Mean Peak Nasal Inspiratory Flow Research Articles

Exploring the Relationships Between Clinical Examination Findings, Subjective Reported Symptoms and Objective Nasal Patency Measures in Nasal Obstruction: A Baseline NAIROS Sub-Study Analysis.

The role of objective nasal airflow measures using peak nasal inspiratory flow (PNIF) and rhinospirometry in supporting clinical examination findings when offering patients septoplasty remain undefined. To explore the baseline relationships between clinical examination findings, subjective reported symptoms and objective nasal patency measures in nasal obstruction. This is a sub-study of the NAIROS trial. Participants with nasal obstruction secondary to septal deviation were included in this NAIROS sub-study. The side of septal deviation, enlargement of inferior turbinate (IT), the need for IT reduction if septoplasty was being performed, the area of septum deflecting into the airway and observer rated airway block (ORAB-arbitrarily divided by <50% and >50% blockage) were assessed by clinicians. The subjective score of nasal obstruction was assessed using the Double Ordinal Assessed Subjective Scale (DOASS). Objective nasal patency measures (e.g., nasal partitioning ratio, [NPR] and PNIF) were measured using PNIF and rhinospirometry. The mean NPR for left-sided, both-sided and right-sided septal deviation was -0.35, -0.02 and 0.51, respectively (p < 0.001). There was very weak correlation between the requirement for IT reduction and PNIF change (0.13, p < 0.01). There was no difference in mean PNIF (94 L/min vs. 93 L/min) and mean DOASS (0.33 vs. 0.38) for participants with ORAB rated <50% and >50%. The mean NPR for participants with ORAB >50% was higher than for those with ORAB <50% (0.51 vs. 0.41, p = 0.002). There was strong correlation between the DOASS and NPR (+0.737, p < 0.001). The mean DOASS score for right-sided, both-sided and left-sided septal deviation was 0.32, 0.05 and -0.29, respectively (p < 0.001). This study identified strong relationships between the clinician rated side of septal deflection, the patient reported DOASS and the objective NPR measurements. NPR and the clinician rated degree of airway blockage were concordant.

Assessment of Nasal Smear Eosinophil Counts in Allergic Rhinitis: How Useful is it?

Objectives: The aim was to find the relationship between nasal smear eosinophil (NSE) counts and allergic rhinitis (AR) along with the impact of treatment on peak nasal inspiratory flow rates and symptom scores in these patients. Material and methods: An observational, comparative study was carried out with 75 patients of AR. Nasal smears were drawn and eosinophil counts were estimated. Nasal symptoms were assessed and compared by visual analogue scale (VAS) and peak nasal inspiratory flow (PNIF) rates before and after treatment. Equal number of healthy individuals formed the control group. Results: There was a strong association between increase in eosinophil count in nasal smears and AR (p = 0.000). A NSE count of 0.2/HPF had a specificity of 98.7%, sensitivity of 53.3%, and positive predictive value of 97.6% in the diagnosis of AR. The mean VAS scores for nasal obstruction improved from 7.35 to 1.01 and the mean peak nasal inspiratory flow from 69.00 L/min to 103.73 L/min (p < 0.0001) after treatment. The mean NSE counts reduced from 4.20/HPF to 0.090/HPF proving a strong correlation between improvement of symptom scores and NSE counts (p = 0.000) in AR. The study also determined that a PNIF value of ≤ 77.50 L/min can be used as a cut off for diagnosing nasal obstruction in these patients. Conclusion: A NSE count of ≥ 0.2 /HPF is to be considered as diagnostic of AR. Nasal congestion is the commonest symptom associated with AR and addition of systemic decongestant is required for management of these patients.

