O impacto do tratamento fonoaudiológico no controle da asma e da rinite alérgica em crianças e adolescentes respiradores orais / The impact of speech therapy on asthma and allergic rhinitis control in mouth breathing children and adolescents

OBJETIVO: Detectar o impacto do tratamento fonoaudiológico no controle da asma e da rinite alérgica em crianças e adolescentes respiradores orais. MÉTODOS: Trata-se de um estudo quase-experimental; foram randomizados 24 pacientes com asma, rinite alérgica e respiração oral, idade de 6 a 15 anos. Todos os pacientes usavam dipropionato beclometasona inalação oral. No momento em que aceitaram participar da pesquisa, a inalação oral foi substituída pela inalação exclusivamente nasal na inspiração e, após 1 mês, associou-se ao tratamento fonoaudiológico em metade dos pacientes. Esses receberam 16 sessões de tratamento fonoaudiológico em 8 semanas, além do dipropionato de beclometasona inalação exclusivamente nasal (grupo DBF). O grupo de comparação recebeu somente dipropionato beclometasona inalação exclusivamente nasal (grupo DBI). Os dois grupos foram avaliados em cinco tempos. Utilizou-se o escore clínico da rinite alérgica, da asma, o protocolo de avaliação miofuncional orofacial adaptado de Marchesan (2003), a observação dos responsáveis, dados de espirometria, de pico de fluxo inspiratório e de pico de fluxo expiratório. RESULTADOS: Houve melhora significativa do grupo DBF: escores clínicos da asma no tempo 5 (p = 0,046); valores do pico de fluxo inspiratório no tempo 4 (p = 0,030); pico de fluxo expiratório no tempo 3 (p = 0,008); modo respiratório e postura de lábios (p = 0,000) a partir do tempo 3; observação dos responsáveis, no tempo 2, tempo 4 e tempo 5 (p = 0,010; p = 0,027; p = 0,030). CONCLUSÕES: O tratamento fonoaudiológico associado ao dipropionato beclometasona por inalação exclusivamente nasal promoveu um controle clínico e funcional mais precoce e duradouro da asma, da rinite alérgica e da respiração oral entre os grupos estudados.

OBJECTIVE: To determine the impact of speech therapy on asthma and allergic rhinitis control in mouth breathing children and adolescents. METHODS: This was a quasi-experimental randomized study of 24 mouth breathing patients with asthma and allergic rhinitis, aged from 6 to 15 years. All patients were taking beclomethasone diproprionate through oral inhalation at the start of the study. At enrollment on the study, oral inhalation was substituted with exclusively nasal inhalation and 1 month later half of the patients began speech therapy. They attended 16 speech therapy sessions in 8 weeks and continued taking beclomethasone dipropionate through exclusively nasal inhalation (BDT group). The comparison group received only beclomethasone diproprionate through exclusively nasal inhalation (BDI group). Both groups were assessed five times. Clinical scores were calculated for allergic rhinitis and asthma, an adapted version of the Marchesan orofacial myofunctional assessment protocol was applied, and parents/guardians' observations were recorded, in addition to spirometry measurements of peak inspiratory and peak expiratory flow. RESULTS: There were significant improvements in the BDT group: clinical asthma score at T5 (p = 0.046); peak inspiratory flow at T4 (p = 0.030); peak expiratory flow at T3 (p = 0.008); breathing mode and lip position (p = 0.000) from T3 onwards; and parents/guardians' observations at T2, T4, and T5 (p = 0.010; p = 0.027; p = 0.030). CONCLUSIONS: Speech therapy in combination with beclomethasone diproprionate through exclusively nasal inhalation resulted in earlier and longer-lasting clinical and functional control of asthma, allergic rhinitis, and mouth breathing than was achieved in the group that only took beclomethasone diproprionate.

The impact of speech therapy on asthma and allergic rhinitis control in mouth breathing children and adolescents.

