Orapan Poachanukoon

Efficacy of buffered hypertonic saline nasal irrigation in children with symptomatic allergic rhinitis: A randomized double-blind study ☆

BACKGROUND Nasal irrigation has been used as an adjunctive therapy of allergic rhinitis (AR). Available evidence suggested that buffered hypertonic saline (BHS) is superior to buffer normal saline (BNS) for relief nasal symptoms. OBJECTIVE To evaluate the effectiveness of BHS nasal irrigation in the management of children with symptomatic AR. DESIGN This was a randomized, prospective, double-blind placebo-controlled study. METHODS The present study was a randomized prospective double-blind placebo-controlled study. Eighty-one children with symptomatic AR who had a total nasal symptom score (TNSS)≥4 were included in this study. Each participant was randomly treated with either normal saline (NSS) or BHS by a blinded investigator. Nasal saccharine clearance time (SCT) and TNSS were measured before and 10 min after nasal irrigation. Quality of life (QoL) was assessed using the questionnaire for Thai allergic rhinoconjunctivitis patients (Rcq-36). The 7-point Likert scale for satisfaction was also performed. All participants were assigned to perform nasal irrigation twice daily for the period of 4 weeks. During this period, they recorded TNSS, side effects and antihistamine use on daily diary card. A physical examination and subjective evaluation were performed at 2nd and 4th week visits, and daily diary cards were collected. RESULTS Patients with BHS were significantly improved in SCT (39.2% versus 15.5%, P=0.009) and TNSS (82.7% versus 69.3%, P=0.006) compared to the NSS group. However, at 2nd and 4th week both groups had improvement in TNSS and QoL compared to baseline visit. There was a significant improvement in mean QoL score in BHS group at 2nd week visit compared to NSS group (P=0.04) but not at the 4th week. Nasal congestion but not TNSS was significantly improved in the BHS group (P=0.04). Moreover, a decreased use of oral antihistamine was observed in BHS group (P=0.04). There were few complaints reported, and side effects were seen equally in both groups. CONCLUSION Nasal irrigation with BHS causes an improvement in SCT, TNSS and QoL compare to NS in children with symptomatic AR.

Pediatric asthma quality of life questionnaire (PAQLQ) : Validation among asthmatic children in thailand

Quality of life (QoL) is an important consideration among asthma sufferers. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) is one of the most widely used instruments for measuring health‐related QoL in children with asthma. The standardized version of PAQLQ contains 23 questions in three domains, i.e., activity limitation, symptoms and emotional function. The objective of this study was to validate the Thai‐translated version of the PAQLQ. The study design consisted of a five‐week single cohort study. Patients recorded symptoms, and peak expiratory flow rate (PEFR) each morning and evening during the first and fifth week of the study in asthma diary. At each clinic visit, a trained‐interviewer administered the PAQLQ and performed spirometric measurements. Fifty‐one children, ages between 7 and 17 yr participated in the study. Scores from the asthma diary were used to classify patients into stable vs. unstable groups. The construct validity of the questionnaire was confirmed in both cross‐sectional and longitudinal studies by demonstrating correlations between various PAQLQ domains with clinical asthma parameters (asthma diary, β‐agonist use and PEFR). There was high internal consistency for scores of the three domains (Cronbachs α‐coefficient = 0.83–0.95). For those with stable asthma, the reliability of PAQLQ was good for the rating scale (intra‐class correlation coefficient – ICC = 0.84) and for total score (α = 0.97) indicating high reproducibility of the PAQLQ. The significant difference of changes QoL scores between stable and unstable groups was observed in all domains. We conclude that the Thai version of PAQLQ is valid and reliable for implementing in Thai children with asthma.