In healthy subjects nasal nitric oxide does not correlate with olfactory sensitivity, trigeminal sensitivity, and nasal airflow

The aim of the study was to determine the relationship between nasal nitric oxide (nNO) and olfactory sensitivity, trigeminal sensitivity and nasal airflow in healthy subjects. This is a correlational study. This study was carried out in a tertiary referral centre. Forty healthy participants were recruited. nNO was measured using a chemiluminescence analyser (Niox Vero® , CircassiaAB, Uppsala, Sweden), olfactory sensitivity was determined using phenyl ethyl alcohol odour thresholds using the 'Sniffin' Sticks', trigeminal sensitivity was assessed with carbon dioxide delivered by an automated device, and nasal airflow was measured using the peak nasal inspiratory flow (PNIF). The median nNO was 518ppb (IQR=333) in the right nostril, and it was 567ppb (IQR=314) in the left nostril. The median odour threshold was 7.1 (IQR=4.4), the median CO2 threshold was 919ms (IQR=1297) and the mean PNIF was 108L/min (SEM=4.9). nNO did not correlate significantly with odour threshold, CO2 threshold or PNIF (Spearman's|ρ| <0.15, p>.18). In healthy subjects, nNO does not appear to be associated with olfactory sensitivity, trigeminal sensitivity and PNIF.

Reference Value of Nasal Peak Inspiratory Flow Rate in Indian Children: A Cross-sectional Study

Introduction: Peak Nasal Inspiratory Flow (PNIF) measurement is a basic, convenient, easy to use and low cost method of determining the nasal airway patency. However, normative data for paediatric population is scarce and not available for Indian children aged 6 to 12 years. Aim: To establish reference value of PNIF in Indian children aged 6 to 12 years of age. Materials and Methods: A descriptive cross-sectional study was conducted between July 2012 and June 2013 in the Himalayan range of east Sikkim district and Sub-Himalayan Terai region of Darjeeling district of West Bengal. Total 1001 children aged 6 to 12 years were selected from 16 schools by simple random sampling. Of these 1001 children, 784 children were enrolled in the study after taking into account inclusion and exclusion criteria. Repeated PNIF measurements were taken from these 784 children. Mean PNIF value was calculated. The effect of age and height on PNIF was studied. The mean and standard deviation of Peak Inhalation Flow Rate (PIFR) are calculated and compared across groups using a one-way ANOVA test. Regression analysis was done to establish an equation of predicting PNIF level based on height for normal children. The analysis was carried out using Statistical Package for Social Sciences (SPSS) version 16 statistical software. An alpha level of 5% was chosen, which means that any p-value less than 0.05 was considered significant. Results: Mean value of PNIF age group; 6-7 years-53.36 L/min, &gt;7-8 years-56.79 L/min, &gt;8-9 years-63.91 L/min, &gt;9-10 years- 69.45 L/min, &gt;10-11years- 80.71 L/min, &gt;11-12 years-85.69 L/ min. PNIF increases with age and height. A simple formula has also been established to calculate mean PNIF at a given height. PNIF or PIFR (L/min)=-52.716+0.945×height in cm. Conclusion: PNIF measurements are possible in children aged six years and older. Age and height also affect PNIF.

Upper and Lower Respiratory Signs and Symptoms in Workers Occupationally Exposed to Flour Dust

A group of 142 bakers was studied in order to investigate the relationship between higher/lower respiratory signs/symptoms and inflammation biomarkers and occupational exposure to flour dust. A complete upper and lower respiratory tract evaluation was performed. Seven percent of bakers complained of lower respiratory symptoms, while 22% of them complained of upper respiratory symptoms. Fifty five percent of the bakers were allergic, and 37.1% showed sensitization to occupational allergens. Abnormal spirometries were found in 15% of bakers, while fractional exhaled nitric oxide (FeNO) was above the normal reference in 24.5% of them. Moreover, 23.8% of bakers were found to be hyposmic. Population mean peak nasal inspiratory flow (PNIF) was in the normal range even if almost all the workers suffered from neutrophilic rhinitis at nasal cytology with the number of nasal neutrophils increasing with the increase of the duration of exposure to flour dust (p = 0.03). PNIF and FEV1 (forced expiratory volume in the 1st second) showed a positive correlation (p = 0.03; r = 0.19). The Tiffeneau index decreased with the increase of dust (p = 0.017). A similar result was obtained once we divided our population into smokers and non-smokers (p = 0.021). Long-term exposure to bakery dusts can lead to a status of minimal nasal inflammation and allergy.

