*For medical professionals only
Allergic rhinitis, also known as allergic rhinitis (AR), is a non-infectious inflammatory disease of the nose mediated by IgE after exposure to allergen stimulation by specific individuals. AR affects 10 to 40 percent of the population globally, with 8.5 percent of school-age children aged 6 to 7 years, 14.6 percent in adolescents aged 13 to 14 years, and 11.8 to 46.0 percent of adults aged 20 to 44 years [1-3]. How to scientifically and effectively treat AR and further alleviate the clinical symptoms of AR is a topic of clinical discussion. On July 10, 2024, under the chairmanship of Chief Physician Wang Jianbo of Shanghai Fengxian District Central Hospital, the Children's AR Professional Committee of the Chinese Medical Doctor Association invited Wu Jinhong, Deputy Chief Physician of Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine, and Wang Yang, Attending Physician of Shanghai Tongji Hospital, to gather in the cloud to discuss the clinical diagnosis and treatment strategy of AR. This article distills the essence of the conference for the benefit of readers.
Clinical progress in the treatment of the same airway disease
There is a close relationship between asthma and AR, and the two often go hand in hand, significantly affecting the quality of life of patients. Studies have shown that AR is an important risk factor for asthma onset, especially in children, and asthma patients with rhinitis have a significantly higher incidence of asthma in later stages. More than 75 percent of patients with allergic asthma have coexisting AR, suggesting that clinicians must pay attention to the presence of rhinitis when managing asthma [4].
Asthma and AR share similar pathological features, and both involve chronic inflammatory responses in the airways [5]. Inflammatory mediators interact with each other between the upper and lower airways, leading to worsening of symptoms. AR not only independently increases the risk of asthma, but also leads to a reduced quality of life and an increased risk of emergency department visits in asthma patients. Therefore, effective management of AR is essential for asthma control [6, 7].
In terms of treatment, intranasal glucocorticoids are considered the preferred option for the management of concomitant AR [8, 9]. Studies have shown that these medications are not only effective in relieving nasal symptoms, but also improving asthma control. Clinical data suggest that patients treated with nasal corticosteroids have significant improvements in nasal symptoms and lung function, and are associated with a reduced risk of asthma exacerbations [10].
Guidelines recommend maintaining daily low-dose inhaled corticosteroid therapy in patients with stable asthma, a strategy that can help with long-term disease control [11]. The safety of low-dose inhaled hormones is widely recognized and suitable for long-term use. By managing asthma and AR together, the overall quality of life of patients can be significantly improved.
In summary, the comorbidity of asthma and AR requires clinicians to adopt a comprehensive management strategy in the diagnosis and treatment process. Effective drug therapy, especially nasal corticosteroids, can significantly improve patients' symptoms, reduce emergency department visits, and thus improve patients' quality of life. Future research should continue to explore the interaction between the two and the best management options to provide patients with more comprehensive treatment options.
Allergic rhinitis "small symptoms" big troubles,
Budesonide quickly relieves nasal congestion
AR is a common disease whose prevalence has increased significantly worldwide in recent years. In China, the prevalence of AR in children was 15.79 percent, while the self-reported prevalence in adults increased from 11.1 percent in 2005 to 17.6 percent in 2011 [12, 13]. Studies have shown that about 85 percent of patients with AR have nasal congestion, which is not only the main manifestation of AR, but also the most bothersome and preventable symptom [14]. Surveys have shown that nasal congestion affects the concentration and work-study efficiency of about 60 percent of patients, and more than 80 percent of patients believe that nasal congestion interferes with their sleep [14].
The severity of nasal congestion has a significant impact on the patient's daily life, especially in outdoor activities and routines. The effects of nasal congestion are particularly pronounced when patients are engaged in outdoor activities, exercise, and family affairs. Therefore, symptomatic control of nasal congestion is critical to the management of AR [14].
In terms of treatment options, nasal corticosteroids are considered the most effective agents for the treatment of AR nasal congestion [9, 15]. At present, there are a variety of nasal hormones on the market, among which budesonide has attracted widespread attention due to its good physicochemical properties and rapid anti-inflammatory effects. Budesonide rapidly relieves symptoms such as nasal itching, sneezing, and runny nose, and although the improvement in nasal congestion is relatively limited, the overall efficacy is significant [16, 17].
Numerous clinical studies have confirmed the effectiveness of budesonide in improving nasal congestion symptoms, and its improvement effect is better than placebo. Studies have shown that budesonide has been shown to have local drug concentrations 8 times higher than mometasone furoate [18], and the improvement in nasal ventilation after 10 days of administration is approximately 2-fold that of mometasone furoate [19]. Budesonide has been on the market for nearly 40 years and is the only nasal hormone included in the WHO essential drug list, and it is also the FDA category B nasal hormone for pregnancy.
In summary, the nasal congestion problems faced by patients with allergic rhinitis seriously affect their quality of life, and budesonide as an effective treatment option can significantly improve nasal congestion symptoms and improve the overall quality of life of patients. With the in-depth research on AR management, the application prospect of budesonide will be broader.
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