Rinite alérgica na visão do paciente / Allergic rhinitis from a patient's perspective

Os sintomas nasais têm impacto na vida dos pacientes com rinite alérgica. A maioria das pessoas alérgicas relata impacto negativo dos sintomas de alergia no trabalho e no desempenho escolar. Dentre todos os sintomas de alergia, o mais incômodo é a obstrução nasal, embora outros sintomas também tenham impacto na qualidade de vida dos pacientes, especialmente no sono. Os anti-histamínicos orais e corticosteroides nasais são as medicações mais frequentemente utilizadas para o tratamento de rinite, seguidos por descongestionantes orais ou intranasais. Os pacientes alérgicos frequentemente compram medicações sem prescrição médica nas farmácias, e nem sempre estão satisfeitos com o tratamento que lhes é oferecido. Os médicos devem trabalhar mais na comunicação com os pacientes alérgicos para atender às suas necessidades, abordando medo de efeitos colaterais, preocupações quanto aos sintomas de alergia e como estes interferem na qualidade de vida. Desse modo, a educação do paciente baseada em melhor comunicação pode facilitar o controle da rinite alérgica.

Nasal symptoms have an impact on the daily lives of patients with allergic rhinitis. Most allergic individuals report a negative impact of allergy symptoms on work and school performance. Among all allergy symptoms, the most bothersome is nasal congestion, although other symptoms also have an impact on patients' quality of life, especially on their sleep. Oral antihistamines and intranasal corticosteroids are the most frequently used medications for rhinitis, followed by oral or intranasal decongestants. Allergic patients frequently purchase different over-the-counter medications and sometimes are not satisfied with proposed treatments. Physicians should improve the communication with allergic patients to meet their needs, addressing fear of side effects, concerns about allergy symptoms and how they impact quality of life. Thus, educating patients through better communication may improve the control of allergic rhinitis.

Intoxicación grave con nafazolina: puesta al día a partir de un error terapéutico / Severe poisoning with naphazoline: update from a therapeutic error

La nafazolina es un fármaco utilizado como descongestivo, generalmente, en pacientes adultos. Su indicación en pediatría no es frecuente; su uso está aprobado a partir de los 12 años por los efectos tóxicos que posee. La intoxicación en niños genera un cuadro clínico potencialmente grave. Se caracteriza por la aparición inmediata de hipotonía, deterioro del sensorio, hipotermia y bradicardia con grado variable de compromiso clínico. Si bien es una intoxicación infrecuente, la anamnesis y el manejo inicial del paciente son la clave en su evolución. Se presenta a un niño de 4 años que, por un error terapéutico, recibió este fármaco y se destaca la instauración rápida y potencialmente grave del cuadro clínico.

Naphazoline is a drug commonly used as a decongestant in adult patients. Its indication in Pediatrics is not frequent, being approved its use from the age of 12 for the toxic effects it possesses. Intoxication in children generates a potentially serious clinical picture. It is characterized by the immediate appearance of hypotonia, deterioration of the sensory, hypothermia and bradycardia of variable degree of clinical compromise. Although it is an infrequent intoxication, the anamnesis and the initial management of the patient are the key in the evolution. We present a 4-year-old boy who, as a therapeutic error, receives this drug, emphasizing the rapid and potentially severe establishment of the clinical picture.

Ophthalmic adverse effects of nasal decongestants on an experimental rat model / Efeitos oftálmicos adversos de descongestionantes nasais em modelo experimental com ratos

ABSTRACT Purpose: To investigate the potential effects of chronic exposure to a nasal decongestant and its excipients on ocular tissues using an experimental rat model. Methods: Sixty adult male Wistar rats were randomized into six groups. The first two groups were control (serum physiologic) and Otrivine® groups. The remaining four groups received the Otrivine excipients xylometazoline, benzalkonium chloride, sorbitol, and ethylene diamine tetra acetic acid. Medications were applied into both nostrils twice a day for 8 weeks. Before the rats were sacrificed, epithelial staining, the Schirmer test, and intraocular pressure measurements were performed under ketamine/xylasine anesthesia (50 and 5 mg/kg, respectively). Results: Epithelial defects and dry eye were common findings in all study groups. Cataracts developed in two cases clinically. Histopathological evaluation revealed many different pathological alterations in all parts of the ocular tissues such as corneal edema, polypoid proliferation and hyalinization of the vessel wall, cystic formation of the lens, retinal nerve fiber layer degeneration, and corpora amylacea formation of the lacrimal gland. Conclusions: Prolonged usage of the nasal decongestant xylometazoline and its excipients may cause ophthalmic problems such as dry eyes, corneal edema, cataracts, retinal nerve fiber layer, and vascular damage in rats. Although these results were obtained from experimental animals, ophthalmologists should keep in mind the potential ophthalmic adverse effects of this medicine and/or its excipients and exercise caution with drugs containing xylometazoline, ethylene diamine tetra acetic acid, benzalkonium chloride and sorbitol for patients with underlying ocular problems.