Mometasone furoate is not superior to saline for chronic rhinitis in the elderly

IntroductionPrevalence of diseases associated with ageing is rising; among these are the rhinologic problems. Chronic rhinitis appears as one of the most common worrisome nasal disorders in this age group. At the same time, the allergic form diminishes because of the immunosenescence. ObjectiveThis study aimed to evaluate the effect of a corticosteroid nasal spray (mometasone furoate) over nasal patency and the severity of rhinitis and its impacts on quality of life as compared with the saline nasal spray. MethodsThis open label-trial randomized subjects ≥60y with chronic rhinitis (allergic and nonallergic rhinitis) with mometasone spray 100mcg/d and isotonic saline nasal spray or saline alone for two weeks. The primary endpoint was the improvement in nasal patency evaluated by the peak nasal inspiratory flow (PNIF). Secondary outcomes included the severity of symptoms and the quality of life assessed by a visual analogic scale (VAS) and the sinonasal outcome test (SNOT-22), respectively. ResultsForty patients underwent randomization, in equal number in each group of treatment, either with allergic (AR) and nonallergic rhinitis (NAR). At week 2, the mean PNIF score was 79.5 in the corticosteroid (CE) plus saline group and 82.0 in the saline group (p = 0.37). Also, SNOT-22 and VAS were not improved with the addition of mometasone furoate. ConclusionsTreatment with mometasone furoate nasal spray plus isotonic saline is not superior to saline alone in elderly patients with rhinitis in respect of improving nasal patency, quality of life, and reducing the intensity of symptoms. Trial registrationThe trial is registered at the Brazilian Clinical Trials Registry (ReBEC) #RBR-498bnq. Registered 05 July 2017.

The effect of the titanium butterfly implant on nasal patency and quality of life.

The titanium butterfly implant seems to be a powerful technique to repair nasal valve insufficiency. However, the effect of these implants on nasal patency and quality of life has been controversial due to a lack of evidence. The purpose of this study is to evaluate the objective and subjective effect of the titanium butterfly implant on nasal patency and corresponding quality of life. Nasal patency and quality of life of 32 patients undergoing a titanium butterfly implant were evaluated by measuring peak nasal inspiratory flow (PNIF) and completing three validated questionnaires: the NOSE, SNOT-22 and GBI, before surgery, six weeks and six months after surgery. The mean PNIF increased significant after 6 weeks, as well as after 6 months. Both the NOSE and SNOT-22 questionnaire scores showed a significant decrease at both post-operative measurements. The GBI indicated a significant increase at 6 weeks and 6 months. There were no significant differences between both of the post-operative measurements. This is the first study indicating that the titanium butterfly implant provides a significant and clinically relevant increase in nasal patency and corresponding quality of life in patients with nasal valve insufficiency.

The effect of the titanium butterfly implant on nasal patency and quality of life

The titanium butterfly implant seems to be a powerful technique to repair nasal valve insufficiency. However, the effect of these implants on nasal patency and quality of life has been controversial due to a lack of evidence. The purpose of this study is to evaluate the objective and subjective effect of the titanium butterfly implant on nasal patency and corresponding quality of life. Nasal patency and quality of life of 32 patients undergoing a titanium butterfly implant were evaluated by measuring peak nasal inspiratory flow (PNIF) and completing three validated questionnaires: the NOSE, SNOT-22 and GBI, before surgery, six weeks and six months after surgery. The mean PNIF increased significant after 6 weeks, as well as after 6 months. Both the NOSE and SNOT-22 questionnaire scores showed a significant decrease at both post-operative measurements. The GBI indicated a significant increase at 6 weeks and 6 months. There were no significant differences between both of the post-operative measurements. This is the first study indicating that the titanium butterfly implant provides a significant and clinically relevant increase in nasal patency and corresponding quality of life in patients with nasal valve insufficiency.

Technical and clinical validation of an environmental exposure unit for ragweed.

