diease

Chronic Rhinitis


OVERVIEW OF Chronic Rhinitis :

The  term Rhinitis refers to the inflammation of the inner lining of the nose. Chronic rhinitis occurs more than 4 weeks


CAUSES :

There are two types of Rhinitis.

Allergic (involving the immune system) and non allergic( not involving the immune system).

Allergic Rhinitis:

SEASONAL ALLERGIC RHINITIS  :

Include the allergic reactions to the pollen leading to inflammation of the mucosal surfaces of the nose and eye(conjunctivitis).It is also known as the Hay Fever.

Clinical symptoms include sneezing,watery nose and eyes.This can be avoided by staying away from the pollen.

Dust mites

Dust mites are minute organisms that lives in the dust and also in pillows,windows,bedsheets and other household items.This is similar to the pollen allergies and try to keep the house dust free.

Molds

They are small fungus like organisms found in air. Mold is a common trigger for allergies. Mold can also be present indoors such as  the basement, kitchen, or bathroom, as well as outdoors in grass, leaf piles, hay, mulch or under mushrooms.

Animal dander

The proteins secreted from the sweat gland are seen as dander in pet skin and sometimes from the salivary gland of the pet.It act as an allergen.The best precaution is usage of air filter at home and keep your pet cleaned.

Non allergic Rhinitis:

Nasal polyp

Deviated nasal septum

Smoke

Air pollution

Certain types of foods

Asthma

Chronic sinusitis

  • Risk factor: Having a blood relative with with chronic rhinitis, such as a parent or sibling
  • Having another allergic condition, such as atopic dermatitis — which causes red, itchy skin — or hay fever — which causes a runny nose, congestion and itchy eyes
  • Being overweight
  • Being a smoker
  • Exposure to secondhand smoke
  • Exposure to exhaust fumes or other types of pollution
  • Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing


PATHOPHYSIOLOGY :

Chronic rhinitis is described as an chronic infection which shows inflammation in the pulmonary airway and bronchial hyperresponsiveness to an allergen resulting in asthmatic condition .inflammatory cells are accumulated in respiratory bronchioles.

Physiologically, allergen inhaled results in provocation of the inflammatory system of the respiratory system resulting in increased secreation of inflammatory mediators such as methacalmine and histamine. Release of histamine from the mast cells results in activation of the prostaglandins and leukotrienes.In addition to that cytokines are also released from the mast cells which leads to Increased vascular permeability, bronchospasm,wheezing and mucus secreation.

Triggering factors that results in  blockage of the pulmonary airway include cold air, exercise, viral upper respiratory infection, cigarette smoke, and respiratory allergens. Bronchial provocation with allergen induces a prompt early phase immunoglobulin E (IgE)-mediated decrease in bronchial airflow. Initially there is an increase in the leukocyte count in the pulmonary ares with help of CD4+ cells. The activated T-lymphocytes also direct the release of inflammatory mediators from eosinophils, mast cells, and lymphocytes. The cross-linkage of two IgE molecules by allergen causes mast cells to degranulate, releasing histamine, leukotrienes, and other mediators that perpetuate the airway inflammation. Histolopathology of the bronchial airway might shows  an inflammatory infiltrate consisting of esinophil, mast cells, lymphocytes, monocytes and neutrophils.


COMMON CLINICAL SIGNS AND SYMPTOMS :

Nasal congestion

Post Nasal drip

Sneezing

Itching in eyes, nose and throat

cough

Difficulty breathing, cough.

Swelling of your face, throat or mouth tissue.

Wheezing or difficulty swallowing.

Restlessness and anxiety.


DIAGNOSTIC :

A nasal endoscopy:

It is the instrument where a thin tube with a light source and visualizing unit at one end (ebdoscope) is inserted up to your nose so the physician can view the internal structure of nose clearly

A nasal inspiratory flow test:

A small device is placed over the mouth and nose to measure the air flow when you inhale the air through the nose.

Spirometry:

It  is a type of lung function test that measures how hard a person can blow air out of their lungs. It can determine the level of obstruction in the airway. The test is performed using a machine called a spirometer


TREATMENT AND PROGNOSIS :

Nasal douching:

Cleaning of the nostrils with salt water known as salt water irrigation od salt water douching.

Surgery:

Chronic rhinitis that is caused by structural problems with the nose and sinuses, like a deviated nasal septum or nasal polyps may require surgical correction. Surgery is typically reserved as a last resort if several other treatment options don’t work.

Fast–acting:

Slabutamol is used as inhaler in the treatment of asthmatic attack.They are beta 2 adrenoreceptorand these are the first choice of treatment in asthma.

Ipatropium an anticholinergic medications when used with an SABA provides best results.

Adrenergic agonist such as epinephrine are used in asthmatic attacks but it is contraindicate din cardiac patients.

A shorter course of corticosteroids provides relief and prevents the relapse of the episodes.

Long–term control

Fluticasone propionate metered is used as an inhaler in long term asthmatic attack.

 

  • Corticosteroids such as beclomethasone provides relief 
  • Long acting beta receptor agonists LABA) such as salmetrol and formetrol can improve asthma control, at least in adults, when given in combination with inhaled corticosteroids.
  • Leukotriene receptor antagonists  (anti-leukotriene agents such as montelukast and zafirlukast) may be used in addition to inhaled corticosteroids, typically also in conjunction with a LABA. When these drugs are administered in adjuvant to the corticosteroid they provide relief in moderat and  severe attacks
  • Intravenous administration of the drug aminophylline does not provide an improvement in bronchodilation when compared to standard inhaled beta-2 agonist treatment. Aminophylline treatment is associated with more adverse effects compared to inhaled beta-2 agonist treatment.
  • Mast cell inhibitors such as  cromolyn sodium are preferred in case of corticosteroids and they reduces the inflammatory reactions.
  • In paediatric patients long acting beta blockers(LABA) and cinhalational corticosteroids provides an better relief. 
  • . Antocholinergic medications such as Ipatropium bromide are not indicated in long term of treatment in adults.

Delivery methods

Medications are typically provided as metered dose inhaler (MDIs) in combination with an asthma spacer or a dry powder inhaler Spacer is the type of cylinder that mixes the medicines with the air to enhance sthe effectiveness of the intake of the drug .Nebulizers are also used in the treatment with adjuvant to spacers.The main disadavantage of using these medications are oral thrush,inflammation in the mucosa.

Duplimab,Omalizumab are the monoclonal antibodies that are used to treat atopy asthmatic attack.

 


PROGNOSIS :

The chronic rhinitis shows good prognosis but it might make day to day life little difficult.

Try to avoid triggering factors

 


PREVENTION :

Stay away from the triggering factors

If any surgical correction is indicated do it early

Follow healthy lifestyle

Use a vacuum cleaner fitted with a high efficiency particulate air such as HEPA filter- it can remove more dust than ordinary vacuum cleaners.


Medicines used in the Treatment :

montelukast

Zafirlukast

epinephrine

Duplimab

Cromyln sodium