RESUMO Objetivo: Investigar os possíveis efeitos da exposição crônica de descongestionante nasal e seus excipientes em tecidos oculares, utilizando um modelo experimental com ratos. Métodos: Sessenta ratos Wistar adultos machos foram divididos aleatoriamente em seis grupos. Os primeiros dois grupos foram controle (soro fisiológico) e Otrivina®. Os quatro grupos restantes receberam os excipientes de Otrivina, tais como Xilometazolina, Benzalcônio, Sorbitol e Ácido Etilenodiamino Tetracético (EDTA). Os medicamentos foram aplicados em ambas as narinas dos ratos, duas vezes ao dia, durante 8 semanas. Antes que os ratos fossem sacrificados, a coloração epitelial, o teste de Schirmer e a medida da pressão intraocular foram realizados sob anestesia com Ketamina/Xilasina (50 e 5 mg/kg, respectivamente). Resultados: Defeitos epiteliais e olho seco foram achados comuns nos grupos de estudo. A catarata desenvolveu-se clinicamente em dois casos. A avaliação histopatológica revelou a existência de alterações em todas as partes dos tecidos oculares, tais como edema de córnea, proliferação polipoide e hialinização da parede vascular, formação cística da lente, degeneração da camada de fibra nervosa da retina (RNFL) e formação de corpos amiláceos da glândula lacrimal. Conclusões: O uso prolongado do descongestionante nasal Xilometazolina e seus excipientes pode causar vários problemas oftalmológicos, como olho seco, edema de córnea, catarata, RNFL e dano vascular em ratos. Embora esses resultados tenham sido obtidos a partir de animais experimentais, os oftalmologistas devem ter em mente os potenciais efeitos oftalmológicos adversos desse medicamento e/ou de seus excipientes.

Elucidation of the profound antagonism of contractile action of phenylephrine in rat aorta effected by an atypical sympathomimetic decongestant

Vasoconstrictive properties of sympathomimetic drugs are the basis of their widespread use as decongestants and possible source of adverse responses. Insufficiently substantiated practice of combining decongestants in some marketed preparations, such are those containing phenylephrine and lerimazoline, may affect the overall contractile activity, and thus their therapeutic utility. This study aimed to examine the interaction between lerimazoline and phenylephrine in isolated rat aortic rings, and also to assess the substrate of the obtained lerimazoline-induced attenuation of phenylephrine contraction. Namely, while lower concentrations of lerimazoline (10⁻⁶ M and especially 10⁻⁷ M) expectedly tended to potentiate the phenylephrine-induced contractions, lerimazoline in higher concentrations (10⁻⁴ M and above) unexpectedly and profoundly depleted the phenylephrine concentration-response curve. Suppression of NO with NO synthase (NOS) inhibitor N(w)-nitro-L-arginine methyl ester (L-NAME; 10⁻⁴ M) or NO scavanger OHB₁₂ (10⁻³ M), as well as non-specific inhibition of K⁺-channels with tetraethylammonium (TEA; 10⁻³ M), have reversed lerimazoline-induced relaxation of phenylephrine contractions, while cyclooxygenase inhibitor indomethacin (10⁻⁵ M) did not affect the interaction between two vasoconstrictors. At the receptor level, non-selective 5-HT receptor antagonist methiothepin reversed the attenuating effect of lerimazoline on phenylephrine contraction when applied at 3×10⁻⁷ and 10⁻⁶ M, but not at the highest concentration (10⁻⁴ M). Neither the 5-HT1D-receptor selective antagonist BRL 15572 (10⁻⁶ M) nor 5-HT₇ receptor selective antagonist SB 269970 (10⁻⁶ M) affected the lerimazoline-induced attenuation of phenylephrine activity. The mechanism of lerimazoline-induced suppression of phenylephrine contractions may involve potentiation of activity of NO and K⁺-channels and activation of some methiothepin-sensitive receptors, possibly of the 5-HT(2B) subtype.

