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Introduction: Allergic rhinitis is a chronic inflammatory disease which affects 1 out of 6 individuals. Perennial allergic rhinitis accounts for 40% of AR cases. Ciclesonide is one of the relatively new intranasal steroid for allergic rhinitis. Objective: The purpose of this study was to evaluate the efficacy and safety of ciclesonide in the treatment of perennial allergic rhinitis. Methods: We searched Pubmed, Scientific Citation Index, Embase, Clinical Trial Registries for randomized controlled trials and Cochrane Central Register of Controlled Trials to find out the randomized controlled Trial comparing ciclesonide with placebo for PAR. Results: Eight studies were included. In comparison with placebo groups, ciclesonide groups significantly decreased Reflective Total Nasal Symptom Score (MD = −0.56; 95% CI −0.72 to 0.39, p

INTRODUCTION: Turbinoplasty is a procedure that aims to reduce the size of the inferior turbinate through exuberant bone removal with high mucosal preservation. The procedure is recommended for patients with or without allergic rhinitis and those showing irreversible hypertrophy of inferior turbinates. OBJECTIVE: To evaluate the efficacy of inferior turbinoplasty for obstructive and non-obstructive symptoms in patients with or without allergic rhinitis. METHODS: Prospective study with 57 patients who underwent inferior turbinoplasty. They were evaluated for nasal obstruction, snoring, facial pressure, smell alterations, sneezing, nasal itching and runny nose symptoms, surgery time, and intraoperative bleeding. The last evaluation took place three months after surgery. RESULTS: Thirty-nine patients with allergic rhinitis and 18 without were assessed. Ninety days after surgery, 94.7% of patients showed degrees IV and V of breathing improvement; 89.5% showed moderate or complete improvement in snoring; all patients showed smell improvement (only one showed moderate improvement; all the others had full improvement); 95.5% experienced complete facial pressure improvement; and 89.7% showed moderate to complete improvement in nasal itching and runny nose symptoms, as well as in sneezing. CONCLUSION: The efficacy of inferior turbinoplasty was confirmed not only for obstructive symptoms, but also for non-obstructive symptoms in patients with and without allergic rhinitis. RESUMO INTRODUÇÃO: A turbinoplastia é procedimento que visa a redução da concha inferior, à custa da remoção óssea exuberante e maior preservação da mucosa. É indicada para pacientes com e sem rinite alérgica, com hipertrofia irreversível das conchas inferiores. OBJETIVO: Avaliar a eficácia da cirurgia de turbinoplastia inferior nos sintomas obstrutivos e não obstrutivos em pacientes com e sem rinite alérgica. MÉTODO: Estudo prospectivo com 57 pacientes submetidos a turbinoplastia inferior. Foram avaliados quanto à obstrução nasal, roncos, pressão facial, alterações no olfato, espirros, prurido nasal e coriza, tempo de cirurgia e sangramento intraoperatório. A última avaliação foi com 3 meses de operação. RESULTADOS: 39 pacientes com rinite alérgica e 18 sem. Com 90 dias de operação, 94,7% dos pacientes apresentaram graus IV e V de melhora na respiração; 89,5% apresentaram melhora moderada ou total dos roncos; todos os pacientes tiveram melhora no olfato (apenas 1 moderada, os demais melhora total); 95,5% obtiveram melhora total da pressão facial e 89,7% obtiveram melhora moderada ou total em prurido nasal, espirros e coriza. CONCLUSÃO: Comprovou-se a eficácia da cirurgia de turbinoplastia inferior não só nos sintomas obstrutivos, mas também nos sintomas não obstrutivos tanto em pacientes com ou sem rinite alérgica.

