Peter Borum

Nasal methacholine challenge: A test for the measurement of nasal reactivity

The aim of this study was to develop a test for the measurement of nasal reactivity. Different concentrations of methacholine were sprayed intranasally, and the nasal secretion and blockage were measured in normal subjects. The simple collection and measurement of secretion was found to be a valuable parameter of mucosal reactivity, while measurement of nasal airway resistance was unreliable, due in part to the presence of secretion in the nasal cavity. The methacholine test had a fairly good reproducibility when the amount of secretion was used as the only parameter. It caused a significantly stronger reaction in women than in men. Patients with perennial rhinitis had a more vigorous response than the controls. It is concluded that the methacholine test may prove useful as a sign of perennial rhinitis and also for the objective evaluation of medication, but further studies are warranted.

Efficacy of an aqueous and a powder formulation of nasal budesonide compared in patients with nasal polyps.

Nasal polyps are commonly treated surgically. Intranasal administration of topical corticosteroids has gained increased acceptance as a treatment alternative. The aim of our study was to compare the efficacy of treatment of two formulations of budesonide with placebo on nasal polyps. At four Danish clinics 138 patients suffering from moderate or severe nasal polyps were randomized to a twice daily treatment with Rhinocort® Aqua 128 μg, Rhinocort Turbuhaler® 140 μg or placebo (Astra Draco, Sweden) for 6 weeks. Polyp size (primary efficacy variable), nasal symptoms, sense of smell, and patients’ overall evaluation of treatment of efficacy were assessed by scores. Polyp size was reduced significantly in both budesonide treated groups compared with placebo, but there was no statistical difference between the two actively treated groups. Patients’ nasal symptom scores was significantly more reduced in the Aqua compared to the Turbuhaler treated group, and both reduced symptom scores were significantly better compared to placebo. Sense of smell was significantly improved in the actively treated groups compared to placebo. The proportion of patients rating substantial or total control over symptoms after 6 weeks treatment was 60.9% and 48.2% in the Aqua and Turbuhaler-treated groups, respectively, which was significantly better compared with 29.8% in the placebo-treated group. Rhinocort Aqua and Rhinocort Turbuhaler were equally well tolerated.

Inhibition of the immediate allergic reaction in the nose by the beta-2 adrenostimulant fenoterol

Abstract Sympathomimetic agents inhibit antigen-induced release of histamine in animal experiments and in in vitro studies of human tissue, but the significance of this effect for treatment of allergic airway diseases has not been established. It was the aim of our study to investigate the protective effect of the beta-2 adrenostimulant fenoterol on allergen-induced nasal symptoms and to relate the efficacy to dose and time. In a double-blind crossover design 16 patients with hay fever were challenged with grass pollen extract in the nose after pretreatment with intranasal placebo and fenoterol in different doses, delivered as a micronized powder from a pressurized canister and as a watery solution from a pump spray. Sneezing was recorded, and rhinorrhea and changes in nasal airway resistance were measured for 15 min after the provocation. Fenoterol, micronized powder as well as solution, had a marked inhibitory effect on all three nasal symptoms (p

Anticholinergic Treatment of Watery Rhinorrhea

When the anticholinergic drug ipratropium bromide is given as a nasal spray, it can reach the glandular cholinoceptors and block the secretory response to methacholine. Nine placebo-controlled clinical trials have shown that the treatment significantly reduces watery rhinorrhea in patients with perennial rhinitis not responsive to other types of treatment. To avoid a sensation of nasal dryness as a side effect from spraying, it is important in the individual patient to match the dosage to the severity of hypersecretion. Ipratropium has no effect on sneezing or on nasal blockage.