Premedication Methods in Nasal Endoscopy: A Prospective, Randomized, Double-Blind Study

OBJECTIVES: To identify the optimal pharmacological method of preparing patients for nasal endoscopy. METHODS: Twenty healthy volunteers were enrolled in this prospective, randomized, double-blind study. Four types of medications were applied in their nostrils with binary combinations of spray bottles on four different days in a random order: placebo (normal saline [NS]+NS), decongestant (NS+oxymetazoline), anesthetic (NS+lidocaine), and decongestant plus anesthetic (oxymetazoline+lidocaine). Rigid nasal endoscopy was performed 10 minutes after spray application. The volunteers evaluated the discomfort caused by each spray application, and nasal pain scores due to the passage of the endoscope. The physicians quantified nasal decongestion using a visual analogue scale. Endoscopy duration as well as pulse and mean blood pressure (MBP) before spray application, 10 minutes after the application, and immediately after endoscopic examination were also recorded. RESULTS: The discomfort caused by lidocaine was significantly higher than that caused by the other sprays (P<0.001). The lowest pain score related to endoscopy was obtained for oxymetazoline+lidocaine (P<0.001). Nasal decongestion was best achieved with NS+oxymetazoline (P<0.001). Endoscopy duration was the shortest for oxymetazoline+ lidocaine (P<0.05). Statistically significant MBP changes were only seen with the application of NS+oxymetazoline (P<0.05). However, neither MBP nor pulse rate change was significant clinically. CONCLUSION: Application of decongestant and anesthetic sprays together seems to be the best method of pharmacological preparation of patients for nasal endoscopy.

Correlations between anatomic variations of maxillary sinus ostium and postoperative complication after sinus lifting

OBJECTIVES: The maxillary sinus mucosa is reported to recover to preoperative sterility after sinus floor elevation. However, when drainage of maxillary sinus is impaired, recovery can be delayed and maxillary sinusitis can occur. Therefore, in this study, we investigated the correlations between anatomic variants that can interrupt the ostium of the maxillary sinus and incidence of complication after sinus lifting. MATERIALS AND METHODS: The subjects are 81 patients who underwent sinus lifting in Wonkwang University Dental Hospital (Iksan, Korea). Computed tomography (CT) images of the subjects were reviewed for presence of nasal septum deviation, anatomic variants of the middle turbinate, and Haller cells. Correlations between anatomic variations and occurrence of maxillary sinusitis were statistically analyzed. RESULTS: Patients with anatomic variants of ostio-meatal units, such as deviated nasal septum, concha bullosa or paradoxical curvature of the middle turbinate, or Haller cells, showed a higher rate of complication. However, only presence of Haller cell showed statistically significant. CONCLUSION: Before sinus lifting, CT images are recommended to detect anatomic variants of the ostio-meatal complex. If disadvantageous anatomic variants are detected, the use of nasal decongestants should be considered to reduce the risk of postoperative sinusitis.

Drug therapy for the common cold

The common cold is an acute, self-limiting viral infection of the upper respiratory tract involving the nose, sinuses, pharynx and larynx. Drug therapies for the common cold are normally aimed at relieving the symptoms of the illness. Over-the-counter cough and cold medications should not be used in children younger than four years old because of potential harms and lack of benefit. Antibiotics, antitussives, anti-histamines, and inhaled corticosteroids are not effective in children. Products that may improve symptoms in children include expectorants, mucolytics, honey, vitamin C, zinc lozenges, geranium extract, and nasal saline irrigation. In adults, antihistamines, intranasal corticosteroids, codeine, intranasal ipratopium, and antibiotics are not effective. Decongestants, antihistamine/decongestant combi-nations, expectorants, and mucolytics may improve cold symptoms in adults. Nonsteroidal anti-inflammatory drugs and acetaminophen reduce pain secondary to upper respiratory tract infection in adults. Among complementary and alternative medicinetherapeutics, products containing vitamin C, zinc, or garlic may improve cold symptoms in adults. Prophylactic use of probiotics may decrease the frequency of colds in adults and children.

Dimensoes internas nasais de adultos com obstrucao nasal / Internal nasal dimensions of adults with nasal obstruction

O desvio septal (DS) e a hipertrofia de conchas (HC) aumentam a resistência ao fluxo aéreo respiratório, podendo prejudicar a patência nasal. OBJETIVO: Caracterizar a geometria nasal de indivíduos com obstrução nasal (ON) por DS e/ou HC usando rinometria acústica. Forma de estudo: Clínico prospectivo. MÉTODO: Foram avaliados 30 adultos com queixa de ON e DS+HC (n = 24), DS (n = 5) ou HC (n = 1) ao exame clínico e determinadas as áreas seccionais transversas em três principais deflexões do rinograma (AST1, AST2, AST3), suas distâncias relativamente às narinas (dAST1, dAST2, dAST3) e os volumes dos segmentos 1,0-3,2 cm (V1), 3,3-6,4 cm (V2) e 7,0-12,0 cm (V3), pré e pós-descongestão nasal (DN). Foram consideradas, para análise, as somas de AST e V das cavidades direita e esquerda e a média de dAST. RESULTADOS: Os valores médios (± DP) pré-DN corresponderam a 0,83 ± 0,23 (AST1), 1,66 ± 0,52 (AST2) e 2,36 ± 0,77 (AST3) cm2, 2,19 ± 0,20 (dAST1), 4,01 ± 0,33 (dAST2) e 5,85 ± 0,37 (dAST3) cm, 2,77 ± 0,51 (V1), 6,52 ± 1,99 (V2), 26,00 ± 9,62 (V3) cm3, todos menores (p < 0,05) que valores de referência do laboratório. A DN causou aumentos proporcionalmente maiores neste grupo ON, sugerindo componente funcional associado. A análise individual mostrou 12 casos com resultados normais, apesar da ON. CONCLUSÃO: A maioria dos pacientes com ON estrutural apresentou resultados sugestivos de comprometimento da patência nasal ao exame rinométrico. .

