Relationship between rhinitis severity and lung function in children and adolescents without asthma. / [Relación entre grado clínico de rinitis y función pulmonar en niños y adolescentes sin asma.]

Background: The link between upper and lower airways is recognized clinically as a "unique airway". Subclinical spirometric abnormalities have been observed in patients with rhinitis without asthma, which could be proportional to rhinitis severity. Objectives: To investigate possible subclinical alterations in lung function and bronchodilator reversibility in children and adolescents with allergic (AR) and non-allergic rhinitis (NAR) without asthma, according to the clinical grade of rhinitis classified by ARIA (Allergic Rhinitis and Its Impact on Asthma). Methods: In a cross-sectional analytical study, we included patients aged 5 to 18 years with symptoms of AR and NAR without asthma. Spirometry was performed by flow-volume curve and we analyzed the abnormalities in respiratory function and bronchodilator response in relation to clinical grade of rhinitis by ARIA using an adjusted logistic model. Results: We studied 193 patients; 42 (21.7%) had some spirometric abnormalities. Patients with moderate-severe persistent rhinitis had greater impairment of lung function compared to the other grades of rhinitis (p=0.009). This defect was associated with both frequency (p=0.03) and severity of rhinitis (p=0.04) but not with atopic status (p=0.28). A positive bronchodilator response was more frequent in grades moderate-severe of rhinitis than in mild forms (p=0.04). Conclusion: Abnormalities of lung function was more prevalent in moderate-severe persistent rhinitis and was associated with the frequency and severity of rhinitis but not to atopic status. The bronchodilator reversibility was observed in patients with intermittent and persistent moderate-severe rhinitis.

Introducción: Las vías aéreas superior e inferior se comportan como una unidad. Se han observado alteraciones espirométricas subclínicas en pacientes con rinitis, sin asma, que podrían ser proporcionales a la magnitud de la rinitis. Objetivos: Investigar las posibles alteraciones de la función pulmonar y reversibilidad al broncodilatador en niños y adolescentes con rinitis alérgica (RA) y no alérgica (RNA), sin asma, según el grado clínico de rinitis establecido por ARIA (Rinitis Alérgica y su Impacto en Asma). Población y métodos: Estudio transversal analítico. Se incluyeron pacientes entre 5 y 18 años con RA y RNA, sin asma. Se analizó la existencia de anormalidades en la función pulmonar (curva flujo-volumen) y la respuesta broncodilatadora en relación al grado clínico de rinitis por ARIA ajustando un modelo logístico.Resultados: Se estudiaron 193 pacientes; 42 (21,7%) tuvieron al menos un parámetro espirométrico alterado. Los pacientes con rinitis persistente moderada-grave presentaron mayor afectación de la función pulmonar respecto a otros grados de rinitis (p=0,009). El defecto se asoció a la frecuencia (p=0,03) y a la gravedad de la rinitis (p=0,04) pero no con la atopia (p=0,28). La respuesta broncodilatadora positiva fue más frecuente en los grados de rinitis moderada-grave que en los leves (p=0,04). Conclusiones: La alteración de la función pulmonar fue más prevalente en la rinitis persistente moderada-grave y se asoció a la frecuencia y la gravedad de la rinitis pero fue independiente de la condición de atopia. La reversibilidad al broncodilatador se observó en pacientes con rinitis intermitente y persistente moderada-grave.

Clinical comparison between patients with selective immunoglobulin A deficiency and other primary immunodeficiencies.

Primary immunodeficiencies (PID) are low-prevalence diseases. There are warning signs that may raise clinical suspicion. The objectives of this study were to describe the clinical characteristics and warning signs of patients with PID and to compare the clinical differences between selective immunoglobulin A (IgA) deficiency and other PIDs. Eighty-nine patients were studied; their median age at the time of diagnosis was 6 years old (4.08-11.67). Fifty-three (59.5%) patients were male. Fifty-four (60.7%) patients had selective IgA deficiency, and 35 (39.3%) had other PIDs. The main clinical manifestations were rhinopharyngitis in 65 (73.03%) patients and atopy in 39 (43.82%). Twenty- four (26.97%) patients showed warning signs, and none had selective IgA deficiency. Patients with other PIDs had a higher incidence of lower respiratory tract infection, sepsis, skin infections, mucocutaneous candidiasis, dental alterations, cardiovascular malformations, angioedema, hospitalizations and death. Ten (28.57%) patients received intravenous gammaglobulin, 15 (42.85%) antibiotic prophylaxis, and 2 (2.24%) antifungal prophylaxis.

[The relationship between rhinitis and asthma: is that all?]. / Relación entre rinitis y asma: ¿esta todo dicho?

