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Valls-Mateus M, Marino-Sanchez F, Ruiz-Echevarría K, Cardenas-Escalante P, Jiménez-Feijoo R, Blasco-Lozano J, Giner-Muñoz MT, Haag O, Alobid I, Plaza Martin AM, Mullol J. Nasal obstructive disorders impair health-related quality of life in adolescents with persistent allergic rhinitis: A real-life study. Pediatr Allergy Immunol 2017; 28:438-445. [PMID: 28423474 DOI: 10.1111/pai.12724] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND We previously reported a higher prevalence of nasal obstructive disorders (NOD) in pediatric patients with persistent allergic rhinitis (PER) not responding to medical treatment. The aim of this study was to determine the impact of NOD on quality of life (QoL) in this population. METHODS Real-life prospective study including 142 patients (41 children, 6-11 years old and 101 adolescents, 12-17 years old) with moderate and severe PER. After 2 months of medical treatment (intranasal steroids and antihistamines), patients were asked whether their symptoms had improved (yes/no) and classified accordingly in R, responders and NR, non-responders. Nasal symptoms (visual analog scale, VAS), NOD (nasal endoscopy), and QoL (PRQLQ, AdolQRLQ) were also assessed. RESULTS Sixty-nine adolescents and 24 children were included in the NR group. NR presented worse QoL overall scores in adolescents (3.16±1.1 vs 1.63±0.99; P=.00001) and children (2.19±0.82 vs 1.51±0.77, P=.02). Medical treatment failure was associated with worse outcomes in QoL (adolescents OR: 1.6, P<.0001; children OR: 1.04, P=.036). Female adolescents presented worse QoL scores than males (3.19 vs 2.36, P=.001). The presence of obstructive septal deviation (OR: 1.02, P=.005), obstructive turbinate hyperplasia (OR: 1.03, P=.0006), and coexistence of both (OR=2.06, P=.001) was associated with worse QoL in adolescents. A strong and highly significant correlation was found between nasal symptoms VAS and QoL. CONCLUSION The presence of NOD, particularly in adolescents, is associated with poor QoL outcomes. Assessment of NOD in pediatric PER should be considered an essential approach to determine the response to treatment and its impact on patient's QoL.
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Affiliation(s)
- Meritxell Valls-Mateus
- Unitat de Rinologia Pediàtrica, Otorhinolaringology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain.,Unitat de Rinologia i Clínica de l'Olfacte, Otorhinolaringology Department, Hospital Clínic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Franklin Marino-Sanchez
- Unitat de Rinologia Pediàtrica, Otorhinolaringology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Unidad de Rinología, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Karen Ruiz-Echevarría
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Paulina Cardenas-Escalante
- Unitat de Rinologia Pediàtrica, Otorhinolaringology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Rosa Jiménez-Feijoo
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Jaime Blasco-Lozano
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - María Teresa Giner-Muñoz
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Oliver Haag
- Unitat de Rinologia Pediàtrica, Otorhinolaringology Department, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Isam Alobid
- Unitat de Rinologia i Clínica de l'Olfacte, Otorhinolaringology Department, Hospital Clínic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ana María Plaza Martin
- Sección de Inmunoalergología, Servicio de Pediatría. Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Joaquim Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Otorhinolaringology Department, Hospital Clínic, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
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Mariño-Sánchez F, Valls-Mateus M, Cardenas-Escalante P, Haag O, Ruiz-Echevarría K, Jiménez-Feijoo R, Lozano-Blasco J, Giner-Muñoz MT, Plaza-Martin AM, Mullol J. Influence of nasal septum deformity on nasal obstruction, disease severity, and medical treatment response among children and adolescents with persistent allergic rhinitis. Int J Pediatr Otorhinolaryngol 2017; 95:145-154. [PMID: 28576524 DOI: 10.1016/j.ijporl.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/24/2017] [Accepted: 02/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the impact of different types of nasal septum deformity (NSD) on nasal obstruction, rhinitis severity and response to medical treatment among pediatric persistent allergic rhinitis (PER) patients. METHODS In a prospective, real-life study, 150 children and adolescents (mean age 13 ± 2.8 years, females 32.6%) diagnosed with PER according to ARIA guidelines were assessed by nasal endoscopy for NSD according to Mladina's classification, their response to medical treatment (intranasal steroids and antihistamines or antileucotriens), the presence of comorbidities, rhinitis severity (modified-ARIA criterion) and nasal obstruction visual analog scale score (VAS). RESULTS Most patients (87%) had 1 of the 7 types of septal deformities. There was a high prevalence of bilateral (types 4 and 6; 46%) and anterior unilateral (types 1 and 2; 25%) NSD in patients not responding to medical treatment. Type 4 (OR = 6.4; p = 0.005) or type 6 (OR = 4.4; p = 0.03) NSD increased the risk of lack of improvement with medical treatment. Coexistence of anterior unilateral or bilateral NSD with severe turbinate enlargement increased >20-fold the risk of lack of improvement. Patients with bilateral NSD presented greater rhinitis severity. Non-responder adolescents displayed higher prevalence of bilateral NSD than children (53% vs. 23%; p = 0.02). Nasal obstruction VAS was higher for patients with anterior than posterior NSD, and greater for patients with bilateral NSD than any other type of septal morphology. CONCLUSION Nasal endoscopy shows that bilateral and unilateral anterior nasal septum deformities are strongly associated with a poor response to medical treatment, greater rhinitis severity and higher nasal obstruction VAS. Consequently, nasal endoscopy is necessary in the PER patients to understand the disease severity as well as to plan a specific surgical treatment in order to improve nasal obstruction, disease severity, and patient's quality of life.