Dental caries, cariogenic microorganisms and salivary properties of allergic rhinitis children

OBJECTIVES The aim of this study was to observe the caries activities of allergic rhinitis patients in relation to salivary properties, salivary levels of mutans streptococci (MS) and lactobacillus (LB), oral hygiene and dietary habits. METHODS The study groups composed of 40 allergic rhinitis children and 40 healthy controls aged between 6 and 13 years old. Demographic data, oral hygiene practices and dietary habits were recorded by questionnaire. For permanent teeth, caries experience was expressed as DMFT (D=decayed; M=missing; F=filled; T=teeth) index. The dmft (d=decayed; m=missing; f=filling; t=teeth) index was used for caries prevalence in primary teeth. Unstimulated salivary flow rate, salivary buffering capacity, and salivary MS and LB were also determined in children with allergic rhinitis and controls. RESULTS There were no significant differences in combined DMFT/dmft, salivary flow rate, buffer capacity of saliva, salivary LB levels, and sugary food consumption between cases and controls (p>0.05). However, higher salivary MS levels were observed in allergic rhinitis patients, compared to controls (P<0.05). CONCLUSIONS Our results demonstrated that patients with allergic rhinitis had an increase in the level of salivary MS.

Safety Evaluation of Zingiber cassumunar Roxb. Rhizome Extract: Acute and Chronic Toxicity Studies in Rats

Zingiber cassumunar Roxb. has been used for traditional medicine, but few studies have described its potential toxicity. In this study, the acute and chronic oral toxicity of Z. cassumunar extract granules were evaluated in Sprague-Dawley rats. The extract at a single dose of 5000 mg/kg body weight did not produce treatment related signs of toxicity or mortality in any of the animals tested during the 14-day observation period. However, a decrease in body weights was observed in treated males (P < 0.05). The weights of lung and kidney of treated females were increased (P < 0.05). Treated males were increased in spleen and epididymis weights (P < 0.05). In repeated dose 270-day oral toxicity study, the administration of the extracts at concentrations of 0.3, 3, 30, 11.25, 112.5, and 1,125 mg/kg body weight/day revealed no-treatment toxicity. Although certain endpoints among those monitored (i.e., organ weight, hematological parameters, and clinical chemistry) exhibited statistically significant effects, none was adverse. Gross and histological observations revealed no toxicity. Our findings suggest that the Z. cassumunar extract granules are well tolerated for both single and chronic administration. The oral no-observed-adverse-effect level (NOAEL) for the extract was 1,125 mg/kg body weight/day for males and females.

Macrolides Attenuate Phorbol Ester-Induced Tumor Necrosis Factor-α and Mucin Production from Human Airway Epithelial Cells

Background/Aims: Macrolide antibiotics are effective drugs in chronic bronchiolitis and chronic rhinosinusitis with mucus hypersecretion. However, the mechanism of action is unclear. This study was designed to investigate the effect of azithromycin (AZM; 15-membered) and midecamycin acetate (MDM; 16-membered) on MUC5AC and MUC2 gene expression and secretion from human airway epithelial cells. The effects of the two macrolides on tumor necrosis factor-α (TNF-α) release were also examined. Methods: Confluent NCI-H292 human mucoepidermoid airways epithelial cells were pretreated with AZM or MDM for 2 h and then stimulated with 200 nmol/l phorbol 12-myristate 13-acetate (PMA) for 8 h. The MUC5AC and MUC2 gene expression was measured by real-time quantitative RT-PCR. Total mucin in culture supernatants was measured using enzyme-linked lectin assay. Enzyme-linked immunosorbent assay was used to determine MUC5AC, MUC2 and TNF-α released by the cells. Results: AZM and MDM attenuated PMA-induced MUC5AC and MUC2 gene and protein expression in NCI-H292 cells. They also suppressed PMA-mediated TNF-α in the cells. Conclusion: The present study demonstrates that AZM and MDM suppress the synthesis of mucin and TNF-α from human airway epithelial cells.

A randomized-controlled study comparing the efficacy of positive pressure nasal saline irrigation device versus syringe use in children with acute rhinosinusitis.

OBJECTIVE To evaluate the efficacy of positive-pressure nasal irrigation devices in children with acute sinusitis, in addition to bacterial colonization of the irrigation device. METHOD We performed a randomized, prospective, controlled study of 80 children with acute sinusitis, aged between 3 and 15 years. Participants were randomly separated into two groups, where one group was treated using a squeezable bottle and the other group treated using a syringe. All patients were instructed to use a 1.25% buffered hypertonic solution for nasal irrigation twice daily for 2 weeks, in addition to amoxicillin-clavulanic acid. During this period, all participants recorded a 5S score, satisfaction score, any side effects and use of antihistamines. Parents were instructed to clean the device with soap after each use. After this period, the nasal irrigation devices were sent to a microbiological laboratory for bacterial identification. RESULTS At the 2-week follow-up, improvement in both 5S and satisfaction scores were observed in both groups compared to baseline, which were significantly higher in the group treated with the squeezable bottle compared to the syringe. Few complaints were reported, and side effects were equal in both groups. The overall rate of bacterial contamination for both treatments was approximately 80%, but this did not translate into higher rates of infection amongst patients. CONCLUSIONS The use of a squeezable bottle for nasal irrigation in children with acute sinusitis was associated with further improvements in 5S and satisfaction scores compared to syringe use, and there were no significant differences in bacterial contamination between methods.