Introduction In teenagers with perennial allergic rhinitis, exposure to tobacco cigarette smoke increases the count of eosinophils in the nasal mucosa; the recruitment of eosinophils arises from the combined action of a number of cellular and molecular signals, including eotaxin. Objective To assess the effect of exposure to tobacco cigarette smoke on the count of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa of children and teenagers with perennial allergic rhinitis. Methods In a cross-sectional study, forty-four patients were evaluated (aged 7–19 years old): 22 with and 22 with no exposure to tobacco cigarette smoke. After replying to 2 validated questionnaires, on Asthma and Allergies in Childhood and on the severity of nasal symptoms, nasal mucosal samples were obtained by scraping the middle one-third of the inferior turbinates. Then counts of immunoreactive cells to eotaxin-1 and eosinophils were assessed by immunohistochemistry. Results Patients with exposure to tobacco cigarette smoke showed higher cell counts of both eotaxin-1 and eosinophils than patients with no exposure to the smoke, with no correlation between the two variables. However, both counts, of eotaxin-1 and eosinophils, were related to the cotinine/creatinine ratio. Conclusions Exposure to tobacco cigarette smoke can increase eotaxin-1 and the count of eosinophils in the nasal mucosa of young patients with perennial allergic rhinitis.

Resumo: Objectivos: Com o objectivo de identificar hábitos alimentares e características habitacionais como factores de risco para a prevalência de problemas respiratórios na população escolar do 1.° ciclo da cidade de Lisboa foi realizado um estudo transversal. Material e Métodos: De Outubro a Dezembro de 2008, os pais de 900 alunos das escolas do 1.° ciclo de Lisboa foram convidados a responder a um questionário similar ao do Programa Internacional de Estudo de Asma e Alergias na Infância (International Study of Asthma and Allergies in Childhood Program â ISAAC). A taxa de resposta foi de 40%. Aos resultados foi aplicada análise de regressão logística. Resultados: A prevalência de asma, rinite alérgica e sibilância foi de 5,6, 43,0 e 43,3%, respectivamente. Os factores de risco independentemente associados à asma foram a sibilância e a tosse seca à noite, não relacionadas com sintomas de constipação comum nos últimos 12 meses. As crises de pieira foram consideradas susceptíveis de afectar as actividades diárias das crianças. Os factores de risco para sibilância foram a febre dos fenos e a presença de um animal de estimação em casa. A tosse durante a noite foi identificada como um factor de risco para a rinite. O consumo frequente de ovo foi também associado a um maior risco de manifestar rinite. Conclusões: Ao contrário da asma, a prevalência de rinite alérgica e sibilância aumentou em comparação com estudos anteriores ISAAC. Os ataques de pieira foram associados com os episódios asmáticos, e a febre dos fenos foi identificada como um factor de risco para a pieira. Ter animais de estimação em casa foi apontado como um factor de risco para a rinite, enquanto a exposição ao fumo, mofo, artigos de peluche, alimentação (excepto o consumo de ovos), amamentação ou outros parâmetros não representaram um factor de risco para a doença. Abstract: Aims: A cross-sectional study was carried out with the objective of identifying nutrition habits and housing conditions as risk factors for respiratory problems in schoolchildren in Lisbon. Material and Methods: Between October and December 2008, parents of 900 students of the basic schools of Lisbon were invited to answer a questionnaire of the International Study of Asthma and Allergies in Childhood Program (ISAAC). The response rate was 40%. Logistic regression was used in the analysis of results. Results: The prevalence of asthma, allergic rhinitis and wheeze was 5.6%, 43.0% and 43.3%, respectively. Risk factors independently associated with asthma were wheezing attacks, and dry cough at night not related to common cold in the last 12 months. Wheezing crises were found to affect children daily