Intranasal steroids and the risk of emergency department visits for asthma
ABSTRACT In patients with asthma, treatment for associated conditions, such as rhinitis, is recommended. It is unknown whether this treatment can reduce the risk for emergency department (ED) visits for asthma.
We sought to determine whether treatment with intranasal steroids or prescription antihistamines in persons with asthma is associated with a reduced risk for ED visits caused by asthma.
We performed a retrospective cohort study of members of a managed care organization aged greater than 5 years who were identified during the period of October 1991 to September 1994 as having a diagnosis of asthma by using a computerized medical record system. The main outcome measure was an ED visit for asthma.
Of the 13,844 eligible persons, 1031 (7.4%) had an ED visit for asthma. The overall relative risk (RR) for an ED visit among those who received intranasal corticosteroids, adjusted for age, sex, frequency of orally inhaled corticosteroid and beta-agonist dispensing, amount and type of ambulatory care for asthma, and diagnosis of an upper airways condition (rhinitis, sinusitis, or otitis media), was 0.7 (95% confidence interval [CI], 0.59-0.94). For those receiving prescription antihistamines, the risk was indeterminate (RR, 0.9; 95% CI, 0.78-1.11). When different rates of dispensing for intranasal steroids were examined, a reduced risk was seen in ED visits in those with greater than 0 to 1 (RR, 0.7; 95% CI, 0.57-0.99) and greater than 3 (RR, 0.5; 95% CI, 0.23-1.05) dispensed prescriptions per year.
Treatment of nasal conditions, particularly with intranasal steroids, confers significant protection against exacerbations of asthma leading to ED visits for asthma. These results support the use of intranasal steroids by individuals with asthma and upper airways conditions.
- SourceAvailable from: CS Rhee
- "These results suggest that treatment of inflammation in the upper airways indirectly improves asthma symptoms and decreases bronchial hyperresponsiveness, which is not a direct effect of the intranasally administered corticosteroid on the lower airways (Watson et al., 1993). A 3-year retrospective cohort study conducted in 14 US centers evaluated whether treatment with intranasal corticosteroid (INS) in patients of 5 years or older with asthma was associated with a reduced risk of emergency room visits for asthma (Adams et al., 2002). Treatment of nasal conditions, particularly with INSs, appeared to prevent asthma exacerbations leading to emergency room visits. "
Chapter: Comorbidities of Allergic RhinitisAllergic Diseases - Highlights in the Clinic, Mechanisms and Treatment, 03/2012; , ISBN: 978-953-51-0227-4
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- "These findings suggest that postnasal drip associated with sinusitis might trigger upper airway hyperresponsiveness and subsequently affect the lower airway through a pharyngeal-pulmonary reflex. This hypothesis is consistent with reports that demonstrate that treatment with intranasal corticosteroids can reduce the likelihood of acute exacerbations of asthma . Finally, some data indicate that chronic sinusitis and asthma may both be manifestations of a generalized inflammatory disorder of the respiratory mucosa, thus explaining their frequent coexistence. "
ABSTRACT: Respiratory infections can cause wheezing illnesses in children of all ages and also can influence the causation and disease activity of asthma. For years it has been recognized that respiratory syncytial virus infections often produce the first episode of wheezing in children who go on to develop chronic asthma. More recently, it has been proposed that repeated infections with other common childhood viral pathogens might help the immune system develop in such a way as to prevent the onset of allergic diseases and possibly asthma. In addition to the effects of viral infections, infections with certain intracellular pathogens, such as chlamydia and mycoplasma, may cause acute and chronic wheezing in some individuals, whereas common cold and acute sinus infections can trigger acute symptoms of asthma. In this article, the epidemiologic, mechanistic, and treatment implications of the association between respiratory infections and asthma are discussed.Pediatric Clinics of North America 07/2003; 50(3):555-75, vi. DOI:10.1016/S0031-3955(03)00040-3 · 2.20 Impact Factor
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- "En considérant la récente révision européenne de la nomenclature de la RA  et la nouvelle classification ARIA , nous notons que le 1/5 de nos patients rhinitiques a des tests d'allergie négatifs et que la RA est le plus souvent intermittente légère (45 %). Plusieurs études suggèrent qu'un traitement optimal de la RA améliore l'asthme     . La moitié de nos patients ne sont pas traités pour leur RA probablement parce qu'elle était sous-estimée. "
ABSTRACT: This prospective study aimed to: 1) validate a paediatric questionnaire score from which allergic rhinitis (AR) could be diagnosed, 2) estimate its prevalence in asthmatic children, and 3) ascertain if AR is an additional risk factor for the severity of asthma. The questionnaire, modified from the adult form of the SFAR, was administered to 352 asthmatic children seen in consultation between June 2005 and April 2006. AR was diagnosed in 200 of these children (56.8%). AR was mild and intermittent in 45% of cases, moderate-to-severe and intermittent in 11%, mild and persistent in 27% and moderate-to-severe and persistent in 17%. A total score ≥ 9 was discriminant for AR (sensitivity = 90.5%, specificity = 94.7%, positive predictive value = 95.8%, negative predictive value = 88.3%, Youden's Index = 0.86). The proportion of children having mild or moderate-to-severe asthma was independent of the presence of AR (43.5% vs 48.6% and 56.5 vs 51.3%, respectively). © 2006 Elsevier Masson SAS. Tous droits réservés. Mots clés : Asthme ; Enfant ; Rhinite allergique