Evaluating the impact of allergic rhinitis on quality of life among Thai students.

The prevalence of allergic rhinitis (AR) in Thailand continues to rise. We report the prevalence and evaluate its impact upon quality of life (QoL) in students on a metropolitan campus.

Mometasone Furoate Suppresses PMA-Induced MUC-5AC and MUC-2 Production in Human Airway Epithelial Cells

Background Mucus hypersecretion from airway epithelium is a characteristic feature of airway inflammatory diseases. Tumor necrosis factor α (TNF-α) regulates mucin synthesis. Glucocorticoids including mometasone fuorate (MF) have been used to attenuate airway inflammation. However, effects of MF on mucin production have not been reported. Methods Effects of MF and budesonide (BUD) on the phorbol-12-myristate-13-acetate (PMA)–induction of mucin and TNF-α in human airway epithelial cells (NCI-H292) were investigated in the present study. Confluent NCI-H292 cells were pretreated with PMA (200 nM) for 2 hours. Subsequently, the cells were stimulated with MF (1–500 ng/mL) or BUD (21.5 ng/mL) for 8 hours. Dexamethasone (1 µg/mL) was used as the positive control. Real-time polymerase chain reaction was used to determine MUC2 and MUC5AC mRNA levels. The level of total mucin, MUC2, MUC5AC, and TNF-α in culture supernatants were measured using enzyme-linked immunosorbent assay. Results MF and BUD significantly suppressed MUC2 and MUC5AC gene expression in PMA-stimulated NCI-H292 cells. The inhibitory effects of the two steroid drugs were also observed in the production of total mucin, MUC2 and MUC5AC proteins, and TNF-α. Conclusion Our findings demonstrated that MF and BUD attenuated mucin and TNF-α production in PMA-induced human airway epithelial cells.

Inhibitory effect of Phlai capsules on skin test responses among allergic rhinitis patients: a randomized, three-way crossover study

BACKGROUND Zingiber cassumunar Roxb., commonly known as Phlai in Thai, has been used as a traditional medicine in Thailand for the treatment of various diseases, including inflammation and chronic airway disease. OBJECTIVE The purpose of this study was to assess the antihistaminic effect of Phlai on skin testing. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION This was a randomized, open-label, three-way crossover study. Twenty allergic rhinitis (AR) patients were enrolled. In randomized sequence, patients received a single dose of Phlai capsules (100 or 200 mg) or loratadine (10 mg) with a washout period of 1 week between each treatment. MAIN OUTCOME MEASURES Skin prick testing for histamine and common aeroallergen (house dust mite) were performed before treatment and after 1, 2, 3, 4, 6, 8, 12 and 24 hours of treatment. The main treatment outcomes were the mean wheal and flare responses to the skin prick test after treatment. RESULTS Both 100 mg and 200 mg Phlai doses suppressed wheal and flare responses to house dust mite allergen, but only 200 mg of Phlai capsules significantly suppressed wheal and flare responses to histamine. Repeated measures analysis of variance showed that loratadine caused more wheal and flare suppression than Phlai capsules in responses to the histamine skin prick test. However, there were no significant differences among the effects of 100 mg Phlai capsules, 200 mg Phlai capsules and loratadine in suppression of wheal and flare induced by the mite skin prick test. Both doses of Phlai were well-tolerated with no adverse events. CONCLUSION Both 100 mg (compound D 4 mg) and 200 mg (compound D 8 mg) Phlai capsules, when taken as a single therapeutic dose, inhibited skin reactivity to histamine and mite skin prick tests in AR patients. TRIAL REGISTRATION Thai clinical trial registry (TCTR20160510001).