OBJECTIVE: To determine the impact of speech therapy on asthma and allergic rhinitis control in mouth breathing children and adolescents. METHODS: This was a quasi-experimental randomized study of 24 mouth breathing patients with asthma and allergic rhinitis, aged from 6 to 15 years. All patients were taking beclomethasone diproprionate through oral inhalation at the start of the study. At enrollment on the study, oral inhalation was substituted with exclusively nasal inhalation and 1 month later half of the patients began speech therapy. They attended 16 speech therapy sessions in 8 weeks and continued taking beclomethasone dipropionate through exclusively nasal inhalation (BDT group). The comparison group received only beclomethasone diproprionate through exclusively nasal inhalation (BDI group). Both groups were assessed five times. Clinical scores were calculated for allergic rhinitis and asthma, an adapted version of the Marchesan orofacial myofunctional assessment protocol was applied, and parents/guardians' observations were recorded, in addition to spirometry measurements of peak inspiratory and peak expiratory flow. RESULTS: There were significant improvements in the BDT group: clinical asthma score at T5 (p = 0.046); peak inspiratory flow at T4 (p = 0.030); peak expiratory flow at T3 (p = 0.008); breathing mode and lip position (p = 0.000) from T3 onwards; and parents/guardians' observations at T2, T4, and T5 (p = 0.010; p = 0.027; p = 0.030). CONCLUSIONS: Speech therapy in combination with beclomethasone diproprionate through exclusively nasal inhalation resulted in earlier and longer-lasting clinical and functional control of asthma, allergic rhinitis, and mouth breathing than was achieved in the group that only took beclomethasone diproprionate.

Comparison of a generic and a rhinitis-specific quality-of-life (QOL) instrument in patients with house dust mite allergy: relationship between the SF-36 and Rhinitis QOL Questionnaire.

BACKGROUND: Generic and disease-specific quality-of-life (QOL) questionnaires are commonly used in subjects with allergic rhinitis (AR). AR, however, is closely associated with other disorders such as bronchial asthma and atopic dermatitis (AD). These co-morbid associations may have an effect on the inter-relation of generic and disease-specific QOL outcomes and the behaviour of this inter-relation in time. OBJECTIVE: To unravel the inter-relationships between the outcome of a generic instrument (SF-36) and a disease-specific instrument (Rhinitis QOL Questionnaire (RQLQ)). MATERIALS AND METHODS: In the framework of a randomized clinical trial with respect to the efficacy of impermeable bedding covers in house dust mite (HDM) allergy, SF-36 and RQLQ were administered to 224 adults with AR and/or allergic asthma and/or AD at baseline and after 12 months of intervention. Regression analysis and canonical correlation were used to estimate overlap. RESULTS: Overlap between SF-36 and RQLQ domains in terms of explained variance ranged from 6% to 56%. Canonical correlation yielded low coefficients (0.16-0.27). Moreover, both SF-36 and RQLQ scores did not change significantly during the intervention. CONCLUSION: In patients with HDM allergy characterized by co-morbid associations, SF-36 and RQLQ cover different aspects in QOL. It is advocated to use both simultaneously in performing QOL studies.

[The efficacy of subterranean therapy in the salt chamber of Kinga Spa in Wieliczka for patients suffering from allergic rhinitis]. / Skutecznosc leczenia subterraneoterapia alergicznego niezytu nosa w komorach solnych Szpitala Uzdrowiskowego Kinga w Wieliczce.

42 patients (27 women and 15 men aged 14-65 years) suffering from atopic and non atopic rhinitis were submitted for 24 days to the subterraneo-therapy in salt chambers of Kinga Spa in Wieliczka during the exacerbation of their illness. 20 patients suffered from pollen or dust mites allergy and the next 22 patients from non atopic rhinitis with recurrent nasal polyposis. In the first week and at the end of the therapy rhinoscopy, peak nasal inspiratory flow and smell were evaluated as well as daily symptoms score was noted in each treated patient. The results of performed observations indicate that unrelatively to the type of the rhinitis: 1. the nasal symptoms (running nose, sneezing, block of the nose) resolved directly during the stay of the patient in the salt chamber but the more constant effect was visible with the time of the therapy. 2. an increase in the peak nasal expiratory flow was connected with the decrease of nasal mucosal edema, 3. the smell disturbances disappeared in the patients together with the decrease of mucosal edema. The observed changes seem to be connected with the influence of the salt chambers' microclimate on the cells osmolarity disturbances in the nasal mucosa provoked by the non infectious chronic inflammation.

