- Klíčová slova
- mykotická rinosinusitida,
- MeSH
- chronická nemoc MeSH
- mykózy chirurgie diagnostické zobrazování diagnóza farmakoterapie MeSH
- rýma diagnóza epidemiologie etiologie mikrobiologie terapie MeSH
- sinusitida diagnóza epidemiologie etiologie mikrobiologie terapie MeSH
- Publikační typ
- kazuistiky MeSH
INTRODUCTION: Data from mHealth apps can provide valuable information on rhinitis control and treatment patterns. However, in MASK-air®, these data have only been analyzed cross-sectionally, without considering the changes of symptoms over time. We analyzed data from MASK-air® longitudinally, clustering weeks according to reported rhinitis symptoms. METHODS: We analyzed MASK-air® data, assessing the weeks for which patients had answered a rhinitis daily questionnaire on all 7 days. We firstly used k-means clustering algorithms for longitudinal data to define clusters of weeks according to the trajectories of reported daily rhinitis symptoms. Clustering was applied separately for weeks when medication was reported or not. We compared obtained clusters on symptoms and rhinitis medication patterns. We then used the latent class mixture model to assess the robustness of results. RESULTS: We analyzed 113,239 days (16,177 complete weeks) from 2590 patients (mean age ± SD = 39.1 ± 13.7 years). The first clustering algorithm identified ten clusters among weeks with medication use: seven with low variability in rhinitis control during the week and three with highly-variable control. Clusters with poorly-controlled rhinitis displayed a higher frequency of rhinitis co-medication, a more frequent change of medication schemes and more pronounced seasonal patterns. Six clusters were identified in weeks when no rhinitis medication was used, displaying similar control patterns. The second clustering method provided similar results. Moreover, patients displayed consistent levels of rhinitis control, reporting several weeks with similar levels of control. CONCLUSIONS: We identified 16 patterns of weekly rhinitis control. Co-medication and medication change schemes were common in uncontrolled weeks, reinforcing the hypothesis that patients treat themselves according to their symptoms.
- MeSH
- lidé MeSH
- longitudinální studie MeSH
- průzkumy a dotazníky MeSH
- rýma * epidemiologie MeSH
- telemedicína * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease," coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis." This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis, and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitization patterns (mono- or pauci-sensitization versus polysensitization), (iii) severity of symptoms, and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and autoimmune diseases.
- Klíčová slova
- muškát léčivý,
- MeSH
- dítě MeSH
- fytoterapie * dějiny MeSH
- lékové roztoky terapeutické užití MeSH
- lidé MeSH
- rýma * epidemiologie farmakoterapie prevence a kontrola terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
BACKGROUND: Chronic rhinosinusitis (CRS) is a chronic inflammatory disease associated with a substantial personal and socioeconomic burden. Monitoring of patient-reported outcomes by mobile technology offers the possibility to better understand real-life burden of CRS. METHODS: This study reports on the cross-sectional evaluation of data of 626 users of mySinusitisCoach (mSC), a mobile application for CRS patients. Patient characteristics of mSC users were analysed as well as the level of disease control based on VAS global rhinosinusitis symptom score and adapted EPOS criteria. RESULTS: The mSC cohort represents a heterogeneous group of CRS patients with a diverse pattern of major symptoms. Approximately half of patients reported nasal polyps. 47.3% of all CRS patients were uncontrolled based on evaluation of VAS global rhinosinusitis symptom score compared to 40.9% based on adapted EPOS criteria. The impact of CRS on sleep quality and daily life activities was significantly higher in uncontrolled versus well-controlled patients. Half of patients had a history of FESS (functional endoscopic sinus surgery) and reported lower symptom severity compared to patients without a history of FESS, except for patients with a history of more than 3 procedures. Patients with a history of FESS reported higher VAS levels for impaired smell. CONCLUSION: Real-life data confirm the high disease burden in uncontrolled CRS patients, clearly impacting quality of life. Sinus surgery improves patient-reported outcomes, but not in patients with a history of more than 3 procedures. Mobile technology opens a new era of real-life monitoring, supporting the evolution of care towards precision medicine.
