Abstract
BackgroundChronic rhinitis, pharyngitis and sinusitis are common health problems with a significant impact on public health, and are suspected to be influenced by ageing factors. Nasal inhalation with thermal water may be used to reduce symptoms, inflammation and drug intake. A pre-post clinical study was conducted in 183 consecutive adult and elderly patients with chronic rhinitis, pharyngitis or sinusitis, to evaluate whether thermal water nasal inhalations could improve their symptoms, clinical signs and rhinomanometry measurements, and influence inflammatory biomarkers levels in nasal epithelial cells.ResultsParticipants profile revealed that they were aged on average (mean age and SD 60.6 ± 15.2 years, median 65, range 20–86, 86 aged ≤ 65 years (47%), 96 aged > 65 years (53%)) and extremely concerned about wellbeing. Older age was associated with better compliance to inhalation treatment. Total symptom and clinical evaluation scores were significantly ameliorated after treatment (p < 0.001), with no substantial difference according to age, while rhinomanometry results were inconsistent. Persistence of symptom improvement was confirmed at phone follow up 1 year later (n = 74). The training set of 48 inflammatory genes (40 patients) revealed a strong increase of CXCR4 gene expression after nasal inhalations, confirmed both in the validation set (143 patients; 1.2 ± 0.68 vs 3.3 ± 1.2; p < 0.0001) and by evaluation of CXCR4 protein expression (40 patients; 1.0 ± 0.39 vs 2.6 ± 0.66; p < 0.0001). CXCR4 expression was consistently changed in patients with rhinitis, pharyngitis or sinusitis. The increase was smaller in current smokers compared to non-smokers. Results were substantially unchanged when comparing aged subjects (≥ 65 years) or the eldest quartile (≥ 71 years) to the others. Other genes showed weaker variations (e.g. FLT1 was reduced only in patients with sinusitis).ConclusionsThese results confirm the clinical impact of thermal water nasal inhalations on upper respiratory diseases both in adults and elders, and emphasize the role of genes activating tissue repair and inflammatory pathways. Future studies should evaluate CXCR4 as possible therapeutic target or response predictor in patients with chronic rhinitis, pharyngitis or sinusitis.Trial registrationCommunication to Italian Ministry of Health - ICPOM 000461. Registered 10/11/2014.
Highlights
Chronic rhinitis, pharyngitis and sinusitis are common health problems with a significant impact on public health, and are suspected to be influenced by ageing factors
As regards the pathologies of interest, half of the patients suffered from sinusitis (ICD10 code: J32), 29% from pharyngitis (J31.1-J31.2), a quarter had chronic, vasomotor or allergic rhinitis (J30, J31.0), with 10 subjects declaring two pathologies at once
After stratifying for pathology, we found that CXCR4 expression was consistently changed in patients suffering from all three diseases of interest, while FLT1 demonstrated a statistically significant post-treatment reduction only in those affected by sinusitis
Summary
Pharyngitis and sinusitis are common health problems with a significant impact on public health, and are suspected to be influenced by ageing factors. Pharyngitis and sinusitis are common health problems with a significant impact on public health in term of costs and quality of life [1]. Thermal water inhalation therapy for the diseases of the upper respiratory tract has a longstanding tradition and may be used in addition to pharmacological treatment, with the aim of attenuating symptoms and reducing drug intake. This is a major issue in older patients, which often use several drugs to treat chronic diseases or control complex conditions. A bibliometric study conducted by our group showed recently that scientific interest in thermal hydrotherapy applied to nose diseases was quite high in the period between the 1950’s and the 1970’s, decreased dramatically in the subsequent decade to re-expand again thereafter, with a constant grow of scientific production in number and quality of publications (personal results)
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