Important research questions in allergy and related diseases: 3-chronic rhinosinusitis and nasal polyposis - a GALEN study

Chronic rhinosinusitis is one of the most common health care challenges, with significant direct medical costs and severe impact on lower airway disease and general health outcomes. The diagnosis of chronic rhinosinusitis (CRS) currently is based on clinical signs, nasal endoscopy and CT scanning, and therapeutic recommendations are focussing on 2 classes of drugs, corticosteroids and antibiotics. A better understanding of the pathogenesis and the factors amplifying mucosal inflammation therefore seems to be crucial for the development of new diagnostic and therapeutic tools. In an effort to extend knowledge in this area, the WP 2.7.2 of the GA(2)LEN network of excellence currently collects data and samples of 1000 CRS patients and 250 control subjects. The main objective of this project is to characterize patients with upper airway disease on the basis of clinical parameters, infectious agents, inflammatory mechanisms and remodeling processes. This collaborative research will result in better knowledge on patient phenotypes, pathomechanisms, and subtypes in chronic rhinosinusitis. This review summarizes the state of the art on chronic rhinosinusitis and nasal polyposis in different aspects of the disease. It defines potential gaps in the current research, and points to future research perspectives and targets.

Chronic cough related to the upper airway cough syndrome: one entity but not always the same

Purpose

Upper airway cough syndrome (UACS), described as chronic cough (CC) associated with allergic (AR), non-allergic rhinitis (NAR) or chronic rhinosinusitis (CRS), is one of the major causes of CC. We aimed to characterize a cohort of UACS patients with special attention to differences between patients with AR and NAR.

Methods

A prospective analysis of clinical data of patients, diagnosed with UACS between 2015 and 2018.

Results

There were 143 patients diagnosed with UACS, median age 52 years, women predominance (68.5%), The group comprised of 59 (41%) AR and 84 (59%) NAR subjects, CRS diagnosed in 17 (12%). Median cough duration: 48 months (IQR 24–120), median cough severity (VAS)—60 mm (IQR 42–78), median Leicester Cough Questionnaire (LCQ) score—11.3 (IQR 8.7–13.7), never-smokers: 70%. The most common symptoms: PND (62%), rhinorrhea (59%), nasal congestion (54%), abnormalities of sinus CT: septum deviation (62%), turbinates hypertrophy (53%), mucosal thickening (53%). UACS as the only cause of CC, was presented in 20 patients (14%). We found no differences between patients with AR and NAR in terms of age, gender, duration and severity of cough, BMI, blood eosinophil count, total IgE and FeNO. AR was associated with higher comorbidity of asthma than NAR (54% vs 35%, p = 0.019). Abnormalities in sinus CT scan were more frequently found in patients with NAR than AR (p = 0.018).

Conclusion

NAR is the most common upper airway disease associated with UACS. Clinical characteristics of UACS patients with AR and NAR are similar with only minor differences between these groups. It seems reasonable to plan further studies concerning relationship of NAR and cough sensitivity, also in terms of potential similar neurogenic mechanism.

Chronic cough - assessment of treatment efficacy based on two questionnaires

INTRODUCTION

Efficacy of chronic cough treatment is ambiguous. The aim of the study was to analyze chronic cough alleviation after specific treatment and the relationship between cough etiology and treatment efficacy.

MATERIAL AND METHODS

A stepwise diagnostic approach was used to diagnose cough etiology in non-smoking adults with chronic cough. In all patients specific treatment was applied. Two different questionnaires - a visual analog scale and a 5-degree scale - were used to assess cough severity before and after 4-6 months of treatment.