activities. Risk factors for wheeze were hay fever and the presence of a pet at home. A risk factor for rhinitis was cough at night. The frequent consumption of egg was also associated with increased risk of rhinitis. Conclusion: Contrarily to asthma, the prevalence of allergic rhinitis and wheeze increased in comparison with previous ISAAC studies. Wheezing attacks were associated with asthma and hay fever was identified as a risk factor of manifesting wheezing symptoms. Having pets at home was pointed out as a significant risk factor for rhinitis, but not smoking exposure, mould, plush toys, diet (except egg consumption), breastfeeding or other conditions. Palavras-chave: Asma, Rinite, Pieira, Inquéritos, Crianças, Keywords: Asthma, Rhinitis, Wheeze, Questionnaire, Children

Asthma is the most common chronic disease in pediatrics. Most data on the prevalence of childhood allergic diseases come from the International Study of Asthma and Allergies in Childhood (ISAAC) phase II held in 1995 and phase III from 2002. ISAAC created a methodology for studying two age groups 6--7 and 13--14 years old. In 2002, according to the data gathered in the phase III of ISAAC, the prevalence of asthma among Portuguese children from 6 to 7 years old was 9.4%, 29.1% for rhinitis and 28.1% for wheezing. In the last decade, little information on the prevalence of childhood asthma and rhinitis in Portugal has been documented, and to the best of our knowledge, none in Coimbra. In 2002, 5 centers from 5 Portuguese cities joined the ISAAC project: Lisbon, Oporto, Coimbra, Portimao and Funchal. The Coimbra research center only studied 13--14 years old adolescents. The district of Coimbra, with a total area of 3974 km, is located in central Portugal and has 434,311 inhabitants. Coimbra is the biggest city in the central region, and the 6th largest in Portugal. The most recent published data on childhood asthma prevalence in Portugal come from the Lisbon 2008 study where the prevalence of asthma, allergic rhinitis and wheezing was 5.6%, 43.0% and 43.3%, respectively, and from

Resumo: Objectivos â Determinar a prevalência da associação de sintomas de rinoconjuntivite e asma em adolescentes, analisar se os sintomas de asma são mais intensos e frequentes entre os adolescentes com sintomas de rinoconjuntivite alérgica e avaliar se os adolescentes reconhecem os sintomas de rinoconjuntivite.Métodos â Realizou-se um estudo do tipo corte transversal com dois componentes: um estudo de prevalência e um estudo entre casos (sintomas de rinoconjuntivite), com um grupo de comparação (ausência de sintomas de rinoconjuntivite) a partir de informações dos questionários aplicados na fase 3 do ISAAC, no ano de 2002, na cidade do Recife.Resultados â A prevalência da associação de sintomas de rinoconjuntivite e de provável asma foi de 5,1% (48/940; IC 95%: 3,8 %-6,6%), apenas de asma de 10,9% (103/940; IC 95%: 9,1%-13,1%) e de rinoconjuntivite isolada foi de 9,7% (91/940; IC 95%: 7,9%-13%). Entre os adolescentes com sintomas de rinite, 81,3% (39/48) tinham provável asma persistente, 31,8% (48/151) dos com sintomas de asma referiam também sintomas de rinoconjuntivite. Não reconheciam os sintomas de rinoconjuntivite 65,1% (86/132) dos adolescentes que apresentavam esses sintomas.Conclusão â A associação de sintomas de rinoconjuntivite e asma é frequente e está associada à maior gravidade dos sintomas de asma. O facto de os adolescentes não reconhecerem os sintomas de rinoconjuntivite reflecte o subdiagnóstico, que pode resultar na desvalorização dos sintomas e, consequentemente, no tratamento inadequado.Rev Port Pneumol 2009; XV (4): 613-628 Abstract: Aim â Our study aimed to determine the rate of association of rhinoconjunctivitis and asthma symptoms in adolescents to analyse whether asthma symptoms are more severe and frequent in asthmatics with concomitant allergic rhinitis and assess if adolescents are aware of having rhinoconjunctivitis.Methods â A cross-sectional study, with two components: a study in prevalence and an inter-case study (rhinitis symptoms) with a comparison group (no rhinitis symptoms), based on information from questionnaires applied in phase 3 of ISAAC in Recife in 2002.Results â Associated rhinoconjunctivitis and probable asthma symptoms were observed in 5.1% of adolescents (48/940; CI 95%: 3.8 %-6.6%), probable asthma alone in 10.9% (103/940; CI 95%: 9.1%-13.1%) and rhinoconjunctivitis alone in 9.7% (91/940; CI 95%: 7.9%-13%). Among the rhinitisbearing adolescents, almost 81.3% (39/48) had persistent probable asthma and 31.8% (48/151) of asthmatic patients rhinoconjunctivitis. 