Upper respiratory tract disease - RHINITIS

Question 1

what is rhinitis?

Answer 1

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)

Question 2

3 examples of respiratory viruses that cause rhinitis?

Answer 2

• rhinovirus
• coronavirus
• adenovirus

Question 3

How do you become infected with rhinitis?

Answer 3

• from close personal contact or droplets

- spread is facilitated by overcrowding and poor ventilation

Question 4

symptoms & presentation of rhinitis

Answer 4

• tiredness
• slight pyrexia (slight fever)
• malaise
• sore nose & pharynx
• sneezing
• profuse, battery nasal discharge = rhinorrhea

Question 5

what are the 3 different types of rhinitis?

Answer 5

1) allergic
2) non-allergic
3) mixed

Question 6

what are the 3 classes of allergic rhinitis?

Answer 6

1) seasonal
2) perennial
3) episodic

Question 7

symptoms of seasonal rhinitis

& and example of seasonal rhinitis

Answer 7

• nasal irritation
• sneezing
• watery rhinorrhoea
• itching of the eyes
• soft palette
• wheezing

example = hay fever

Question 8

symptoms of perennial rhinitis

Answer 8

• 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

Question 9

what are the 4 categories perennial rhinitis can be divided into?

Answer 9

1) perennial allergic rhinitis
2) perennial non-allergic rhinitis with eosinophilia
3) vasomotor rhinitis
4) nasal polyps

Question 10

give examples of allergens that may affect perennial allergic rhinitis.

Answer 10

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

Question 11

since perennial non-allergic rhinitis no do react with any extrinsic allergic cause what can set these individuals off?

Answer 11

eosinophilic granulocytes

Question 12

what are patients with perennial non-allergic rhinitis with eosinophilia intolerant to?

Answer 12

• aspirin/non-steroidal anti-inflammatory drugs

Question 13

in people with vasomotor rhinitis, what triggers the watery secretions or nasal congestion?

Answer 13

examples;
- cold air
- smoke 
- perfume 
- newsprint 
= possibly because of an imbalance ini autonomic nerves controlling the erectile tissue in the nasal mucosa

Question 14

what investigations would need to be done?

Answer 14

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

Question 15

give examples of how to manage rhinitis.

Answer 15

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

Question 16

give ways in which you could avoid allergens.

Answer 16

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

Question 17

give 2 examples of drugs used as vasoconstrictors/decongestants?

Answer 17

1) oxymetazoline

2) xylometazoline

Question 18

how do these vasoconstrictors/decongestants work?

Answer 18

• 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

Question 19

how are decongestants/vasoconstrictors drugs most commonly taken?

Answer 19

• most commonly intra-nasally but they can be taken orally

Question 20

why is nasal administration of these specific vasoconstrictors/decongestants for more than a few days not recommend?

Answer 20

• due to the development of a rebound increase in nasal congestion upon discontinuation

Question 21

what types of patients should immunotherapy be used on?

Answer 21

• patients with seasonal allergic rhinitis who have not responded to standard drugs

Question 22

how are immunotherapy treatments usually administered?

Answer 22

orally or as injectable vaccines

Question 23

give example of second generation anti-histamines/H1 receptor antagonists.
why are second generation drugs preferred to first generation drugs?

Answer 23

1) cetirizine
2) loratadine
3) fexofenadine

• these are preferred due to reduced sedation

Question 24

how do anti-histamines/H1 receptor antagonists work?

Answer 24

• they are a competitive antagonists that reduce the effects of mast cell derived histamine

Question 25

What 2 symptoms are anit-histamines less effective at targeting?

Answer 25

• nasal congestion

- rhinorrhoea

Question 26

when should cysteinyl leukotriene receptor antagonists be used and why?

Answer 26

• 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

Question 27

give examples of glucocorticoids.

Answer 27

1) beclometasone
2) fluticasone
3) prednisolone (oral)

Question 28

when should glucorticosteroids be used?

Answer 28

for seasonal & perennial allergic rhinitis

Question 29

how are glucocorticoids administered?

Answer 29

they should be administered nasally

Question 30

to make a pretty effective treatment what would you combine with glucocorticoids?

Answer 30

you would combine glucocorticoids with ANTI-HISTAMINES

Question 31

what function does sodium cromoglicate have?

Answer 31

mast cell stabilisation

Question 32

what type of rhinitis should sodium cromoglicate be used to treat?

Answer 32

• allergic conjunctivitis