Rhinitis

Doc · 04-28-2006, 19:15

What are your thoughts on rhinitis and what do you use to treat it?

I would like to hear the good, bad, and ugly.

Doc

Doc · 04-30-2006, 05:41

Any comments on the "one airway, one disease" correlation with asthma and rhinitis?

medicerik · 05-10-2006, 19:21

I'd be hesitant to say one airway one disease. Rhinitis is an upper airway issue where asthma is an issue below the carina. Oh well, off to medline to get data to either support or refute my position

medicerik · 05-10-2006, 19:25

There are 751 hits on medline. One common theme I kept coming across though was allergic rhinitis as a comorbidity for asthma. I'm still not convinced the two are directly associated yet. It's getting late, so I'll do the statistics tomorrow if anyone is interested.

Erik

**Roguish Lawyer** · 05-10-2006, 20:04

Quote:

Originally Posted by medicerik

There are 751 hits on medline. One common theme I kept coming across though was allergic rhinitis as a comorbidity for asthma. I'm still not convinced the two are directly associated yet. It's getting late, so I'll do the statistics tomorrow if anyone is interested.

Erik

Please

medicerik · 05-11-2006, 07:48

After digging through the data, I've come across what's called the integrated airway hypothesis (what Doc referred to as one airway one disease) A study from the Allergy and Asthma Medical Group and Research Center showed by doing a metanalysis of several studies that 19 to 38 percent of patietns with rhinitis also have asthma.

The belief is that local inflammation in the upper airways by an allergen also causes inflammation in the lower airways leading to worsening of asthma. The same metanalysis of the data showed a moderate improvement in asthma symptoms in those who had their allergic rhinitis appropriately treated.

I learn something new everyday!!!!!
Erik

Doc · 06-10-2006, 09:36

Does anyone have a preference for what inhaled nasal spray they use and/or prescribe???

Gypsy · 06-10-2006, 12:08

Doc based on the recommendation from someone here I've used Afrin Sinus, found it very effective. I don't have to use it very often however.

AF IDMT · 06-19-2006, 03:03

Quote:

Originally Posted by Doc

Does anyone have a preference for what inhaled nasal spray they use and/or prescribe???

Doc,
Sir, I use two different ones depending on how bad off the patient is. Bear in mind I can only give what my preceptor will allow me to, so sometimes that ties my hands, but very rarely. For just a straight decongestant I reach of Genasal with VERY detailed instructions to only to take it for three days. I've never had a patient have a "rebound" reaction to it, but I am told it's bad. Has anyone seen this? Why give Goldline Genasal instead of Afrin brand? My pharmacy stocks one and not the other, that's the only reason.
If I suspect allergies to be the cause then I reach for Flonase. Again I talk the patient to death about how long it takes for this stuff to kick in and to stick with it. I've had patients go as long as a week before they saw any effects. Consequently I tell the patient not to take it just on the days they think they need it, but for the whole allergy season so the levels stay up in their system. That piggybacks on regime compliance that you mentioned. I’m a really simple person, I like simple solutions. A GYN doc told me one time that she tells her patients to attach their BCP’s to their toothbrush with a rubber band. As long as the patient brushes their teeth everyday they will “remember” to take their BCP’s. I like it, I’ll steal it. I tell my allergic rhinitis patients to do the same with the bottle of corticosteroid. It’s hard to grab a toothbrush with a bottle attached to it and not remember why it’s there.

Are there faster acting corticosteroids out there that would be suitable for allergies? Time for me to call my pharmacy and look it up on-line. I don’t run across many drug reps out here in the woods.

Edited--because I can't spell. . .

Doc · 06-19-2006, 05:46

1. Inhaled corticosteroids (ICSs) may take anywhere from a couple of days to a couple of weeks to exert their total therapuetic effect on a patient. That is why you need to find out the answer to number 2 down below. If you know for instance that a certain allergen that the patient is allergic to is coming on in April, the patient should start taking his meds a couple of weeks prior to that; say March 15th.

I think ICSs do a better job of taking on the underlying cause of rhinnitis which is inflammation than the other preparations out there.

2. I would send my guy with rhinnitis to an allergy clinic to find out what he is allergic to. Could immunology play a role in treatment?

3. If you have those two pieces of information, you can devise a long term treatment plan that he can understand and implement.

Patient compliance has always been an issue and your idea of attaching the medicine to a tooth brush could work. I would still keep an eye on him to make sure he's taking his meds.

Hope this helps,

Doc

AF IDMT · 06-19-2006, 06:30

Quote:

Originally Posted by Doc

If you know for instance that a certain allergen that the patient is allergic to is coming on in April, the patient should start taking his meds a couple of weeks prior to that; say March 15th.

I couldn't agree more. A little planning can do wonders.

Quote:

Originally Posted by Doc

2. I would send my guy with rhinnitis to an allergy clinic to find out what he is allergic to. Could immunology play a role in treatment?

Absolutely. I can think of no reason why is shouldn't play a role. Yes, ICS will take down the inflammation, as you said, and why not get the body to stop freaking out about the allergen in the first place. I can't remember the exact phrasing but I remember hearing, "Give them just enough medicine that their own body can take over and heal itself." in IDMT school. With a course of allergy shots wouldn't we be setting the patient's body up to take care of itself in the future?

Quote:

Originally Posted by Doc

Patient compliance has always been an issue and your idea of attaching the medicine to a tooth brush could work. I would still keep an eye on him to make sure he's taking his meds.

I have a few "fire and forget" patients but the majority of mine need a little help now and again. The advantage I have is with such a small patient population I am GOING to see them again outside the clinic.

Thanks for the help, Doc.

x SF med · 06-19-2006, 07:46

I got sensitized to something in all of my travels and it finally hit me when I went to live in FWTX after getting out of SF. Nothing worked properly - I tried Rhinocort, Afrin, Claritin... all the prescription stuff, until I started using a normal saline spray, that was pH balanced - it just got rid of the little nasties in the air. My.02 from experience.