RESULTS

A significant correlation between pre-treatment and post-treatment results of both questionnaires was found (Spearman coefficient 0.43, p = 0.0003 and 0.73, p < 0.0001, respectively). Baseline questionnaire analysis revealed no differences in cough severity between patients with different cough causes or multiple cough causes. Although specific treatment resulted in a significant decrease of cough severity in the entire group, only partial improvement was noted. According to the visual analogue scale, a decrease of cough severity by at least 50% was achieved only in 54.4% of patients (37/68). Similarly, satisfactory improvement was noted in only 54.4% (37/68) of patients when using the 5-point scale. There were three sub-groups of patients, in whom no relevant decrease of cough severity was observed despite treatment: patients with 1. three coexisting cough causes, 2. non-asthmatic eosinophilic bronchitis, and 3. chronic idiopathic cough.

CONCLUSIONS

Cough severity does not depend on its etiology. Efficacy of chronic cough treatment in non-smoking patients is only moderate.

Causes of Chronic Cough in Non-smoking Patients

Chronic cough is a common medical problem. The aim of the study was to analyze chronic cough causes in non-smoking patients and to search for demographic factors associated with different cough reasons. The etiology of cough was determined by medical history, diagnostic tests and response to specific treatment. Patients with significant abnormalities in the chest radiograph or spirometry were not included. The study included 131 non-smoking patients; median age 54 years, 77 % female. The most frequent causes of cough were gastroesophageal reflux disease (GERD) (62 %) and upper airway cough syndrome (UACS) (46 %). Cough variant asthma and non-asthmatic eosinophilic bronchitis (NAEB) were diagnosed in 32 (25 %) and 19 (15 %) patients, respectively. Other cough causes were found in 27 patients (21 %). Asthma was a significantly more common cause of chronic cough in women than in men (31 % vs. 3 %, p = 0.005). A reverse relationship was demonstrated for UACS (39 % vs. 67 %, p = 0.01). Patients with chronic cough aged >50 yrs were more likely to be diagnosed with less common cough causes. In conclusion, the most common chronic cough reasons are GERD and UACS. Asthma-related cough is diagnosed more frequently in females, while UACS-related cough is more frequent in males.

Recorded prevalence of nasal polyps increases with age

INTRODUCTION

Nasal polyps are a multifactorial inflammatory condition of the upper airways. Nasal polyps typically affect middle-aged and elderly patients, average age at diagnosis is 40 to 60, and men are affected more commonly than women.

AIM

To analyse the reported prevalence of nasal polyps in the Polish population, including demographics and co-morbidities, and to estimate the costs of outpatient and hospital (inpatient) services financed by the National Health Fund.

MATERIAL AND METHODS

Statistical analysis of data extracted from the National Health Fund (NHF) registers for 2008-2018.

RESULTS

In 2018, the recorded prevalence of nasal polyps in Poland was 52.0/10,000 population (0.52%), amounting to 64.6/10,000 (0.65%) in men and 40.2/10,000 (0.40) in women. Nasal polyps were much more frequent in patients aged 55-59 (98.1/10000) and 75-79 years (98.7/10,000). Among men, the highest prevalence was found in the 75-79 age group (164.3/10,000 population), and among women in the 55-59 age group (75.1/10,000). In 2018, the Polish NHF spent PLN 17.2 million (equivalent to EUR 4.0 million/USD 4.7 million) on health services related to the diagnosis of nasal polyps. Hospital services accounted for 77.4% of the total cost.

CONCLUSIONS

Nasal polyps are more than one and a half times as prevalent in men than in women. The recorded prevalence of nasal polyps increases with age, with the rates peaking in those between 75 and 79 years old, and is more often in urban than rural areas.

Znaczenie czynnościowej chirurgii nosa w leczeniu obturacyjnego bezdechu podczas snu (OBPS)

INTRODUCTION

Nasal obstruction is widely mentioned among the factors influencing pathophysiology of obstructed breathing disorders during sleep. However numerous observations confirms such relation, influence of nasal surgery on frequency and intensity of obstructive episodes during sleep remains modest and unpredictable in vast majority of cases. The aim of this study was to evaluate the role of functional nasal surgery in the treatment of Obstructive Sleep Apnea Syndrome (OSAS).