BackgroundAllergic rhinitis is a common condition, with ragweed pollen one of the more prevalent aeroallergens. Environmental exposure units such as the Allergen BioCube® are valuable models for clinical allergy studies. A study was conducted to validate the Allergen BioCube for uniform ragweed pollen concentrations and clinically relevant sign and symptom responses to ragweed exposure.MethodsRagweed pollen concentrations were measured on 3 consecutive days in the Allergen BioCube and verified by Rotorod collection and continuous laser particle count measurements. Subjects (N=10) were exposed to ragweed pollen in the BioCube for 3 hours per day for 3 consecutive days. Subjects assessed their nasal itching, sneezing, rhinorrhea, and nasal congestion during each BioCube exposure; total nasal symptom score was computed. Peak nasal inspiratory flow was also assessed during BioCube exposure.ResultsUniform ragweed pollen concentrations were obtained throughout each of the 3-hour testing periods in the Allergen BioCube, both spatially and temporally, at all subject positions, with a low mean standard deviation of 10%. Pronounced increases in mean total nasal symptom scores (6.7±0.94 to 7.6±0.86, last 90 minutes of exposure) occurred for all three BioCube ragweed pollen exposure visits. Mean peak nasal inspiratory flow decreased 24% at 3 hours of BioCube exposure on Day 3. No safety issues of concern occurred in this study.ConclusionThe Allergen BioCube achieved technical and clinical validation for ragweed allergen. Ragweed pollen concentration was uniform both temporally and spatially. Allergic rhinitis signs and symptoms were induced in subjects during exposure to ragweed in the BioCube at clinically meaningful levels for allergy studies.

Spreader grafts: functional or just aesthetical?

Spreader grafts are commonly used in rhinoplasty to achieve an aesthetic improvement of the nose or a functional improvement of the nasal airway. Currently, the aesthetic role of spreader grafts is well established. The functional effect of these grafts, however, has been controversial due to the lack of studies clearly demonstrating an increase on nasal airflow assigned to spreader grafts. The purpose of this study is to evaluate the effect of spreader grafts on nasal breathing. Nasal breathing of 72 consecutive patients undergoing rhinoplasty was evaluated by measuring peak nasal inspiratory flow (PNIF) before surgery and six months after surgery. The mean preoperative PNIF of the 72 patients included in this study was 79.44 l/min and the mean postoperative PNIF was 110.42 l/min (p < 0.001). In 37 patients of this study no spreader grafts were used. In this group of patients the mean PNIF values changed from 73.24 l/min before surgery to 99.46 l/min after surgery. In the group of 35 patients in whom spreader grafts were used the mean PNIF values changed from 86.00 l/min before surgery to 122.00 l/min after surgery. The increase in the mean PNIF value after rhinoplasty was slightly higher in the group of patients with spreader grafts than in the group of patients without spreader grafts. The difference in the postoperative increase of PNIF between these two groups of patients, however, is not statistically significant. This study suggests that patients undergoing rhinoplasty have a statistically significant improvement in nasal breathing after surgery. However, patients receiving spreader grafts in a non-randomized way do not have statistically significant greater benefit than those who do not.

Spreader grafts: functional or just aesthetical?

Spreader grafts are commonly used in rhinoplasty to achieve an aesthetic improvement of the nose or a functional improvement of the nasal airway. Currently, the aesthetic role of spreader grafts is well established. The functional effect of these grafts, however, has been controversial due to the lack of studies clearly demonstrating an increase on nasal airflow assigned to spreader grafts. The purpose of this study is to evaluate the effect of spreader grafts on nasal breathing. Nasal breathing of 72 consecutive patients undergoing rhinoplasty was evaluated by measuring peak nasal inspiratory flow (PNIF) before surgery and six months after surgery. The mean preoperative PNIF of the 72 patients included in this study was 79.44 l/min and the mean postoperative PNIF was 110.42 l/min (p < 0.001). In 37 patients of this study no spreader grafts were used. In this group of patients the mean PNIF values changed from 73.24 l/min before surgery to 99.46 l/min after surgery. In the group of 35 patients in whom spreader grafts were used the mean PNIF values changed from 86.00 l/min before surgery to 122.00 l/min after surgery. The increase in the mean PNIF value after rhinoplasty was slightly higher in the group of patients with spreader grafts than in the group of patients without spreader grafts. The difference in the postoperative increase of PNIF between these two groups of patients, however, is not statistically significant. This study suggests that patients undergoing rhinoplasty have a statistically significant improvement in nasal breathing after surgery. However, patients receiving spreader grafts in a non-randomized way do not have statistically significant greater benefit than those who do not.

Application of Peak Nasal Inspiratory Flow reference values in the treatment of allergic rhinitis.