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Affiliation(s)
- Franklin Mariño-Sánchez
- Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain; Unidad de Rinología, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Immunoal lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain.
| | - Meritxell Valls-Mateus
- Immunoal lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain; Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | | | - Oliver Haag
- Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Karen Ruiz-Echevarría
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rosa Jiménez-Feijoo
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jaime Lozano-Blasco
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - María T Giner-Muñoz
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ana M Plaza-Martin
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Joaquim Mullol
- Immunoal lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain; Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain.
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Mariño-Sánchez FS, Valls-Mateus M, Ruiz-Echevarría K, Alobid I, Cardenas-Escalante P, Jiménez-Feijoo R, Lozano-Blasco J, Giner-Muñoz MT, Rodríguez-Jorge J, Haag O, Plaza-Martin AM, Mullol J. Nasal obstructive disorders induce medical treatment failure in paediatric persistent allergic rhinitis (The NODPAR Study). Pediatr Allergy Immunol 2017; 28:176-184. [PMID: 27801958 DOI: 10.1111/pai.12679] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is the most common chronic disease among children. To characterize the disease, a modified classification of severity (m-ARIA) has recently been validated in AR children. When medical treatment fails, surgery for nasal obstructive disorders (NOD) may be a therapeutic option. Our objective was to assess the prevalence of NOD and their influence in medical treatment response among children with persistent AR (PER). METHODS In a prospective, real-life study, 130 paediatric PER patients (13.1 ± 2.8 years, females 31.5%, severe rhinitis 49%) referred from Allergy to ENT department were assessed for their response (R, responders; NR, non-responders) to medical treatment (intranasal steroids and antihistamines or antileukotrienes) by direct questioning and nasal symptom visual analogue scale, the presence of NOD (septal deformity, turbinate enlargement and adenoidal hyperplasia), comorbidities, nasal symptoms, rhinitis severity (modified ARIA criterion) and asthma control (International Consensus On Pediatric Asthma criterion). RESULTS After 2 months of treatment, the NR group presented a higher prevalence of obstructive septal deformity and severe inferior turbinate enlargement when compared with the R group. Higher septal deformity and turbinate enlargement scores were strongly associated with treatment refractoriness. The prevalence of severe PER was also higher for the NR group. Higher asthma control scores were associated with the probability of treatment-induced improvement. CONCLUSIONS In paediatric PER patients, medical therapy refractoriness was associated with NOD, mainly septal deformity and turbinate enlargement. In those patients, ENT examination will facilitate an early NOD diagnosis in order to indicate potential corrective surgery.
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Affiliation(s)
- Franklin S Mariño-Sánchez
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain.,Unidad de Rinología, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya)
| | - Meritxell Valls-Mateus
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain.,Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Karen Ruiz-Echevarría
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Isam Alobid
- Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya).,Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Paulina Cardenas-Escalante
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rosa Jiménez-Feijoo
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Jaime Lozano-Blasco
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - María T Giner-Muñoz
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | | | - Oliver Haag
- Unidad de Rinología Pediátrica, Servicio de Otorrinolaringología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ana M Plaza-Martin
- Sección de Inmunoalergología, Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Joaquim Mullol
- Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain. Research Group of Excellence 2014-SGR-748, (Generalitat de Catalunya).,Unitat de Rinologia i Clinica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Barcelona, Catalonia, Spain
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