MATERIAL AND METHODS

The study included 83 subjects with OSAS diagnosed by polysomnography and elevated nasal resistance due to different deformities of nasal skeleton. All patients underwent appropriate surgical treatment. Evaluation of day somnolence using Epworth Scale and subjective analysis of snoring and other sleep disturbances using linear scale was carried before and after surgery. Objective results of treatment were assessed by polysomnograpy performed 3 to 4 months after operation.

RESULTS

The results obtained in our group of patients showed a large discrepancy between the subjective estimation of the treatment indicated by the patients and the objective determinations of the polysomnographic test. The average day somnolence intensity was decreased approximately 2 times and 72 (86%) patients stated that snoring intensity as well as other night time symptoms of sleep apnea greatly diminished. Furthermore in the group of 19 patients who continued nCPAP therapy after surgery the side effects of this treatment diminished and lower therapeutic pressure could be provided.

CONCLUSIONS

Correction of nasal obstruction have to be considered in all patients with OSAS because it may help relieve airway obstruction during sleep and improve the general quality of live at least in patients self estimation. Furthermore, an improvement of nasal patency diminishes the side effects of nCPAP therapy and provides lower therapeutic pressure.

Allergic rhinitis - effective treatment according to the latest recommendations

Allergic rhinitis (AR) is a common chronic respiratory disease, that affects millions of individuals, has significant impact on their quality of life, productivity, and other existing conditions, including asthma and conjunctivitis. Despite a substantial burden on individuals, society and health economies, AR remains under-diagnosed, under-estimated and under-treated. Main symptoms defining this IgE-dependent inflammation of nasal mucosa are: sneezing, itchy nose, rhinorrhoea and nasal congestion. Real-world data obtained by mobile technology offer new insights into AR phenotypes and therapy. Clinical management aims to relieve or control symptoms, resolve allergic inflammation, and potentially induce allergen tolerance, using allergen immunotherapy. Most cases of AR respond rather satisfied to pharmacotherapy. A very useful tool, especially recommended for everyday clinical practice, is VAS (visual analogue scale) which can help with: to assessing the intensity of AR symptoms as well as choosing the most optimal therapeutic option. Pharmacological treatment of the condition should be safe; effective and easy to administer as we treat patients with chronic condition, sometimes for a long time. Most frequently used treatment of AR include oral, intranasal or ocular antihistamines, intranasal corticosteroids or combined intranasal antihistamines and corticosteroids. Based on real-life clinical experience it can be concluded that a fixed combination of intranasal corticosteroid and intranasal antihistamines (mainly MP-AzeFlu) may be considered to be most beneficial, particularly in monotherapy and AR resistant to previous treatment. Some AR patients are not satisfied with provided treatment results when the disease becomes only partially controlled. We still have unmet patients needs and we are still looking for better therapeutic options in this area. New initiatives such as EUFOREA are developed in parallel with existing ones, such as ARIA to integrate patients and healthcare professionals in the therapeutic process and create new recommendations that are closest to the idea of precision medicine, delivering the right treatment to the right patient at the right time.

Acute sinusitis in daily clinical practice

Understanding the appropriate use of diagnostics and treatment in acute rhinosinusitis is of immense importance given the high prevalence of this disease in the general population. The ability to differentiate between the principal phenotypes of acute sinusitis, namely acute viral infection (cold), acute post-viral sinusitis and acute bacterial sinusitis, determines the future management and is fundamental to providing rational therapeutic recommendations - especially as regards antibiotic treatment, which is very often overused in acute sinusitis even though bacterial phenotypes only account for 0.5-2% of all cases of the disease. The latest therapeutic recommendations contained in the EPOS2020 position paper introduce a system based on integrated care pathways (ICPs), which comprise pharmacy-supported self-care and e-health as the first level, followed by primary care as the second, with specialist care being reserved for patients who develop a more severe course of the disease, have suspected complications or suffer from recurrent acute sinusitis. Management of acute sinusitis is primarily based on symptomatic treatment modalities, with phytotherapeutic support, as well as on antiinflammatory treatment, while antibiotic therapy is used in very specific and limited indications. Complications are relatively rare in acute sinusitis and they are not considered to be associated with antibiotic intake. Considering the high prevalence of acute forms of sinusitis, their significant impact on quality of life and high direct and indirect costs of treatment, the right diagnosis and management, without unnecessary escalation of therapy, can substantially translate into a number of public health benefits.

