Repeated bronchial histamine challenges before, during, and after the birch pollen season were performed in 22 allergic patients with bronchial hyperreactivity (BHR) treated for 6 wk with sodium cromoglycate (SCG), 20 mg, four times a day, or placebo in a double-blind, randomized group comparison. Clinical assessments of the asthmatic symptom score and peak expiratory flow revealed less symptoms and less use of bronchodilators in the SCG group. Responsiveness to histamine was significantly increased in the placebo group after 14 days with high pollen counts. After the season there was an immediate return to preseasonal value. There was no change in responsiveness in the SCG group, demonstrating significant protection against pollen-induced increase of BHR. The results support the hypothesis that inhibition of mediator release, which is demonstrated for SCG, leads to a reduction of the nonspecific BHR.
"Bronchial responsiveness is also increased in viral rhinitis  , and following nasal allergen challenge  . These observations suggest that bronchial inflammation is associated with nasal inflammation, an idea which is supported by the fact that bronchial hyperreactivity is reversed by intranasal treatment with sodium cromoglycate , nedocromil sodium  and corticosteroids  . Patients with co-existent asthma and rhinitis who are receiving treatment for allergic rhinitis have a significantly lower risk of attending accident and emergency departments and hospitalizations for asthma . "
[Show abstract][Hide abstract] ABSTRACT: There is increasing interest in the possibility that rhinitis and asthma are intricately interlinked. The aim of this baseline audit was to investigate the prevalence and characteristics of rhinitis symptoms in a large-scale UK primary care-based survey of patients with asthma.
A questionnaire about the presence/absence and type of nasal symptoms, seasonal variations, and trigger factors was developed and piloted. This was then distributed among approximately 10,500 patients with clinician-diagnosed asthma via a national database of practice nurses.
We achieved a response from 7,129 patients (68%). Of these, 76% (n=5,420) had symptoms indicative of rhinitis as shown by the presence of more than one of the following: nasal blockage; runny nose; sneezing; and itchy eyes, ears or palate. 58% reported predominantly seasonal symptoms and 42% predominantly perennial symptoms. Sneezing was reported in a significantly greater proportion of patients with seasonal (66%) than perennial (58%) symptoms, together with itchy eyes/ears/palate (seasonal 60%, perennial 48%) and rhinorrhoea (56%, 51%) (all p< or =0.001). Symptoms of nasal blockage were more commonly reported in the group with perennial symptoms (perennial 61%, seasonal 53%) (p<0.001).
In this large national baseline survey, 76% of patients with asthma reported symptoms indicative of rhinitis. In view of the very high prevalence of rhinitis among people with asthma, we suggest that the diagnosis of rhinitis is considered in all those with asthma.
[Show abstract][Hide abstract] ABSTRACT: Synthetic orally active angiotensin-converting enzyme (ACE) inhibitors have been successfully used in the treatment of congestive heart failure and hypertension, particularly in hypertensive subjects with increased renin-angiotensin-aldosterone-system activity. Adverse skin reactions, angioneurotic oedema and rapidly decreasing lung function in asthmatics have been reported following medication with ACE inhibitors. Furthermore, these drugs have been associated with a persistent dry cough in subjects without previous known bronchial hyper-reactivity. There is reason to believe that an ACE inhibitor-induced cough is due to an increased inflammatory state in the airways of susceptible individuals, and that this cough might thereby have pathophysiological features in common with the cough seen as an early symptom of asthma. All inflammatory responses, wheal and flare reactions, infiltration of neutrophils, eosinophils, basophils and monocytes were enhanced by ACE inhibitors. A dose-response relationship for the proinflammatory effect of the ACE inhibitor has been demonstrated.
Medical toxicology 10/2012; 4(5):369-80. DOI:10.1007/BF03259918
[Show abstract][Hide abstract] ABSTRACT: Airway hyperreactivity is a common feature in patients with asthma and chronic airflow obstruction. Although the intensity
of airway reactivity and the degree of airflow obstruction are generally related to eachother, airway hyperreactivity is not
an epiphenomenon of airflow obstruction. Apparently, bronchodilator therapy is also important in patients with irreversible
airflow obstruction since it may prevent sudden bronchoconstriction after contacts with nonspecific irritants.
As airway hyperreactivity does not discriminate between asthma and chronic airflow obstruction, this may suggest that they
are two aspects of the same basic process with airway hyperreactivity as one common denominator. Other factors, however, should
not be disregarded.
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