Nasal septum deviation (SD) and turbinate hypertrophy (TH) increase the resistance to respiratory airflow and may impair nasal patency. OBJECTIVE: To characterize the nasal geometry of individuals with nasal obstruction secondary to SD and/or TH by means of acoustic rhinometry. METHOD: This prospective study included 30 adults with complaints of nasal obstruction (NO) and SD + TH (n = 24), SD (n = 5) or TH (n = 1) seen by clinical examination. The cross-sectional areas of the three main dips of the rhinogram (CSA1, CSA2, CSA3), the distance between them and the nostrils (dCSA1, dCSA2, dCSA3), and the volumes of segments 1.0-3.2 cm (V1), 3.3-6.4 cm (V2), and 7.0-12.0 cm (V3) were measured before and after nasal decongestion (DN). For analysis, right and left cross-sectional areas and volumes were added and mean dCSA was calculated. RESULTS: Mean values (standard deviation) before ND were: 0.83 ± 0.23 (CSA1), 1.66 ± 0.52 (CSA2), and 2.36 ± 0.77 (CSA3) cm2; 2.19 ± 0.20 (dCSA1), 4.01 ± 0.33 (dCSA2), and 5.85 ± 0.37 (dCSA3) cm; 2.77 ± 0.51 (V1), 6.52 ± 1.99 (V2), and 26.00 ± 9.62 (V3) cm3; all values were lower than laboratory reference values (p < 0.05). ND led to proportionally greater increases of sectional areas and volumes in the NO group, suggesting an associated functional component. Individual analysis revealed 12 cases with normal results despite nasal obstruction. CONCLUSION: Most patients with structural nasal obstruction had results suggestive of nasal patency impairment in acoustic rhinometry. .

Correlação de três variáveis na descrição da permeabilidade nasal (HD, MCA, escala NOSE) de pacientes saudáveis / Correlation of three variables describing nasal patency (HD, MCA, NOSE score) in healthy subjects

Rinoresistometria e rinometria acústica são dois métodos utilizados na avaliação da função respiratória nasal. Ambos utilizam variáveis diferentes para descrever a permeabilidade nasal: o diâmetro hidráulico, HD, na rinoresistometria; e as áreas mínimas da seção transversal, MCA1 (istmo nasal) e MCA2 (cabeça do corneto inferior e corpo cavernoso do septo nasal), na rinometria acústica. OBJETIVO: Analisar a relação entre HD e MCA em pacientes sem afecções nasais e identificar se tais variáveis objetivas apresentam correlação com a escala NOSE, uma ferramenta validada para avaliar a percepção subjetiva de permeabilidade nasal. MÉTODO: Coleta estruturada dos dados de 24 indivíduos saudáveis sem afecções nasais. RESULTADOS: Correlações estatisticamente significativas de fracas a moderadas foram identificadas entre HD e MCA2 antes do descongestionamento. Foi identificada correlação moderada entre HD, MCA2 e escala NOSE no lado mais estreito. CONCLUSÃO: Na avaliação de permeabilidade nasal, parece ser recomendável determinar HD, MCA1 e MCA2, bem como uma variável subjetiva como a escala NOSE, que não aparentam ser variáveis completamente redundantes. Estudos futuros devem avaliar a correlação destas variáveis em pacientes com afecções nasais.

Rhinoresistometry and acoustic rhinometry are two established apparative methods to objectify the respiratory function of the nose. Both methods use different variables to describe nasal patency: "hydraulic diameter", HD, in rhinoresistometry, and "minimal cross-sectional area", MCA1 (nasal isthmus) and MCA2 (head of the inferior turbinate and cavernous body of the nasal septum), in acoustic rhinometry. OBJECTIVE: This study analyzes the mutual correlation of HD and MCA as a pilot study in patients without nasal pathologies. Additionally, we investigated if these objective variables correlate with the NOSE score, a validated tool to measure subjective perception of nasal patency. METHOD: Planned data collection in a collective of 24 healthy subjects without nasal pathologies. RESULTS: Statistically significant, weak to moderate correlations were found between HD and MCA2 before decongestion. A moderate correlation was found between both HD and MCA2 and the NOSE score on the narrower side. CONCLUSION: In the assessment of nasal patency, it seems advisable to determine HD, MCA1 and MCA2, but also a subjective variable such as the NOSE score, which all seem to be not fully redundant variables. In further studies, the correlation of the variables should be assessed in patients with nasal pathologies.

