| 1. |
- Ehnhage, Anders
(författare)
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Nasal and bronchial testing as well as treatment of patients with airway hyperresponsiveness and inflammation focusing on the united airway concept
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Allergic and non-allergic rhinitis and asthma is a global health problem on the increase that causes major illness and disability worldwide, and also results in a large financial burden on society. This thesis contains six papers, based on four different clinical studies on humans with allergic as well as non-allergic airways inflammation, such as neutrophil inflammation caused by exposure to swine dust, as well as chronic rhinosinusitis and concomitant asthma with and without NSAID intolerance. The purpose was to study different aspects of nasal and bronchial airway inflammation, with special focus on possible links between the upper and lower airways disease. In paper I and II, the nasal and bronchial airway reactivity (sensitivity to histamine) in pollen allergy sufferers was detected after pollen exposure as well as out of pollen season. We found that the histamine-induced swelling of the nasal mucosa was increased in comparison to a control group of healthy individuals, without seasonal differences and with a correlation between nasal (sneezing) and bronchial (PD20) histamine sensitivity. Counting the number of histamine-induced sneezes throughout the challenge test better than mucosal swelling correlated to the current allergic symptoms. The increase in histamine-induced nasal mucosal swelling out of pollen season was interpreted as a sign of minimal persistent inflammation, a phenomenon previously described. In paper III and IV healthy subjects were exposed to swine dust, with the purpose to study upper and lower airway inflammation. Swine dust exposure is a model previously developed for inducing airways inflammation in healthy subjects, and until now used to mainly study the effects on the lower airways. We found the model useful for studying both nasal and bronchial inflammatory parameters, as swine dust exposure caused an increase in upper as well as lower airway sensitivity in healthy subjects, however without any mutual correlation. In this group of healthy volunteers, under inflammatory conditions after exposure to swine dust, we found an increase in histamine-induced nasal swelling and a decrease in bronchial function as measured by histamine-PC20. That is in contrast to the pollen allergy sufferers, where exposure to pollen did not induce such changes. Consequently, the airways reactivity was similar under inflammatory conditions in the allergy sufferers and in the group of healthy volunteers, and the main difference was under non-inflammatory conditions. Moreover, nasal lavage before a histamine challenge affected the outcome of the nasal mucosal swelling, microcirculation as well as nasal patency, which implies that this has to be kept in mind when studies are designed, but it also sheds light on nasal irrigation as a treatment method of rhinitis. As we focused on measurements of the vascular response of the nasal mucosa, rhinostereometry was used in paper I-IV, and in paper IV the method was developed to also contain a laser Doppler flowmeter, in order to perform simultaneous measurements of nasal mucosal swelling and microcirculation at the same area. In paper V, this equipment was also evaluated as a method of detecting aspirin sensitivity throughout the nasal airways challenge test, but also to measure possible concomitant reactions of the nasal mucosa throughout the bronchial challenge. We found that the microcirculatory measurements differed between AIA and ATA patient groups, and that the main reaction, including vascular parameters as well as PNIF and symptom scores, occurred two hours or later after challenge. We therefore conclude that a three hour observation time after a nasal lysineaspirin challenge may be recommended in order to improve the sensitivity of the method. We also found signs of a bronchio-nasal reflex in the AIA patients throughout the bronchial challenge test; with changes in the nasal microcirculation at the time they developed asthma. In paper VI, we evaluated the benefits of local steroid treatment and functional sinus surgery (FESS) on the upper and lower airways, in asthmatic subjects with nasal polyposis. Statistically significant improvements in mean asthma symptom scores and daily PEFR were noted despite the fact that the asthma in general was well controlled with inhaled corticosteroids. Moreover, in addition to a clear-cut improvement in the other nasal parameters, both subjective aspects of the olfactory function and the butanol test improved significantly. Together, these results further highlight FESS as a potent anti-inflammatory treatment method of the upper and lower airways, which could be considered early in the natural course of the disease with concomitant asthma, and a second-line treatment in nasal polyposis patients with a reduced sense of smell. Finally, the findings that FESS has benefits on subjective and clinical asthma parameters, the detection of simultaneous changes in the nasal mucosal microcirculation at the time the AIA patients developed asthma throughout a bronchial lysine-ASA challenge, and the positive correlation between the number of sneezes following a nasal histamine challenge and histamine-PC20-PEF are findings that support the idea that the nose and bronchi are linked in a common functional airway system, also defined as the united airways.
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| 2. |
- Ehnhage, Anders, et al.
