Clinical Observation In The Patients With Asthma And Rhinitis Use The Way Of Upper And Lower Airway Treatment.

Objective: To observe the clinical effect of different treatment on bronchial asthma with allergic rhinitis. To verify the way of combined upper and lower airway treatment is more advantageous to control asthma with rhinitis symptoms.Methods: Sixty-two outpatients with mild to moderate persistent asthma and perennial rhinitis from North China coal university hospital pneumology department were randomly divided into two groups, A group were given orally inhaled salmeterol and fluticasone powder 50μg /250μg, twice a day, and given budesonide nasal spray twice a day , spray each nostril cavity a press every morning and evening, each press 64μg. B group were given orally inhaled salmeterol and fluticasone powder 50μg /250μg, twice a day. The time of therapy was four weeks. Detect two sets of patients with the lung function,serum TIgE,serum ECP,peripheral EOS%,induced sputum EOS%,EOS intensity of nasal secretions,rhinitis symptoms score and ACQ score,before and after the treatments, contrasted the Results whether or not have statistical difference. Thirty healthy Volunteers from North China coal university hospital as healthy controls (group C). Compared serum TIgE, pulmonary function, serum ECP, peripheral EOS, induced sputum EOS % among group A,group B and group C after four weeks treatment. And compare nasal secretions smear EOS intensity,ACQ questionnaire scores,rhinitis symptoms scores between group A and group B. contrasted the Results whether or not have statistical difference.Results: After four weeks treatment, Pulmonary function (FEV1%, FEV1/FVC%, PEF%) were significantly increased in group A and group B (P<0.05). Serum IgE,serum ECP,induced sputum EOS%,rhinitis symptom scores,ACQ questionnaire scores were significantly reduced in group A and group B (P<0.05). EOS intensity of nasal secretions decreased significantly in group A after treatment(P<0.05). But EOS intensity of nasal secretions had no significant decline in group B after treatment(P>0.05). Neither group A nor group B had no significant decrease in peripheral blood EOS% after treatment(P>0.05). After treatment, the pulmonary function (FEV1%, FEV1/FVC%, PEF%) had difference among group A,group B and group C (P<0.05), Further multiple comparisons showed that there was no difference between group A and group B(P>0.05), but either group A or group B compared with group C, the pulmonary function have significant different(P<0.05). After treatment, serum TIgE and serum ECP had difference among group A,group B and group C (P<0.05), Further multiple comparisons showed that there was significant difference between group A and group B, or group A and group C, or group B and group C (P<0.05). After treatment, Peripheral blood EOS% and induced sputum EOS% had difference among group A,group B and group C (P<0.05), Further multiple comparisons showed that there was no difference between group A and group B(P>0.05), but either group A or group B compared with group C, the level of peripheral blood EOS% and induced sputum EOS% have significant different (P<0.05). After treatment, Rhinitis symptom score,ACQ scale score and nasal secretion smear EOS intensity had significant difference between group A and group B (P<0.05).Conclusions: 1,ICS+LABA combined with IC could better control the Eosinophil-mediated inflammation in upper and lower airway than only use ICS+LABA. 2,ICS+LABA combined with IC and ICS+LABA could reduce the level of serum TIgE and serum ECP, but the effect much significant in the way of ICS+LABA combined with IC. 3,ICS+LABA combined with IC and ICS+LABA could improve the pulmonary function to the patients with mild to moderate persistent asthma and perennial rhinitis, and the degree of improvement have no difference. 4,ICS+LABA combined with IC and ICS+LABA could improve the symptoms of rhinitis and asthma, but ICS+LABA combined with IC could improve the symptoms rapidly. 5,Short-term medium and low dose inhaled ICS + LABA or ICS + LABA combined with IC could not reduce the level of peripheral blood EOS% in the patients with mild to moderate persistent asthma and perennial rhinitis.