Body build--is it a factor in acute subglottic laryngitis?

Acute subglottic laryngitis (pseudocroup) is caused by viral infection and usually occurs in children from 6 months to 4 years of age. Obese children are considered to be more susceptible to the disease. In order to evaluate the influence of nutritional status on acute subglottic laryngitis occurrence, an analysis of 193 patients was performed. A group of 70 age-matched healthy children served as the control subjects. The nutritional status of children (body weight and height) was assessed and their percentile positions on the weight and weight-height charts were determined. The recurrence of pseudocroup coexistence of allergy and breast-feeding history were considered in the study. Results of statistical analysis indicate no significant difference in weight and weight-height percentile distribution between patients group and controls. The recent changes in child nutrition might be the explanation of decreased susceptibility to pseudocroup among overfed children.

The relationship between nasal polyps, bronchial asthma, allergic rhinitis, atopic dermatitis, and non-allergic rhinitis

INTRODUCTION

Nasal polyps are frequently associated with bronchial asthma and rhinitis. The chronic nature of the symptoms, the high post-treatment recurrence rates, as well as various comorbidities, constitute key factors that significantly affect the quality of life of patients diagnosed with this condition.

AIM

The purpose of the study was to estimate the prevalence of nasal polyps in the examined population and to assess the possible associative occurrence of nasal polyps (NP) with bronchial asthma (BA), allergic (AR) and non-allergic rhinitis (NAR), and atopic dermatitis (AD).

MATERIAL AND METHODS

The ECRHS II and ISAAC questionnaires of the study group of 18,458 individuals, including 4,473 6-7-year-olds (24.2%), 4,675 13-14-year-olds (25.4%), and 9,310 20-44-year-olds (50.4%) were performed.

RESULTS

The prevalence of nasal polyps in the examined group was 1.1%, reported by a total of 204 individuals. Nasal polyps were reported more frequently among urban residents (191 (1.1%)) than rural residents (13 (0.6%)). Our study demonstrated a correlation between the presence of nasal polyps and asthma, as well as allergic and non-allergic rhinitis The greatest risk factor for NP in the evaluated subpopulation with multiple allergic conditions was the co-existence of non-allergic rhinitis and atopic dermatitis (OR = 6.09; 95% CI: 3.4-10.93).

CONCLUSIONS

Nasal polyps are relatively rare in the evaluated Polish population. Nonetheless, we believe their co-occurrence with non-allergic rhinitis, allergic rhinitis, bronchial asthma, and atopic dermatitis to be of significant importance, as it illustrates the phenomenon of multimorbidity of inflammatory conditions affecting the upper and lower respiratory tract.

[Nimesulide (Aulin)--the selective COX-2 inhibitor in the treatment of ENT diseases]