(författare)
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Treatment of idiopathic rhinitis with kinetic oscillations : a multi-centre randomized controlled study
- 2016
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 136:8, s. 852-859
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Tidskriftsartikel (refereegranskat)abstract
- Conclusions: The potential effects of KOS are still uncertain regarding the most effective air pressure to be used as well as the physiological effects on the nasal mucosa. The results of the study do not support a convincing treatment effect by KOS on IR.Objectives: Idiopathic rhinitis (IR) is a common disorder, affecting ∼10-20% of the population. A new method for treating IR, Kinetic Oscillation Stimulation (KOS), has been reported to have beneficial effects on total vasomotor symptom scores (TVRSS). The primary objective with this study was to evaluate if a mean pressure of 65 mbar, pressure amplitude of 100 mbar, and 68Hz treatment with KOS had a positive effect on total vasomotor symptom scores (TVRSS), as compared with a mean pressure of 65 mbar, pressure amplitude of 4 mbar, and 68Hz treatment in patients with idiopathic rhinitis.Methods: Two hundred and seven patients were randomized (Full Analysis Set, FAS) in the study, including five visits and lasting for approximate to 25 weeks. All patients had two treatment episodes, and all patients had at least one treatment, meant as active, with high amplitude pressure for 10min in each nostril. Group 1 had two such treatments, and Group 2 had one treatment with low amplitude pressure, initially meant as placebo, on one occasion. Because of numerical improvements in these two groups, a new control group, Group 3, was introduced. They had one new control treatment where the balloon was inserted into the nose, without any air inflation and without oscillations.Results: KOS treatment with high amplitude pressure did not have significant beneficial effects as compared to low amplitude pressure on TVRSS. Numerical improvements in TVRSS and SNOT 22 were found when comparing high and low amplitude pressure treatments with uninflated balloon treatment. However, this part of the study was initially single-blinded, and these results were secondary objectives.
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| 3. |
- Nordin, Steven, et al.
(författare)
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Effects of FESS and additional fluticasone propionate nasal drops on psychological well-being in nasal polyposis with asthma
- 2013
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Ingår i: Acta Oto-Laryngologica. - : Informa Healthcare. - 0001-6489 .- 1651-2251. ; 133:9, s. 939-943
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Tidskriftsartikel (refereegranskat)abstract
- Conclusion: A combined therapy of fluticasone propionate nasal drops (FPND) and functional endoscopic sinus surgery (FESS) can improve quality of life (QoL). When compared with prior data, the results imply that a generic measure of psychological aspects of QoL may be better than measures of respiratory symptoms and clinical parameters to capture a patient's perception of the disease and its treatment. Objective: To better understand effects of FPND and FESS on generic QoL. Methods: Sixty nasal polyposis patients with concomitant asthma completed participation in a randomized, double-blind, placebo-controlled, 14-week study in which they responded to the General Well-Being Schedule (GWBS). Results: GWBS scores (i) increased significantly after administration of FPND, independent of FESS (from lower than normal to normal), (ii) increased after FESS independent of FPND (from lower than normal to normal), and (iii) increased additively after FPND and FESS.
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| 4. |
- Nordin, Steven, et al.
(författare)
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Effects of smell loss on daily life and adopted coping strategies in patients with nasal polyposis with asthma
- 2011
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Ingår i: Acta Oto-Laryngologica. - : Informa Healthcare. - 0001-6489 .- 1651-2251. ; 131:8, s. 826-832
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Tidskriftsartikel (refereegranskat)abstract
- CONCLUSIONS: Results from prior studies of quality of life (QoL) in heterogeneous patient groups (regarding disorder type and etiology) with olfactory disorders may be useful also for understanding QoL in homogeneous patient groups. Diagnosis and treatment of smell loss should be given high priority in polyposis with asthma, and coping strategies can be suggested to these patients.OBJECTIVES: To investigate the effects of smell loss on daily life and coping strategies in patients with smell loss without dysosmia and with nasal polyposis with asthma as the only primary etiology, and to compare these results with those from a prior study of a patient group with heterogeneous olfactory disorders and etiology.METHODS: Fifty patients with smell loss and with nasal polyposis and asthma responded to questions about consequences of smell loss, QoL, psychological well-being and distress, and coping strategies.RESULTS: Negative consequences of smell loss, associated risks, and diminished food enjoyment were commonly reported, and various aspects of QoL were rated as being deteriorated. Psychological well-being was found to be poorer than normal, and use of both problem- and emotion-focused strategies was common. The results from this homogeneous patient group are very similar to those previously obtained from a heterogeneous group.
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