患者在经过1周的导入期后，每天接受一次220μg的TANS治疗，持续4周。通过鼻声反射测量鼻通畅度，患者在日记中记录鼻塞评分。
患者与健康对照儿童在基线肺功能测试参数方面无显著差异。对照受试者均无BHR。与仅患有AR的组相比，患有AR的哮喘儿童的基线PC20FEV1显著降低[均值±标准误，（1.60±0.57mg/ml对2.93±0.42mg/ml，P=0.021）]。两组在治疗结束时的平均PC20FEV1值均略有增加（从1.60±0.57mg/ml增至3.25±1.11，从2.93±0.42mg/ml增至3.93±1.41mg/ml），但变化无统计学意义。根据患者的每日日记评估，TANS使鼻塞症状显著缓解，并显著改善了所有鼻声反射客观参数。
根据主观和客观评估，每日一次鼻内给予220μg的TANS可有效控制季节性AR儿童的鼻塞，并在高负荷自然花粉暴露后阻止对乙酰甲胆碱的BHR增加。患者对鼻塞的主观评估与鼻声反射客观评估之间无相关性。
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