Posicionamento da Academia Brasileira de Rinologia sobre terapias tópicas nasais / Brazilian Academy of Rhinology position paper on topical intranasal therapy

Opresente documento tem por objetivo esclarecer àqueles que tratam das doenças nasossinusais, tanto especialistas quanto generalistas, sobre as terapêuticas tópicas nasais. Por meio de uma revisão das evidências científicas, a Academia Brasileira de Rinologia vem proporcionar sua visão prática e atualizada sobre as medicações tópicas nasais mais utilizadas, excetuando-se as medicações que possuam antibióticos tópicos na sua formulação.

This documents aims at educating those who treat sinonasal diseases - both general practitioners and specialists - about topical nasal treatments. By means of scientific evidence reviews, the Brazilian Academy of Rhinology provides its practical and updated guidelines on the most utilized topical nasal medication, except for the drugs that have topical antibiotics in their formulas.

Prevalência do uso de vasoconstritores nasais em acadêmicos de uma universidade privada do Rio Grande do Sul / Prevalence of use of nasal vasoconstrictors among students of a private university of Rio Grande do Sul

Introdução: Rinite medicamentosa é uma forma de rinite não alérgica, induzida por drogas associada ao o uso prolongado de vasoconstritores nasais. O objetivo deste estudo consiste em avaliar a prevalência do uso de vasoconstritores nasais em uma amostra de acadêmicos de diferentes cursos da graduação e compará-la entre os acadêmicos da faculdade de Medicina e demais cursos da graduação da Universidade Luterana do Brasil (ULBRA), Canoas. Método: Estudo transversal realizado durante o primeiro semestre de 2012. A associação entre as variáveis foi avaliada pelo teste qui-quadrado de Pearson ou exato de Fisher. O nível de significância adotado foi de 5% (p<0,05) e as análises foram realizadas no programa SPSS versão 18.0. Resultados: A amostra total foi composta por 405 acadêmicos. O período de uso nos grupos foi menor do que três dias (aproximadamente 43%). Cerca de 15% dos estudantes em cada grupo utilizaram gota descongestionante por mais de uma e menos de duas semanas. 10% dos estudantes utilizaram gota descongestionante por até 30 dias. 4.5% (grupo medicina) e 3% (outros cursos) utilizaram por dois meses. 6,8% dos estudantes de medicina utilizaram descongestionante nasal por mais do que um ano, comparado a 5,5% no grupo dos outros cursos. Conclusão:A diferença observada entre a prevalência do uso de vasoconstritores nasais entre acadêmicos do curso de medicina e acadêmicos dos outros cursos não foi significativa. Entretanto, foi alta prevalência do uso de vasoconstritores nasais nos grupos, o que mostra a necessidade de uma maior conscientização a respeito dos riscos da utilização de tais medicações.

Introduction: Drug-induced rhinitis is a form of non-allergic rhinitis associated with prolonged use of nasal vasoconstrictors. The objective of this study is to assess the prevalence of use of nasal vasoconstrictors in a sample of students of different undergraduate programs and compare them with undergraduate students of medicine and other academic courses of the Lutheran University of Brazil (ULBRA), Canoas. Methods: Cross-sectional study carried out in the first half of 2012. The association between variables was evaluated using the chi-square test or Fisher exact test. The level of significance was set at 5% (p <0.05) and the analyses were performed using SPSS version 18.0. Results: The sample was composed of 405 students. The period of use in the groups was less than three days (approximately 43%). About 15% of students in each group used decongestant drops for more than one and less than two weeks. 10% of students used drop decongestant for up to 30 days. 4.5% (medical group) and 3% (other courses) used them for two months. 6.8% of the medical students used nasal decongestant for more than one year, compared to 5.5% in the group of other courses. Conclusion: The difference between the prevalence of nasal vasoconstrictors in students of medicine and in other academic courses was not significant. However, the prevalence of nasal vasoconstrictors in all groups was high, which shows the need for greater awareness about the risks of using such medications.

Treatment of Allergic Rhinitis / 대한내과학회지

Allergic rhinitis (AR) is defined as chronic inflammatory reactions to common allergens in the nasal mucosa with at least two AR symptoms including rhinorrhea, nasal congestion, sneezing, nasal/ocular pruritus, and postnasal drainage. AR is a common health problem, and it affects around 10-25% of general population. Its prevalence is increasing according to the environmental changes. AR and asthma frequently coexist in the same patient, therefore we should consider it and check for asthma to diagnose AR. Antihistamines and nasal corticosteroids are recommended as the 1st line treatment of AR. Decongestants may be effective for nasal congestion, and leukotrienes are helpful to improve both nasal and bronchial inflammations in patients with AR and asthma. Allergen specific immunotherapy is useful in IgE mediated AR and can prevent the progression to asthma and new sensitizations. Appropriate AR treatment including medications and immunotherapy can improve symptoms and reduce medications. Finally improvement of quality of life can be achieved.