Nonsteroidal antiinflammatory drugs (NSAIDs) are widely used in the treatment of controlling inflammatory process and relief of pain in upper airways disorders, due to their inhibition of the cyclooxygenase (COX). After classical NSAIDs different adverse effects are observed, which limit their usage in many patients. The beginning of the nineties gave the evidences, that two cyclooxygenase isoforms existed: COX-1 and COX-2. The blockage of COX-1 in consequence cause the adverse effects of NSAIDs. And COX-2 is responsible for the most inflammatory symptoms, such as pain, oedema, fever, increase of vessel permeability. So the selective inhibitors of COX-2 would be much more safe drugs, comparing with the classical NSAIDs in the treatment of inflammatory diseases. Nimesulide belongs to the new generation of NSAIDs. It not only inhibits more selectively the activity of COX-2, but has also some other properties, that increase its antiinflammatory and analgesic function. Effectiveness of nimesulide has been demonstrated by numerous clinical studies in various inflammatory diseases of upper airways. Its anti-inflammatory, analgesic and antipyretic efficacy has been at least comparable with classical NSAIDs, but the adverse effects of nimesulide have been milder and less frequent. So all those facts suggest, that nimesulide should be taken into account in the treatment of the inflammatory diseases of the ear, nose and throat.

Rational treatment of acute rhinosinusitis in the context of increasing antibiotic resistance

Acute rhinosinusitis is one of the most common diseases in the population, both in primary and specialist otolaryngological care. It is also responsible for a disturbingly high percentage of prescribed antibiotic therapy, regardless of the etiology of the disease. Despite the fact that acute viral and acute postviral rhinosinusitis dominate among the phenotypes of acute rhinosinusitis, and the development of acute bacterial rhinosinusitis occurs in only 0.5-2% of all cases in adults and 5-10% in children, antibiotics still remain an important element of treatment, despite alarming data on the growing antibiotic resistance and the adverse effect of antibiotics on the human microbiome, leading to dysbiosis. The discovery of antibiotics was one of the greatest achievements of modern medicine, but their inappropriate use leads to the gradual increase in the phenomenon of antibiotic resistance, considered one of the most serious public health problems, recognized by the WHO as one of the 10 greatest threats to human health in the 21^st century. The unjustified use of antibiotics in outpatient care is the key to the growth of this problem, in parallel with the lack of patient compliance. The COVID pandemic has intensified this unfavourable trend. That is why the knowledge of antibiotic stewardship is so important. According to the guidelines, in the therapy of acute rhinosinusitis, symptomatic and anti-inflammatory treatment dominates, and antibiotic therapy has very strictly defined and limited indications. The latest guidelines also recommend herbal medicines, including BNO 1016, in the treatment of acute viral and postviral rhinosinusitis. Available studies indicate that it has a beneficial effect not only on shortening the duration of the disease and reducing symptoms, but also reduces the need for antibiotic treatment in acute rhinosinusitis. Complications of acute rhinosinusitis are relatively rare and are not related to taking antibiotics.

[Mucocele of the paranasal sinuses]

Twelve cases selected from the group of 123 chronic rhinosinusitis patients are presented in the paper. Severe headaches were noted as the most typical complaints of the clinical picture of the disease. The most cases were accompanied by rhinitis and paranasal sinusitis symptoms. The best diagnostic method of mucocele is MRI. The endoscopic sinus surgery is a safe and effective method of the treatment in a case of mucocele.

[Spontaneous changes of nasal patency, the nasal cycle, classification, frequency, and clinical significance]

The nasal cycle is classically defined as rhythmic, alternating side to side fluctuation in nasal airflow. It is known to be regulated by autonomic nervous system probably from the centres located in brainstem. Its classical form requires identical periods and equal amplitude of patency changes, with the total airflow remaining unchanged. This pattern was previously shown to occur in 75% healthy adults. In more recent studies is has been shown that spontaneous changes in nasal patency are in most cases of more irregular pattern. This article describes methods of detection, classification, current views on the role of the cycle.

Does the established cause of chronic cough depend on diagnostic approach?