To assess the applicability of the Peak Nasal Inspiratory Flow (PNIF) curves in follow-up of children in the treatment of allergic rhinitis. Prospective study of 40 patients with AR, grouped in corticosteroid spray versus physiological saline solution use. Follow up for 10 weeks through clinical score and PNIF percentages in relation to the reference curves, with was-out at week 8. Statistical assessment of the effect of treatment on variation of PNIF and clinical score was calculated by ANOVA model and Multiple Comparison of Means Test - Least Significant Difference. There was a statistically significant influence of the group, time and interaction between time and group on PNIF percentages. Throughout follow up, patients from the treatment group had mean PNIF percentages significantly higher than the placebo group. Clinical score results also demonstrated a statistically significant influence between the groups, time and interaction between time and group. Increase in PNIF percentage values observed in children treated with intranasal corticosteroids revealed the applicability of PNIF curves in their follow up.

Improvement of nasal breathing and patient satisfaction by the endonasal dilator Airmax®

Background: Patients suffering from nasal obstruction due to external nasal valve dysfunction may benefit from either corrective surgery or a conservative approach with a nasal dilator. At present, devices for widening the external nasal valve region can be applied externally or endonasally. It remains unknown to what extent the en dona sal dilator Airmax® objectively improves the nasal flow and can be offered as an alternative for surgery. Methodology: Thirty patients suffering from nasal obstruction due to external nasal valve problems were proposed to use the nasal dilator for 4 weeks as an alternative for corrective surgery. The improvement of nasal flow by the dilator was evaluated by measuring the peak nasal inspiratory flow (PNIF). Then, patients were asked for their willingness to continue to use the nasal dilator or to undergo nasal valve surgery. Results: The endonasal dilator improved the mean PNIF from baseline values with a mean increase of 176.1 o/o. After a 4 week trial period, 19 of 30 patients expressed the intention to continue the use of the nasal dilator. Inappropriate size, local irritation and/or aesthetic nasal complaints were mentioned by the other patients as reasons for discontinuation of using the nasal dilator. Conclusion: The endonasal dilator Airmax® represents a powerful device to improve nasal breathing in the target patients and therefore represents a good alternative for corrective surgery.

Improvement of nasal breathing and patient satisfaction by the endonasal dilator Airmax®

Patients suffering from nasal obstruction due to external nasal valve dysfunction may benefit from either corrective surgery or a conservative approach with a nasal dilator. At present, devices for widening the external nasal valve region can be applied externally or endonasally. It remains unknown to what extent the en dona sal dilator Airmax® objectively improves the nasal flow and can be offered as an alternative for surgery. Thirty patients suffering from nasal obstruction due to external nasal valve problems were proposed to use the nasal dilator for 4 weeks as an alternative for corrective surgery. The improvement of nasal flow by the dilator was evaluated by measuring the peak nasal inspiratory flow (PNIF). Then, patients were asked for their willingness to continue to use the nasal dilator or to undergo nasal valve surgery. The endonasal dilator improved the mean PNIF from baseline values with a mean increase of 176.1 o/o. After a 4 week trial period, 19 of 30 patients expressed the intention to continue the use of the nasal dilator. Inappropriate size, local irritation and/or aesthetic nasal complaints were mentioned by the other patients as reasons for discontinuation of using the nasal dilator. The endonasal dilator Airmax® represents a powerful device to improve nasal breathing in the target patients and therefore represents a good alternative for corrective surgery.