Treatment of Allergic Rhinitis / 대한내과학회지

Allergic rhinitis (AR) is defined as chronic inflammatory reactions to common allergens in the nasal mucosa with at least two AR symptoms including rhinorrhea, nasal congestion, sneezing, nasal/ocular pruritus, and postnasal drainage. AR is a common health problem, and it affects around 10-25% of general population. Its prevalence is increasing according to the environmental changes. AR and asthma frequently coexist in the same patient, therefore we should consider it and check for asthma to diagnose AR. Antihistamines and nasal corticosteroids are recommended as the 1st line treatment of AR. Decongestants may be effective for nasal congestion, and leukotrienes are helpful to improve both nasal and bronchial inflammations in patients with AR and asthma. Allergen specific immunotherapy is useful in IgE mediated AR and can prevent the progression to asthma and new sensitizations. Appropriate AR treatment including medications and immunotherapy can improve symptoms and reduce medications. Finally improvement of quality of life can be achieved.

Correlação entre a resistência nasal e diferentes parâmetros da rinometria acústica em crianças e adolescentes com e sem rinite alérgica / Correlation between nasal resistance and different acoustic rhinometry parameters in children and adolescents with and without allergic rhinitis

Rinometria acústica e rinomanometria são importantes técnicas de avaliação da função nasal. Ainda não está definido em que extensão suas variáveis se correlacionam. OBJETIVO: Avaliar as relações entre a resistência nasal (RN) e parâmetros da rinometria acústica em crianças e adolescentes com rinite alérgica e controles. MÉTODO: Vinte pacientes com rinite alérgica e 20 controles foram avaliados. RN, volumes (V4, V5, V2-5) e menores áreas transversais (MC1, MC2) foram mensurados em três momentos: basal, após indução de obstrução nasal e após descongestionante tópico. RESULTADOS: No grupo rinite, a RN se correlacionou significantemente com todos os volumes (V5: r = -0,60) e com MC2. Nos controles, MC1 foi o parâmetro com melhor correlação com a RN no momento basal (r = -0,53) e após descongestionante. Na análise conjunta dos dados, V5 foi o que apresentou as melhores correlações, no momento basal (r = -0,53), quando obstruído (r = -0,58) e após descongestionante (r = -0,46). CONCLUSÕES: Nossos dados demonstram haver correlação negativa e significante entre os valores de rinometria acústica e RN. Em geral, os volumes apresentaram melhor correlação com a RN do que as menores áreas transversais. V5 foi a variável com melhor correlação no grupo com rinite alérgica e na análise conjunta.

Acoustic rhinometry and rhinomanometry are important tests used to assess nasal function. The degree to which the parameters of these tests are correlated is yet to be established. OBJECTIVE: This paper aimed to study the correlations between nasal resistance (NR) and acoustic rhinometry parameters in children and adolescents with allergic rhinitis and controls. METHOD: Twenty patients with allergic rhinitis and 20 controls were enrolled. NR, volumes (V4, V5, V2-5), and minimal cross-sectional areas (MC1, MC2) were measured in three moments: baseline, after induction of nasal obstruction and after topical decongestant administration. RESULTS: Patients with allergic rhinitis had significant correlation between NR and all volumes (V5: r = -0.60) and with MC2. Among controls, MC1 was the parameter with the strongest correlation with NR at baseline (r = -0.53) and after decongestant administration. In the combined analysis, V5 had the highest correlation coefficients at baseline (r = -0.53), after obstruction (r = -0.58) and after decongestant (r = -0.46). CONCLUSIONS: Our data showed that NR and acoustic rhinometry parameters have negative and significant correlations. Nasal volumes are, in general, better correlated than minimal cross-sectional areas. V5 was the parameter with the highest correlation in the rhinitis group and in the combined analysis.