The objective of the present study was to evaluate the prevalence of chronic cough causes and to compare the efficacy of two diagnostic approaches used in ambulatory vs. hospitalized setting. Eighty patients with chronic cough, 40 in each group, were enrolled into the study. The etiology of cough was determined on medical history and on either basic (in out-patients) or detailed (in in-patients) investigations on most common causes of chronic cough. We diagnosed etiology of cough in all subjects. The most frequent causes of cough were gastroesophageal reflux disease (GERD) and upper airway cough syndrome (UACS). Nonasthmatic eosinophilic bronchitis (NAEB) and multiple cough causes were recognized more often in hospitalized patients (P<0.05). We conclude that the main causes of chronic cough were GERD and UACS. An extensive diagnostic approach allows recognizing NEAB more frequently and reveals the complex nature of chronic cough.

[Acoustic rhinometry in the assessment of the topical treatment of upper respiratory infections with fusafungin]

The aim of the study was to estimate by means of acoustic rhinometry (AR) the nasal blockade in 37 patients (5-73 years old, mean 32) with upper airways infections treated by fusafungine. The examinations were carried out on the first (D1) and seventh day (D7) of observation. Cross-sectional area (CA) mean values of 3 cm sector laid back to C notch of AR curves (CA-C3) were selected to the analysis.

RESULTS

The mean value of CA-C3: in all patients it was 2.61 cm2 on D1 and 2.8 cm2 on D7; in rhinitis and sinusitis patients--2.23 cm2, in others--3.16 cm2; without nasal discharge--3.48 cm2, in others (with severe or medium)--2.53 cm2 and 2.48 cm2 respectively. 29 patients had nasal blockade (78.4%) with mean CA-C3 = 2.34 cm2 (others--3.56, p < 0.05). During seven days the following enlargement of CA-C3 was reported: 14.9% in all patients (p < 0.01); in viral infections 24% (n = 14, p < 0.01), bacterial 14.3% (n = 11, NI); in nasal blockade patients--15.22%, others--13.55% (p < 0.01). Mean value of CA-C3 increased by 37.7% in patients who demonstrated, according to the physicians, "very good improvement", 5.7%--"good", 1.5%--"weak" (p < 0.05). There was also enlargement of nasal cavities in CA-C3 in non-sneezers (p < 0.05) and medium discharge symptom patients (p < 0.05). There was no statistical difference in clinical and acoustic rhinometry results between patients treated with fusafungine together with non-steroid anti-inflammatory drugs and patients treated with fusafungine.

CONCLUSION

AR is a good instrument to be used in the objective assessment of the nasal blockade changes in people with infection of the nasal mucosa and showed positive efficacy of fusafungine in the treatment of upper airway infection.

[Nasal polyps is not a homogenous pathology]

Nasal polyposis is still a disease of unknown etiology. Looking at its clinical course it seems to be not homogenous pathology. Inflammation of the mucosa, mainly eosinophilic is probably the most important factor, which leads to the development of nasal polyps.

THE AIM OF STUDY

To analyze and compare the history data and eosinophilic inflammation parameters in patients with nasal polyps.

MATERIAL AND METHODS

67 patients with nasal polyposis were included into the study. They were divided into three groups: PP-primary nasal polyps (n = 33-49.2%); A-polyps and bronchial asthma without aspirin intolerance (n = 19-28.4%); ASA-polyps and aspirin-induced asthma (n = 15-22.4%). The history data were taken using patient's questionnaire. To assess the eosinophilic inflammation intensity the blood and nasal eosinophilia and serum eosinophilic cationic protein (ECP) concentration were measured.