- MeSH
- chronická nemoc MeSH
- kvalita života MeSH
- lidé MeSH
- nosní polypy * epidemiologie MeSH
- průřezové studie MeSH
- rýma * diagnóza epidemiologie MeSH
- sinusitida * diagnóza epidemiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- adherence a compliance při léčbě MeSH
- antiastmatika aplikace a dávkování klasifikace MeSH
- bronchiální astma * diagnóza farmakoterapie komplikace prevence a kontrola MeSH
- diferenciální diagnóza MeSH
- komplikace těhotenství * diagnóza farmakoterapie imunologie prevence a kontrola MeSH
- lidé MeSH
- respirační funkční testy klasifikace MeSH
- rýma epidemiologie farmakoterapie klasifikace komplikace MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: During the past decade, extraesophageal reflux (EER) has been hypothesized to be one of the possible factors that contribute to the worsening of chronic rhinosinusitis (CRS). However, the relationship remains indeterminate due to its complexity, and it is not clear whether antireflux treatment is indicated for patients with recurrent CRS and who would benefit from it. OBJECTIVE: The aim of the study was to determine the severity of EER in patients with variable durations of CRS and different numbers of previous endoscopic endonasal surgeries (EES). METHODS: Ninety patients with CRS were recruited for the prospective case series. The age, sex, body mass index, reflux symptom index, duration of treatment of CRS with corticosteroids, and the number of ESS within the previous 5 years were ascertained. The severity of EER was evaluated by oropharyngeal pH monitoring by using the Restech system (the presence of EER, value of the RYAN score) and compared among the groups with varying durations of treatment of CRS (≤10 years, 11-20 years, >20 years) and different numbers of ESS within the previous 5 years (no ESS, 1-2 ESS, >2 ESS). RESULTS: Pathologic EER was present significantly more often in patients with CRS treated for >10 years (p = 0.0054) and in patients who underwent >2 ESS within the previous 5 years (p = 0.0001). CONCLUSION: Patients with CRS treated for >10 years and those who had undergone >2 ESS within the previous 5 years had significant EER. Antireflux therapy (e.g., proton pump inhibitors) can be recommended for these patients. However, its effect has to be confirmed in further studies.
- MeSH
- chronická nemoc MeSH
- dospělí MeSH
- endoskopie * MeSH
- gastroezofageální reflux farmakoterapie epidemiologie chirurgie MeSH
- inhibitory protonové pumpy terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- progrese nemoci MeSH
- prospektivní studie MeSH
- rinoplastika * MeSH
- rýma farmakoterapie epidemiologie chirurgie MeSH
- sinusitida farmakoterapie epidemiologie chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The aim of this study was to determine the severity of extraesophageal reflux (EER) in patients with various degrees of chronic rhinosinusitis (CRS), and particularly in patients with simultaneous bronchial asthma. METHODS: Patients with different severity of CRS were invited to participate in the study. Group I consisted of patients with CRS without nasal polyps or bronchial asthma; group II consisted of patients with CRS with nasal polyps but without bronchial asthma; group III consisted of patients with CRS with nasal polyps and bronchial asthma. The age, gender, Reflux Symptom Index, severity of EER evaluated using the Restech system, and number of previous functional endoscopic sinus surgeries (FESSs) were compared between groups. RESULTS: A total of 90 patients (30 in each group) were recruited for the study. Pathological EER was significantly often present in group III when compared with group I and group II in all parameters analyzed (RYAN score, number of EER episodes, total percentage of time below pH 5.5). Furthermore, patients from group III had undergone more surgeries in the past. CONCLUSION: Patients with CRS with nasal polyps and simultaneous bronchial asthma suffer from significant EER. Antireflux therapy can be recommended for these patients. However, the effect has to be confirmed in further studies.
- MeSH
- bronchiální astma epidemiologie MeSH
- chronická nemoc MeSH
- dospělí MeSH
- gastroezofageální reflux epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nosní polypy epidemiologie MeSH
- prevalence MeSH
- progrese nemoci MeSH
- rýma epidemiologie MeSH
- sinusitida epidemiologie MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Kanada MeSH
Autorka prezentuje kazuistiku dívky, u které po zahájení docházky do mateřské školy došlo k prudkému nárůstu nemocnosti. Na základě této kazuistiky polemizuje nad nutností odborného vyšetření u všech opakovaně nemocných dětí. V teoretické části jsou definovány pojmy recidivující respirační infekty, fyziologická nemocnost, indikace imunologického odběru.
The author presents a case study of a girl, who after starting her kindergarten attendance, has been indicated a sharp increase in morbidity. Based on this case study the author argues against the necessity of expert examination of all repeatedly sick children. In the theoretical part is defined the term recidivous respiratory infection, physiological morbidity and immunological test indication.
- MeSH
- adjuvancia imunologická terapeutické užití MeSH
- dítě MeSH
- kašel * epidemiologie imunologie MeSH
- lidé MeSH
- předškolní dítě MeSH
- recidiva MeSH
- roční období MeSH
- rýma * epidemiologie imunologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- předškolní dítě MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- akutní nemoc MeSH
- chronická nemoc ošetřování prevence a kontrola MeSH
- lidé MeSH
- příznaky a symptomy MeSH
- rýma * diagnóza epidemiologie etiologie klasifikace patologie prevence a kontrola terapie MeSH
- sinusitida * diagnóza epidemiologie etiologie klasifikace patologie prevence a kontrola terapie MeSH
- Check Tag
- lidé MeSH