Correlação entre peak flow nasal inspiratório e escala visual analógica pré e pós uso de vasoconstrictor nasal / Correlation between the peak nasal inspiratory flow and the visual analogue scale before and after using a nasal decongestant

Introdução: A medida do pico de fluxo nasal inspiratório (PFNI) é obtida de forma simples e rápida, mas pouco difundida no Brasil. Por sua vez, a escala visual analógica (EVA) para obstrução nasal é uma medida subjetiva que também pode ser utilizada. Objetivo: Avaliar a correlação entre o PFNI com a EVA para obstrução nasal, antes e após uma mudança da patência nasal, proporcionada pela vasoconstricção tópica. Desenho do estudo: estudo clínico e experimental não randomizado. Método: 60 indivíduos voluntários incluindo pacientes, médicos, enfermeiros e auxiliares administrativos da instituição foram submetidos aos exames de PFNI e EVA antes e após a vasoconstrição nasal com cloridrato de oximetazolina a 0,05%. Resultados: O valor médio encontrado para EVA pré vasoconstricção foi de 4,1 e 2 após a vasoconstrição. Isto representou uma variação de 44% entre as medidas. Em relação aos valores do PFNI, a média encontrada na mensuração pré vasoconstricção foi de 151 l/mim e de 178 l/mim após a vasoconstricção, apresentando um acréscimo de 20%. No momento pré vasoconstrictor, o aumento de um ponto no valor médio da EVA, corresponde a um decréscimo de 3,8% no valor médio do PFNI. No pós, cada incremento de um ponto no valor médio da EVA, corresponde a um decréscimo de 4,5% no valor médio de PFNI. Conclusão: Houve uma correlação importante entre a medida objetiva da obstrução nasal através do PFNI com a mensuração subjetiva proporcionada pela EVA antes da vasoconstricção nasal. Semelhante correlação também pôde ser observada após o uso do vasoconstrictor.

Introduction: The measurement of the peak nasal inspiratory flow (PNIF) is easily and swiftly obtained, but hardly spread in Brazil though. On the other hand, the visual analogue scale (VAS) for nasal obstruction is a subjective measurement that can also be used. Objective: To evaluate the correlation between PNIF and VAS for nasal obstruction before and after occurring a change in the nasal patency caused by the topic vasoconstriction. Study outline: Non-randomized clinical and experimental study. Method: 60 volunteers, including patients, doctors, nurses and administrative assistants of the institution were submitted to PNIF and VAS examinations before and after the nasal vasoconstriction with oxymetazoline chloride at 0.05%. Results: The average value found for pre-vasoconstriction VAS was 4.1 and, for post-vasoconstriction, it was 2. This represented a 44% range between the measurements. With regard to PNIF values, the average found when measuring the vasoconstriction was 151 l/min and 178 l/min after vasoconstriction, showing a 20% increase. At the pre-vasoconstrictor moment, increasing a point in average VAS value corresponds to a 3.8% decrease in average PNIF value. In the post-vasoconstriction, each increase of a point in average VAS value corresponds to a 4.5% decrease in average PNIF value. Conclusion: There was an important correlation between the objective measurement of the nasal obstruction through PNIF and the subjective measurement provided by VAS before nasal vasoconstriction. A similar correlation could also be observed after using the decongestant.

Evaluation of the use of topic nasal decongestants in university students from health sciences courses

Nasal decongestants in Brazil are available without prescription. They are one of the most requested medications in Brazil. The use of nasal decongestants, however, may lead to serious consequences. For this study, university students majoring in the health field were evaluated in terms of their profile regarding the use of nasal decongestants. Additionally, health sciences seniors were evaluated regarding their level of knowledge concerning the correct and proper use of nasal decongestants. Among the 71.8 percent of respondents who had already used topic nasal decongestants, 64.3 percent had used this medication for at least 15 days and 64.6 percent had started using it due to nasal obstruction. The gathered data indicate that the pharmacist was the main health professional reported as having provided patients with guidance on how to use this medication. A five-point Likert Type intensity scale (3.6 ± 0.08) shows that a regular level of knowledge has been observed among the students. Most of the students polled were concluded to incorrectly use topic nasal decongestants. Furthermore, the results of this study indicate that the future health professionals are not well prepared to promote health education for patients concerning the rational use of nasal decongestants.

Os descongestionantes nasais representam um dos grupos de medicamentos mais procurados dentro da automedicação no Brasil e as consequências ocasionadas pelo uso prolongado podem ser graves. Neste estudo foi aplicado a universitários da área de saúde um instrumento de avaliação para coleta de informações relacionadas ao perfil do uso destes medicamentos e outro instrumento para os alunos do último ano destas áreas para avaliar o nível de conhecimentos sobre o uso racional e correto dos descongestionantes nasais. Dos acadêmicos entrevistados, 71,8 por cento fazem ou já fizeram o uso de descongestionantes nasais tópicos e destes, 64,3 por cento utilizaram o medicamento por menos de 15 dias; 64,6 por cento iniciaram o uso do descongestionante devido à obstrução nasal. Os dados obtidos ainda mostraram o farmacêutico como principal profissional responsável pela orientação do uso do medicamento aos usuários. Foi observado nível de conhecimento regular por parte dos alunos, através da escala de intensidade de cinco pontos do tipo Likert (3,6 ± 0,08). Conclui-se pelo uso incorreto de descongestionantes nasais tópicos pela maioria dos entrevistados e que falta preparo aos futuros profissionais para correta educação aos pacientes.

