Upper respiratory tract disease - RHINITIS Flashcards
what is rhinitis?
the COMMON COLD (acute coryza)
Officially as;
- sneezing attacks, nasal discharge or blockage occurring for more than 1hour on most days;
- for a limited period of the year (seasonal or intermittent rhinitis)
- throughout the whole your (perennial rhinitis)
3 examples of respiratory viruses that cause rhinitis?
- rhinovirus
- coronavirus
- adenovirus
How do you become infected with rhinitis?
- from close personal contact or droplets
- spread is facilitated by overcrowding and poor ventilation
symptoms & presentation of rhinitis
- tiredness
- slight pyrexia (slight fever)
- malaise
- sore nose & pharynx
- sneezing
- profuse, battery nasal discharge = rhinorrhea
what are the 3 different types of rhinitis?
1) allergic
2) non-allergic
3) mixed
what are the 3 classes of allergic rhinitis?
1) seasonal
2) perennial
3) episodic
symptoms of seasonal rhinitis
& and example of seasonal rhinitis
- nasal irritation
- sneezing
- watery rhinorrhoea
- itching of the eyes
- soft palette
- wheezing
example = hay fever
symptoms of perennial rhinitis
- sneezing
- watery rhinorrhoea
- nasal blockage
- patients may lose the sense of smell & taste but rarely has eye or throat symptoms
- sinusitis occurs in 50% of cases
- symptoms decrease with age
what are the 4 categories perennial rhinitis can be divided into?
1) perennial allergic rhinitis
2) perennial non-allergic rhinitis with eosinophilia
3) vasomotor rhinitis
4) nasal polyps
give examples of allergens that may affect perennial allergic rhinitis.
1) house dust mites
2) animal dander/domestic pets
3) industrial fumes, vapours, dust
4) non-specific stimuli that your nose is more reactive with e.g.;
- cigarette smoke
- strong perfumes
- washing powders
- traffic fumes
since perennial non-allergic rhinitis no do react with any extrinsic allergic cause what can set these individuals off?
eosinophilic granulocytes
what are patients with perennial non-allergic rhinitis with eosinophilia intolerant to?
- aspirin/non-steroidal anti-inflammatory drugs
in people with vasomotor rhinitis, what triggers the watery secretions or nasal congestion?
examples; - cold air - smoke - perfume - newsprint = possibly because of an imbalance ini autonomic nerves controlling the erectile tissue in the nasal mucosa
what investigations would need to be done?
1) ascertain any allergic factors, this could be done in history or by skin-prick testing
- a + test does NOT mean that the allergen causes the respiratory disease
2) allergen specific IgE antibodies can be measured in the blood
give examples of how to manage rhinitis.
1) avoid the allergen
2) vasoconstrictors / decongestants
3) immunotherapy
4) mediator receptor blockade
- H1 receptor antagonists
- CysLT1 receptor antagonists
5) anti-inflammatory medication
- glucocorticoids & corticosteroids
give ways in which you could avoid allergens.
1) remove household pet
2) pollen avoidance is impossible but to reduce the contact with pollen you could;
- wear sunglasses
- drive with car windows shut
- avoid walks into the countryside
- keep bedroom windows shut at night
3) to reduce mite dust allergen contact which are present everywhere in your house;
- increase room ventilation
- reduce the normal of soft furnishings e.g, carpets, curtains, soft toys
- enclose bedding in fabric specifically designed to reduce passage of mite allergen while allowing water vapour through
give 2 examples of drugs used as vasoconstrictors/decongestants?
1) oxymetazoline
2) xylometazoline
how do these vasoconstrictors/decongestants work?
- they mimic the effect of noradrenaline
- produce vasoconstriction via activation of alpha 1 - adrenoceptor to decrease swelling in vascular mucosa
i. e. reduces nasal obstruction
how are decongestants/vasoconstrictors drugs most commonly taken?
- most commonly intra-nasally but they can be taken orally
why is nasal administration of these specific vasoconstrictors/decongestants for more than a few days not recommend?
- due to the development of a rebound increase in nasal congestion upon discontinuation
what types of patients should immunotherapy be used on?
- patients with seasonal allergic rhinitis who have not responded to standard drugs
how are immunotherapy treatments usually administered?
orally or as injectable vaccines
give example of second generation anti-histamines/H1 receptor antagonists.
why are second generation drugs preferred to first generation drugs?
1) cetirizine
2) loratadine
3) fexofenadine
- these are preferred due to reduced sedation
how do anti-histamines/H1 receptor antagonists work?
- they are a competitive antagonists that reduce the effects of mast cell derived histamine
What 2 symptoms are anit-histamines less effective at targeting?
- nasal congestion
- rhinorrhoea
when should cysteinyl leukotriene receptor antagonists be used and why?
- they should in patients who don’t respond to anti-histamines or topical steroids
- they are used to reduce the effects of CysLTs upon the nasal mucosa
give examples of glucocorticoids.
1) beclometasone
2) fluticasone
3) prednisolone (oral)
when should glucorticosteroids be used?
for seasonal & perennial allergic rhinitis
how are glucocorticoids administered?
they should be administered nasally
to make a pretty effective treatment what would you combine with glucocorticoids?
you would combine glucocorticoids with ANTI-HISTAMINES
what function does sodium cromoglicate have?
mast cell stabilisation
what type of rhinitis should sodium cromoglicate be used to treat?
- allergic conjunctivitis