Sino‐Nasal Characteristics in Asthmatic Patients

The Unified Airways Hypothesis suggests an involvement of the upper airways in asthma. We aimed to evaluate the association between subjective sino-nasal complaints, nasal air flow, and sino-nasal quality of life (QOL) in patients with asthma compared with nonasthmatic subjects. Case-control study. A tertiary referral center. Symptoms, quality of life, and nasal airflow were assessed in 91 asthmatics and 95 nonasthmatic controls with Visual Analog Scale (VAS, 0-100), Sino-Nasal Outcome Test (SNOT-20), and Peak Nasal Inspiratory Flow (PNIF), respectively. Asthma and allergy status were assessed by Asthma Control Questionnaire (ACQ) and skin prick test or specific IgE. Asthmatic patients (men/women, 37/54; mean age, 43.7 years; range, 19-64 years) reported significantly more nasal obstruction (mean VAS, 37 mm; SD = 26, 95% CI, 32-43 vs 9 mm, SD = 11, 95% CI, 7-11, P < .001) and lower sino-nasal quality of life (mean SNOT-20, 1.3; SD = 0.8, 95% CI, 1.1-1.5 vs 0.4, SD = 0.5, 95% CI, 0.3-0.5, P < .001) than controls (men/women, 42/53; mean age, 43.8 years; range, 20-65 years). PNIF was significantly lower in asthmatic patients than controls (mean PNIF, 84 l/min; SD = 24, 95% CI, 79-89 vs 100 l/min SD = 24, 95% CI, 95-105, P < .001). Both allergic and nonallergic asthma were associated with increased sino-nasal symptoms, reduced sino-nasal QOL, and reduced inspiratory nasal air flow compared to controls. This provides further evidence of the clinical importance of the upper airway in the diagnostic and therapeutic management of asthma patients beyond the scope of allergy.

Symptoms and Signs from the Nose and Sinuses in Asthmatics

Objective: The United Airways Disease hypothesis suggests a link between upper and lower airways in asthmatics. However, there is a need to know more about nose and sinus related quality of life, sinonasal symptoms, and objective nasal air flow in asthmatics compared with healthy individuals. Method: One hundred asthmatics and 96 nonasthmatic controls underwent a prospective controlled survey from June 2009 to December 2010. Symptoms, quality of life, and nasal airflow were assessed on Visual Analogue Scales (VAS, 0-100), Sino-Nasal-Outcome-Test (SNOT-20), and Peak Nasal Inspiratory Flow (PNIF), respectively. Results: Asthmatics (male/female 41/59; mean age, 44.1 years; range, 19-64 years) reported significantly more symptoms of nasal obstruction [mean VAS 38mm (SD 26) vs 9 mm (SD 12), P &lt; .001] than controls (male/female 43/53; mean age, 41 years; range, 20-65 years). PNIF was significantly lower in asthmatics than controls [mean PNIF 85 l/min (SD 24) vs 102 l/min (SD 19), P &lt; .001]. Conclusion: This study provides further evidence of the clinical importance of the upper airway in the diagnostic and therapeutic management of asthmatic patients.

Nasal functional modifications after physical exercise: olfactory threshold and peak nasal inspiratory flow

Statement of problem: The respiratory nasal effects of physical exercise have been extensively investigated; on the other hand there are no data regarding olfactory threshold modification after aerobic physical exercise. Methods: The present prospective study investigated the modifications in nasal respiratory flows and olfactory thresholds after controlled aerobic physical exercise in a cohort of 15 adult, healthy volunteers. The Peak Nasal Inspiratory Flow (PNIF), and the Sniffin’ Sticks olfactory threshold test were used for our determinations. Main results: The mean PNIF after physical exercise was significantly higher than the mean PNIF value found before physical exercise. Statistical analysis ruled out any significant difference between mean olfactory thresholds pre vs post physical exercise. Principal conclusions: These outcomes confirmed PNIF sensitivity and reliability also in determining the changes in nasal patency occurring after physical exercise. The active vasoconstriction of nasal mucosa associated with the reduction of blood flow to the olfactory epithelium due to physical exercise may be compensated for by the increase of olfactory molecules that reach the olfactory mucosa because of nasal mucosal shrinkage: this mechanism could explain the stability of mean olfactory threshold after physical exercise.

Nasal functional modifications after physical exercise: olfactory threshold and peak nasal inspiratory flow

The respiratory nasal effects of physical exercise have been extensively investigated; on the other hand there are no data regarding olfactory threshold modification after aerobic physical exercise. The present prospective study investigated the modifications in nasal respiratory flows and olfactory thresholds after controlled aerobic physical exercise in a cohort of 15 adult, healthy volunteers. The Peak Nasal Inspiratory Flow (PNIF), and the Sniffin’ Sticks olfactory threshold test were used for our determinations. The mean PNIF after physical exercise was significantly higher than the mean PNIF value found before physical exercise. Statistical analysis ruled out any significant difference between mean olfactory thresholds pre vs post physical exercise. These outcomes confirmed PNIF sensitivity and reliability also in determining the changes in nasal patency occurring after physical exercise. The active vasoconstriction of nasal mucosa associated with the reduction of blood flow to the olfactory epithelium due to physical exercise may be compensated for by the increase of olfactory molecules that reach the olfactory mucosa because of nasal mucosal shrinkage: this mechanism could explain the stability of mean olfactory threshold after physical exercise.