[Effectiveness of secondary preventive programs for patients with asthma and rhinitis in the baking industry]. / Effektivität eines Sekundär-Präventionsprogramms für asthmatisch und rhinitisch Erkrankte im Bäckerhandwerk.

Since 1992 the German industrial professional association for the food industry and gastronomy (Berufsgenossenschaft Nahrungsmittel und Gaststätten), which is responsible for statutory accident insurance has been offering a specific patient education programme to bakers suffering from occupationally induced obstructive pulmonary disease or allergic rhino-conjunctivitis, who do not quit their jobs and wish to continue working as bakers. The programme aims at preventing aggravation of the disease 74 male bakers with a mean duration of illness of 10 years on entering the programme were examined between 1 and 5 years (mean: 2.9) after participating in the patient education seminar. For a subpopulation of 55 of these patients spirometric measurements were available for the time before programme entry and at follow-up. Data on time spent at the bakehouse, prevalence of symptoms, frequency of symptoms at the site of working and during leisure hours, sleep disturbances and emergency situations were collected at the follow-up examination both for the time before programme entry and at follow-up, respectively. Direct ratings of the amount of changes in distress caused by the disease and of the quality of life were also obtained. The prevalence of 8 of the 9 most frequently reported symptoms decreased significantly, e.g. dysponoea from 70% to 42% and fear of suffocation from 30% to 3%. Participants reported on highly significant reductions in the frequency of disease-specific complaints during work and outside the working place, sleep disturbances and situations requiring immediate medical intervention. Between 64% and 85% of the patients experienced improvement of distress, physical and work performance, private and family life, and ability for self-management. Lung function did not deteriorate: mean FEV1 was 88% (+/- 23) at first and 90% (+/- 19) at second measurement. These results could not be explained by changes in medication. It is concluded that the programme is effective in reducing symptoms and distress and in improving quality of life in bakers with occupational respiratory disease who voluntarily continue to work as bakers.

Repercusión de la amigdalectomía o adenoamigdalectomía en las alergias / Repercussion of tonsyllectomy or adenotonsyllectomy on allergies

Se realizó un estudio retrospectivo y prospectivo longitudinal, randomizado en el cual se valoraron 30 pacientes con rinitis alérgica que fueron sometidos a adenoamigdalectomía o amigdalectomía. El estudio fue realizado en el Departamento de Otorrinolaringología del Hospital de Especialidades del Centro Médico Nacional de Occidente, en la Unidad de Otorrinolaringología S.C. y en el Hospital General Regional Número 45, de octubre de 1990 a septiembre de 1992. Se solicitó a los pacientes pre y postquirúrgicamente inmunoglobulinas séricas IgE, IgA y valoración de signos y síntomas, y número y frecuencia de cuadros de la rinitis. Los resultados de la IgE prequirúrgica fueron de 4 990.68 UI/10 ml ñ 809.20 y la postquirúrgica de 3 149.06 ñ 745.92 (p< 0.01), lgG prequirúrgica 1 044.68 mg/100 ml ñ 143.97 y la postquirúrgica 1 216.33 mg/100 ml ñ 137.89 (p< 0.1). La IgA prequirúrgica 115.13 mg/100 ml ñ 43.22 y postquirúrgica 139.46 mg/100 ml ñ 33.63 (p< 0.1). Los signos y síntomas de rinitis alérgica disminuyeron en todos los casos. Los resultados obtenidos avalan el que al eliminar las infecciones en un paciente con rinitis alérgica aumentaran la IgA e IgG compitiendo así con el antígeno y mejorando los cuadros alérgicos