RESULTS

The average age of all patients was 55 +/- 1.5 (range 32-76), the age distribution was comparable in all groups. The ratio males:females--1.5:1 (PP--2.7:1; A--1.1:1; ASA--0.7:1. The females with nasal polyps much more often suffer from asthma than males (p = 0.036). The age when polyps were first seen was 45.1. The duration of nasal polyps was 10 +/- 10 years (range 0.5-30 years): PP-- 10 +/- 9; A-- 14 +/- 11; ASA-- 7 +/- 7 (A/ASA-- p = 0.045). Period of 6.6 years of rhinitis had preceded the diagnosis of nasal polyposis (PP--7.3; A--7.1; ASA--4.5). Age when asthma was developed (A+ASA groups)--45.5; the duration of asthma was 11 +/- 9 years. 58% of patients had polypectomy/ethmoidectomy (PP--45%; A--60%; ASA--80%). The number of operations per one patient: 1.3 (PP--1.0; A--1.2; ASA--2.0), the most often performed in ASA group (PP/ASA-- p = 0.01 and A/ASA-- p =0.045). The mean interval between polypectomies in all patients--9.1 years (PP--10; A--12, ASA--3.5). Blood eosinophilia: 5.6 +/- 0.4% (PP-- 4.6 +/- 0.5; A-- 6.2 +/- 0.9; ASA-- 7.2 +/- 0.9% and PP/ASA-- p = 0.019; PP/A+ASA-- p = 0.03). Nasal eosinophilia: 18.5 +/- 3% (PP-- 15.0 +/- 4; A-- 15.5 +/- 6; ASA-- 30.0 +/- 8% and PP/ASA-- p = 0.01; A/ASA-- p = 0.02). Serum ECP concentration: 24 +/- 2 microg/l.

CONCLUSIONS

The patient's history and the intensity of eosinophilic inflammation are not similar in all nasal polyposis patients, that support the classification into PP, A and ASA groups. The most severe clinical picture and the highest values of eosinophilic parameters are observed in ASA group. Aspirin intolerance seems to be unfavourable prognostic factor in nasal polyposis.

[Ethmoiditis with orbital complications in children]

Five ethmoiditis cases with orbital complications in children aged 3.5 to 6 years were analysed. All were treated at almost at the same time in Warsaw hospitals in October 1994. Among the five presented cases, four were treated surgically. The value of CT examination in diagnosing ethmoiditis is stressed by the authors.

[Effect of nasal obstruction on subjective assessment of sleep quality by the patients with obstructive sleep apnea]

In 52 patients with Obstructive Sleep Apnea Syndrome (OSAS) and nasal obstruction due to nasal septum deformation, hypertrophy of inferior nasal concha or posttraumatic external nose deformity the evaluation of the day somnolence using the Epworth Scale was carried out. The patients were randomly divided in to two groups. The first group consisted of 40 patients who were subjected to appropriate corrective surgery of the nasal obstruction. The remaining 12 patients constituted the control group. After 3 month each of the patients was asked to fill in the same questionnaire. Among the patients who underwent the surgical procedure day somnolence intensity was decreased approximately 2 times whereas in the control group no significant changes were observed. Results of this study could be crucial for the discussion concerning the complex influence of the nasal obstruction on the pathomechanism and symptomatology of obstructive breathing disorders during sleep.

[Clinical assessment of azelastine nasal spray in seasonal allergic rhinitis]

The authors have studied the effect of azelastine nasal spray in the treatment of seasonal allergic rhinitis. The trial was a double-blind, placebo controlled study, with 33 allergic subjects (17 female, 16 male), 15-40 years old. The patients were randomized into two parallel groups, to receive daily 0.56 mg of azelastine intranasally or placebo during two weeks. Before and after treatment severity of nasal symptoms such as: sneezing, itching, nasal blockage, nasal discharge and general feeling were evaluated by patients according to VAS (visual analogue scale). At the same time the physician's evaluation of nasal oedema, nasal discharge and general patient's condition were performed (VAS). Additionally during the treatment patients noted possible adverse events. Patient's and physician's evaluations showed clinical efficacy in the azelastine group and no evident efficacy in the placebo group--between those two groups statistical significances were noted for all evaluated parameters (p < 0.001). The bitter taste in the mouth was the only serious side effect in some patients in azelastine group, although this was quite well accepted. Generally the treatment was well-tolerated. Azelastine nasal spray is an effective and well-tolerated drug in the treatment of seasonal allergic rhinitis.