哮喘联盟

   摘要
   背景：过敏性鼻炎与哮喘相关的观点已得到广泛认可；但是，上、下呼吸道相互作用的潜在机制并不明确。
   目的：在过敏性患者中研究过敏性鼻炎和哮喘之间的症状-炎症相关性。
   方法：共520例使用吸入型皮质类固醇激素的哮喘患者纳入研究，并进行以下检测：哮喘控制量表、肺功能测试、呼出一氧化氮分数（FENO）、鼻症状视觉模拟评分、过敏性哮喘量表和血清特异IgE（研究1）。针对不完全控制的哮喘患者（哮喘控制量表>0.75）和中重度持续性过敏性鼻炎患者，观察鼻皮质类固醇激素的症状和炎症指标变化。
   结果：共348例（66.9%）患者为特异性的过敏性鼻炎患者。不同鼻炎活动性患者的不完全控制哮喘患者比例存在显著差异（无鼻炎，11.0%；轻度间歇性鼻炎，20.4%；中重度间歇性鼻炎，44.6%；轻度持续性鼻炎，53.1%；中重度持续性鼻炎，65.7%）。FENO水平随着鼻炎活动性的增加而增加，鼻症状视觉模拟评分与FENO水平显著相关(r= 0.31; P < .0001)。鼻腔吸入类固醇激素治疗能改善鼻症状视觉模拟评分、哮喘控制量表和FENO水平。此在，所有指标中的变量变化存在相互影响。
   结论：本项关于过敏性体质患者的观察性研究表明过敏性鼻炎可通过增加下呼吸道炎症而加重哮喘恶化。
 

（刘国梁 审校）
JAllergyClinImmunolPract.2014Mar-Apr;2(2):172-178.e1.doi:10.1016/j.jaip.2013.09.018. Epub 2013 Dec 27.

 

Ongoing allergic rhinitis impairs asthma control by enhancing the lower airway inflammation.
 

Oka A1, Matsunaga K2, Kamei T3, Sakamoto Y4, Hirano T1, Hayata A5, Akamatsu K1, Kikuchi T1, Hiramatsu M1, Ichikawa T1, Nakanishi M1, Minakata Y1, Yamamoto N1.
 

Abstract
BACKGROUND: The relationship between allergic rhinitis and asthma is well accepted; however, little is known about the mechanism that underlies the interactions between the upper and lower airways.
OBJECTIVE: To investigate the symptomatic and inflammatory linkages between allergic rhinitis and asthma in patients with atopy.
METHODS: We enrolled 520 patients with asthma who were taking inhaled corticosteroids, and examined them by using the Asthma Control Questionnaire, spirometry, exhaled nitric oxide fraction (FENO), visual analog scale for nasal symptoms, allergic rhinitis questionnaire, and serum specific IgE (study 1). The symptomatic and inflammatory marker responses to nasal corticosteroids in patients with incompletely controlled asthma (Asthma Control Questionnaire > 0.75) and moderate-to-severe persistent allergic rhinitis were also observed (study 2).
RESULTS: A total of 348 patients (66.9%) had atopy and allergic rhinitis. There was a striking difference in the proportion of patients with incomplete asthma control, depending on the presence as well as the activity of rhinitis (no rhinitis, 11.0%; mild intermittent, 20.4%; moderate-to-severe intermittent, 44.6%; mild persistent, 53.1%; moderate-to-severe persistent, 65.7%). The FENO levels were increased with the activity of rhinitis, and the nasal visual analog scale was positively correlated with the FENO levels (r = 0.31; P < .0001). The additive treatment with nasal corticosteroids improved the nasal visual analog scale, Asthma Control Questionnaire, and FENO levels, and the changes in these variables were correlated with each other in all parameters (all P < .001).
CONCLUSION: This observational study of patients with atopy indicates that the ongoing allergic rhinitis is related to worsening of asthma by enhancing the lower airway inflammation.
 

JAllergyClinImmunolPract.2014Mar-Apr;2(2):172-178.e1.doi:10.1016/j.jaip.2013.09.018. Epub 2013 Dec 27.