Characterization of mucoadhesive nasal gels containing midazolam hydrochloride prepared from Linum usitatissimum L. mucilage

Nasal drug delivery systems prepared from natural materials are gaining importance in the field of pharmaceutical technology. Mucilage isolated from Linum usitatissimum L. (LUM) seeds was reported to be an effective natural mucoadhesive agent. The present study deals with a comparison of various characteristics of nasal gels containing midazolam hydrochloride (HCl) prepared from mucoadhesive agent extracted from Linum usitatissimum L. seeds and synthetic polymers like HPMC and Carbopol 934P in terms of texture profile analysis, mucoadhesive strength, and in vivo drug absorption profiles. It was observed that gels formulated with the natural mucilage showed better results than the synthetic gels in all aspects like hardness, adhesiveness, cohesiveness and mucoadhesive strength. The absolute bioavailability of midazolam hydrochloride from the natural gel was 97.55 percent whereas that of synthetic gels was 57.33 percent and 76.81 percent respectively.

Sistemas de liberação nasal preparados com produtos naturais estão ganhando importância no campo da tecnologia farmacêutica. A mucilagem isolada de sementes de Linum usitatissimum L. (LUM) mostrou-se agente mucoadesivo eficaz. O presente estudo trata da comparação de várias características de géis nasais contendo cloridrato de midazolam preparados com agente mucoadesivo extraído das sementes de Linum usitatissimum L. e com polímeros sintéticos, como HPMC e Carbopol 943P, com relação ao perfil de textura, força mucoadesiva e perfis de absorção do fármaco in vivo. Observou-se que os géis formulados com mucilagem natural apresentam melhores resultados do que os sintéticos em todos os aspectos, como dureza, adesão, coesão e força mucoadesiva. A biodisponibilidade absoluta do cloridrato de midazolam a partir do gel natural foi de 97,55 por cento, enquanto que nos géis sintéticos foi de 57,33 por cento e 76,81 por cento, respectivamente.

Management of Rhinitis: Allergic and Non-Allergic

Rhinitis is a global problem and is defined as the presence of at least one of the following: congestion, rhinorrhea, sneezing, nasal itching, and nasal obstruction. The two major classifications are allergic and nonallergic rhinitis (NAR). Allergic rhinitis occurs when an allergen is the trigger for the nasal symptoms. NAR is when obstruction and rhinorrhea occurs in relation to nonallergic, noninfectious triggers such as change in the weather, exposure to caustic odors or cigarette smoke, barometric pressure differences, etc. There is a lack of concomitant allergic disease, determined by negative skin prick test for relevant allergens and/or negative allergen-specific antibody tests. Both are highly prevalent diseases that have a significant economic burden on society and negative impact on patient quality of life. Treatment of allergic rhinitis includes allergen avoidance, antihistamines (oral and intranasal), intranasal corticosteroids, intranasal cromones, leukotriene receptor antagonists, and immunotherapy. Occasional systemic corticosteroids and decongestants (oral and topical) are also used. NAR has 8 major subtypes which includes nonallergic rhinopathy (previously known as vasomotor rhinitis), nonallergic rhinitis with eosinophilia, atrophic rhinitis, senile rhinitis, gustatory rhinitis, drug-induced rhinitis, hormonal-induced rhinitis, and cerebral spinal fluid leak. The mainstay of treatment for NAR are intranasal corticosteroids. Topical antihistamines have also been found to be efficacious. Topical anticholinergics such as ipratropium bromide (0.03%) nasal spray are effective in treating rhinorrhea symptoms. Adjunct therapy includes decongestants and nasal saline. Investigational therapies in the treatment of NAR discussed include capsaicin, silver nitrate, and acupuncture.

Upper Respiratory Infections in Adults

Despite major advances in medicine, acute upper respiratory infections (URI) continue to be a huge burden on society in terms of human suffering. Acute rhinopharyngitis (common cold), acute sinusitis (viral and bacterial), acute pharyngotonsillitis, acute laryngitis are categorized as this common health problem. Several viruses can cause common cold, but rhinoviruses are by far the most common. Alleviation of symptoms with drugs such as nasal decongestants and acetaminophen, remains as the main way to manage common cold. Patients with acute pharyngotonsillitis should be treated with antibiotics (amoxicillin) for 10 days, but adult patients have low risk for late complications (rheumatic fever and glomerulonephritis) of S. pyogenes infection. Patients with acute viral sinusitis will recover over the course of 7~10 days without antibiotics. Amoxicillin is drug of choice for acute bacterial sinusitis in the practice guidelines. Evidence-based approach is greatly needed for appropriate care for URI patients. Effective antiviral agents and vaccines for URI pathogens should be studied, while the related researches can be challenging. Evidence-based practice for URI and patient education are good medical practice to deal with with these very common health problems.