The link between upper and lower airways has been observed in the past, but only carefully investigated during the last years. Allergic rhinitis and asthma are often comorbid conditions. Its relationship is supported by epidemiological, anatomical and physiological, immunopathological, clinical and therapeutic studies, mostly related to allergic rhinitis. Rhinitis and asthma occur together at rates that greatly exceed what would be expected from the baseline prevalence of each disorder alone. Many researchers have considered rhinitis as a risk factor for developing asthma. Also, the severity of rhinitis has been directly correlated with the severity of asthma although less evidence supporting the reverse impact. Different clinical and experimental observations suggested the hypothesis of the unity of upper and lower respiratory tract. Evidence suggests that rhinitis and asthma are different facets of a broader systemic inflammatory process involving upper and lower airways. Treatment of rhinitis simultaneously produces a favorable effect on symptoms of asthma and concurrent improvement in lung function and bronchial hyperresponsiveness. In this article, we review the most relevant epidemiological, genetic and clinical evidence linking rhinitis and asthma, the possible mechanisms of the nose-lung interaction and the rational basis of a set treatment that support the hypothesis of "one airway, one disease "considering aspects not yet clarified on the subject.

La relación entre la vía aérea superior e inferior ha sido observada desde inicios del siglo XX pero se ha investigado en profundidad en los últimos años. La rinitis y el asma son enfermedades que coexisten frecuentemente. Su interrelación está sustentada por evidencias epidemiológicas, anátomo-fisiológicas, inmunopatológicas, clínicas y terapéuticas mayoritariamente investigadas para la rinitis alérgica. Rinitis y asma se asocian con una frecuencia superior a la esperada por el azar para cada una de ellas. Numerosos estudios consideran a la rinitis como un factor de riesgo para el desarrollo de asma. Asimismo, la gravedad de la rinitis se ha correlacionado directamente con la gravedad del asma aunque son menos las evidencias que demuestran el impacto inverso. Diferentes observaciones experimentales y clínicas han sugerido la hipótesis de unidad entre el tracto respiratorio superior e inferior. Se sugiere que rinitis y asma son diferentes facetas de un amplio proceso inflamatorio sistémico que afecta la vía aérea en su conjunto. El tratamiento de la rinitis produce simultáneamente un efecto favorable sobre los síntomas de asma concurrentes y mejoría en la función pulmonar e hiperreactividad bronquial. En este artículo, se revisan las más relevantes evidencias epidemiológicas, genéticas y clínicas que vinculan la rinitis y el asma, los posibles mecanismos de la interacción nariz-pulmón y las bases racionales de un tratamiento conjunto que sostienen la hipótesis de la "vía aérea única, una sola enfermedad" y se destacan los aspectos aún no definitivamente aclarados sobre el tema.

Relación entre rinitis y asma: ¿esta todo dicho? / [The relationship between rhinitis and asthma: is that all?].

The link between upper and lower airways has been observed in the past, but only carefully investigated during the last years. Allergic rhinitis and asthma are often comorbid conditions. Its relationship is supported by epidemiological, anatomical and physiological, immunopathological, clinical and therapeutic studies, mostly related to allergic rhinitis. Rhinitis and asthma occur together at rates that greatly exceed what would be expected from the baseline prevalence of each disorder alone. Many researchers have considered rhinitis as a risk factor for developing asthma. Also, the severity of rhinitis has been directly correlated with the severity of asthma although less evidence supporting the reverse impact. Different clinical and experimental observations suggested the hypothesis of the unity of upper and lower respiratory tract. Evidence suggests that rhinitis and asthma are different facets of a broader systemic inflammatory process involving upper and lower airways. Treatment of rhinitis simultaneously produces a favorable effect on symptoms of asthma and concurrent improvement in lung function and bronchial hyperresponsiveness. In this article, we review the most relevant epidemiological, genetic and clinical evidence linking rhinitis and asthma, the possible mechanisms of the nose-lung interaction and the rational basis of a set treatment that support the hypothesis of "one airway, one disease "considering aspects not yet clarified on the subject.

Relación entre rinitis y asma: ¿esta todo dicho? / [The relationship between rhinitis and asthma: is that all?].

The link between upper and lower airways has been observed in the past, but only carefully investigated during the last years. Allergic rhinitis and asthma are often comorbid conditions. Its relationship is supported by epidemiological, anatomical and physiological, immunopathological, clinical and therapeutic studies, mostly related to allergic rhinitis. Rhinitis and asthma occur together at rates that greatly exceed what would be expected from the baseline prevalence of each disorder alone. Many researchers have considered rhinitis as a risk factor for developing asthma. Also, the severity of rhinitis has been directly correlated with the severity of asthma although less evidence supporting the reverse impact. Different clinical and experimental observations suggested the hypothesis of the unity of upper and lower respiratory tract. Evidence suggests that rhinitis and asthma are different facets of a broader systemic inflammatory process involving upper and lower airways. Treatment of rhinitis simultaneously produces a favorable effect on symptoms of asthma and concurrent improvement in lung function and bronchial hyperresponsiveness. In this article, we review the most relevant epidemiological, genetic and clinical evidence linking rhinitis and asthma, the possible mechanisms of the nose-lung interaction and the rational basis of a set treatment that support the hypothesis of "one airway, one disease "considering aspects not yet clarified on the subject.