Bronchial hyperresponsiveness plays...

Bronchial hyperresponsiveness plays a central character in the pathophysiology of asthma. This hyperresponsiveness is current in almost all patients with symptomatic asthma and can come from a variety of stimuli. common possible stimulus that may exacerbate asthma is chronic sinusitis. Approximately common half of children with asthma have radiographic evidence of sinusitis, and the incidence of chronic sinusitis ranges from 40 to 60 percent In previous studies, treatment of sinusitis has been shown to decrease bronchial hyperresponsiveness, yet the relationship between sinusitis and asthma remains unclear. Tsao and colleagues bearinged a prospective study to determine whether aggressive treatment of sinusitis has a positive impact forward asthma management and whether chronic sinusitis can induce bronchial hyperresponsiveness.

The trial design was a prospective, open-label meditation of children with asthma. The participants were seven to 12 years of age with a history of mild asthma and sensitivity to dust mites. The close attention also included a control cluster of children with no history of allergic rhinitis, chronic cough sinusitis, or asthma. Participants with chronic sinusitis had to have persistent symptoms of nasal obstruction, headache, and postnasal drainage for more than 12 weeks and thorough opacification or the appearance of fluid in common or both maxillary sinuses and ethmoid small rooms on plain sinus radiography. All of the children with asthma had comput tomography of the sinuses. The children with chronic sinusitis were divided into sum of two units groups. The first group received six weeks of amoxicillin-clavulanate therapy, followed by dint of six weeks of nasal saline irrigation. The secondary group received nasal saline irrigation for six weeks, followed from amoxicillin-clavulanate therapy. The children without chronic sinusitis were treated with 12 weeks of nasal saline irrigation. The issues measured were clinical symptoms of sinusitis, forced expiratory whirl in one second ([FEV.sub.1]), and bronchial hyperresponsiveness, measured from using a methacholine challenge test

The clinical signs and symptoms of sinusitis improved in treated patients. However, no significant differences in the [FEVsub1] values were evident before or after sinusitis treatment. In addition, children with chronic sinusitis had significantly les nocturnal cough after treatment. With regard to bronchial hyperresponsiveness, children treated for sinusitis had significantly better follows during the methacholine challenge trial compared with the baseline measurements taken before treatment was started.

The authors bring to an end that there is an association between sinusitis and bronchial hyperresponsiveness in children with asthma. They add that all patients with asthma should be evaluated to determine if they have concomitant sinusitis. In addition, patients with asthma who have unpredictable replications to appropriate asthma management and also have sinusitis should receive aggressive treatment for sinusitis.

Tsao CH et al. Concomitant chronic sinusitis treatment in children with mild asthma. The consequence on bronchial hyperresponsiveness. Chest March 2003;123:757-64

COPYRIGHT 2003 American Academy of Family Physicians

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