Disconnect between standardized field‐based testing and mannitol challenge in Scottish elite swimmers

Elite swimmers have high rates of rhinoconjunctivitis and exercise-induced bronchoconstriction. Moreover, exposure to chlorine and chlorine metabolites is known to induce bronchial hyper-reactivity. To assess the early and late effects of chlorine and exercise on the unified airway of elite swimmers, and to compare the response to mannitol and field-based exercise challenge. The Scottish national squad underwent exhaled tidal (FE(NO)) and nasal (N(NO)) nitric oxide measurement, peak nasal inspiratory flow (PNIF), and forced expiratory volume in 1 s before, immediately after, and 4-6 h post-swimming. A sport-specific exercise test was carried out during an intensive lactate set (8 min at >/=80% maximum hear rate). All swimmers underwent mannitol challenge, and completed a health questionnaire. N=61 swimmers were assessed: 8/59 (14%) of swimmers had a positive mannitol challenge. Nine out of 57 (16%) of swimmers had a positive exercise test. Only one swimmer was positive to both. Swimmers with a positive mannitol had a significantly higher baseline FE(NO) (37.3 vs. 18.0 p.p.b., P=0.03) than those with a positive exercise challenge. A significant decrease in FE(NO) was observed pre vs. immediate and delayed post-chlorine exposure: mean (95% CI) 18.7 (15.9-22.0) p.p.b. vs. 15.9 (13.3-19.1) p.p.b. (P<0.01), and 13.9 (11.5-16.7) p.p.b. (P<0.01), respectively. There were no significant differences in N(NO.) Mean PNIF increased from 142.4 L/min (5.8) at baseline to 162.6 L/min (6.3) immediately post-exposure (P<0.01). Delayed post-exposure PNIF was not significantly different from pre-exposure. No association was found between mannitol and standardized field-based testing in elite swimmers. Mannitol was associated with a high baseline FE(NO); however, exercise/chlorine challenge was not. Thus, mannitol may identify swimmers with a 'traditional' inflammatory asthmatic phenotype, while field-based exercise/chlorine challenge may identify a swimmer-specific bronchoconstrictor response. A sustained fall in FE(NO) following chlorine exposure suggests that a non-cellular, perhaps neurogenic, response may be involved in this group of athletes.

Desloratadine for the treatment of cypress pollen–induced allergic rhinitis

Few studies have been conducted to assess treatment options for patients with sensitivities to cypress pollens, important triggers of allergic rhinitis (AR) in the Mediterranean region. To evaluate the effect of desloratadine, a second-generation antihistamine, on AR symptoms caused by cypress pollens native to France. Adults (N=233) with symptomatic cypress pollen allergies were randomized to receive desloratadine, 5 mg, or placebo daily for 15 days during 2 consecutive cypress pollen seasons. The primary end point was the percentage change from baseline in morning total nasal symptom scores on day 14; secondary assessments included total symptom score, peak nasal inspiratory flow, the Rhinoconjunctivitis Quality of Life Questionnaire, and global response to therapy. On day 14, the desloratadine group had a significantly greater percentage decrease in total nasal symptom score vs the placebo group (-40% vs. -30%; P < .04). Similarly, on day 14, there was a 47% and 37% respective decrease in total symptom score (P = .01). Mean peak nasal inspiratory flow scores showed numeric, albeit not statistically significant, improvements from baseline through day 14 with desloratadine. A significantly greater improvement in Rhinoconjunctivitis Quality of Life Questionnaire scores occurred with desloratadine vs placebo on day 14 (-1.4 vs. -0.9; P = .004). The mean global response to therapy was better with desloratadine vs placebo (3.4 vs. 3.9; P = .004). The adverse event rate was similar in both groups. Desloratadine is efficacious and safe for the treatment of AR induced by cypress pollens; it also improved disease-related quality of life.