Efficacy and safety of topical combinations of ipratropium and xylometazoline for the treatment of symptoms of runny nose and nasal congestion associated with acute upper respiratory tract infection

Background Rhinorrhea and nasal congestion are simultaneous symptoms associated with the common cold. This study investigated the efficacy and safety of a combination nasal spray of ipratropium and xylometazoline for simultaneous treatment of these symptoms. Methods The trial was a multicenter double-blind, parallel-group, randomized design on patients with common cold symptoms. Patients scored symptoms of runny nose and nasal congestion and recorded adverse events in a diary for up to 7 days. Patients also recorded tissue use. The five test treatments consisted of ipratropium, 0.6 mg/mL, and xylometazoline, 1.0 mg/mL; ipratropium, 0.6 mg/mL, and xylometazoline, 0.5 mg/mL; ipratropium, 0.6 mg/mL; xylometazoline, 1.0 mg/mL; and placebo solution. Results Eight hundred sixty-four patients were screened and 786 patients received treatment. One day after treatment there was a clear separation between the scores for the placebo and ipratropium treatment groups for rhinorrhea and between the placebo and xylometazoline treatment groups for congestion. Both ipratropium/xylometazoline 1.0 and ipratropium/xylometazoline 0.5 treatments were superior to xylometazoline with respect to rhinorrhea (p < 0.0001) and superior to ipratropium with respect to nasal congestion scores (p < 0.001). Both the ipratropium combination treatments had significantly lower tissue use than the xylometazoline treatment group (p < 0.0001). Adverse events were distributed equally between the treatments, except mucus tinged with blood, epistaxis, nasal passage irritation, and nasal dryness, which had a higher incidence in the three groups that received medicines containing ipratropium. Conclusion The results indicate that a combination medicine of ipratropium and xylometazoline is safe and effective for treatment of rhinorrhea and nasal congestion associated with common cold.

Tonsillectomy: assessment of quality by consultation rate after discharge.

The aim of this prospective study was to establish a measure of short-term quality of treatment after tonsillectomy/adenotonsillectomy. One hundred and thirty-four questionnaires, returned after 14 days, from 41 children and 93 adults were analysed. Forty-seven per cent had one or more consultations with health-care professionals. Eighty-three consultations by telephone and 33 consultations in person were made. Two recent studies reported higher consultation rates in person to doctors compared to this study. The predominant reason for consulting health-care professionals was pain. Maximum pain scores were significantly higher among those with consultations vs. no consultations (p = 0.0001). Additionally, the intensity as well as the duration of maximal pain increased with the number of contacts per patient (p = 0.0001, p = 0.0045). Sixty-four per cent felt relieved after consultation by telephone and 83 per cent felt relieved after consultation in person. The present study suggests consultation rate as a parameter of quality of treatment and quality of information.

Methods of haemostasis in tonsillectomy assessed by pain scores and consultation rates. The Roskilde County Tonsillectomy Study.

Objectives : To compare four methods of haemostasis after tonsillectomy assessed by pain scores and consultation rates. Study design and methods : A prospective study. The method of sole compression of the tonsillar fossae with gauze tampons was compared to ligation, bipolar diathermy and ligation/diathermy in combination. Results: Highly significantly lower pain scores after discharge were found in the compression group compared to the other three groups ( p <0.025). The consultation rate in person after discharge of the compression group was significantly lower than in the diathermy group ( p <0.01) and the ligation/diathermy group ( p <0.05). Conclusion : Sole compression was associated with considerably less morbidity and no higher risk of postoperative haemorrhage. Sole compression should therefore be preferred in tonsillectomy whenever the surgeon considers it to be justified.

Seasonal allergic rhinitis treated with a beta‐2‐adrenostimulant

The aim of the study was to investigate whether topical application of a beta‐2‐adre‐nostimulant (fenoterol) on the mucous membrane has a clinically signification anti‐allergic effect. Thirty‐three patients with grass pollen hay fever completed the trial which was a double‐blind, placebo‐controlled cross‐over design. After a run‐in period the patients received two puffs of 50 Hg fenoterol 4 times a day or placebo for 21/2 weeks before crossover. Symptoms were scored on diary cards and there was a moderate, but significant effect of fenoterol on sneezing but the effect on secretion and blockage was insignificant it is concluded that beta‐2‐stimulating agents are not competitors to the very effective topical steroids