65.1% (86/132) of adolescents with diagnosed rhinitis were unaware of rhinitis symptoms.Conclusions â The association of rhinoconjunctivitis and asthma symptoms is frequent and associated to more severe asthma symptoms. Adolescentsâ unawareness of rhinitis symptoms reflects the underdiagnosis that can result in downplaying the symptoms, and the consequent undertreatment.Rev Port Pneumol 2009; XV (4): 613-628 Palavras-chave: Asma, rinite, adolescentes, prevalência, Key-words: Prevalence, rhinoconjunctivitis, asthma, adolescents

Resumo: Introdução: As prevalências da asma e rinite têm aumentado nas últimas décadas, mas nos últimos anos tem sido referida a sua estabilização ou mesmo diminuição.Objectivo: O objectivo foi o de descrever a prevalência de rinite, asma ou sintomas do tipo da asma em adolescentes urbanos de 13 anos.Métodos: Os participantes elegíveis foram todos os alunos das escolas públicas e privadas do Porto, nascidos em 1990; 2161 (77,5%) concordaram em participar. Através de questionários autoaplicados, a informação recolhida contemplou aspectos sociais, demográficos, comportamentais, história clínica de asma e doenças alérgicas do adolescente e família. Foi usada a versão portuguesa do International Study of Asthma and Allergies in Childhoodâs (ISAAC) e foram efectuadas espirometrias.Resultados: Nesta amostra de adolescentes urbanos de 13 anos, a prevalência da asma durante a vida foi de 12,9%, 84,4% com diagnóstico médico. A pieira durante a vida foi 18,3% e no último ano de 9,3%. A rinite foi relatada por 10,1%, mas a prevalência durante a vida de adolescentes com espirros, rinorreia serosa ou obstrução nasal, foi de 32,0%, e no último ano de 27,4%.Conclusão: Verificou-se uma estabilização ou mesmo diminuição da prevalência dos sintomas e diagnóstico de asma e rinite nos adolescentes do Porto, quando comparada com os resultados do ISAAC em 2002, tal como noutras investigações na Europa. A asma e a rinite estão frequentemente presentes no mesmo doente e a tosse nocturna é um importante sintoma que surge associado aos sintomas nasais. A função pulmonar permitiu discriminar os adolescentes com queixas respiratórias.Rev Port Pneumol 2008; XIV (6): 747-768 Abstract: Background: The prevalence of asthma and rhinitis has been increasing over the past few decades, but the last few years have seen these rates stabilise or even decrease.Aim: The aim of our study was to describe the prevalence of rhinitis, asthma or asthma-like symptoms in 13 year-old urban adolescents.Methods: Eligible participants were all students at state and private schools in Porto born in 1990. 2161 (77.5%) agreed to participate. Information was obtained using self-administered questionnaires inquiring into social, demographic, behavioural and clinical history including asthma and allergic diseases in the adolescent and the family. We used the Portuguese version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and we also performed spirometry tests.Results: In this sample of 13 year old urban adolescents the prevalence of asthma ever was 12.9%, 84.4% with physician diagnosis. Lifetime wheezing was reported by 18.3% and current wheezing by 9.3% of the adolescents. Rhinitis was referred to by 10.1%, but the prevalence of adolescents with sneezing ever, or a runny/blocked nose, was 32.0% and the prevalence in the last 12 months was 27.4%.Conclusion: We concluded that there was stabilisation or even decrease in the prevalence of asthma and rhinitis symptoms and diagnosis in adolescents reported in Porto, compared with the 2002 ISAAC study, as observed in other surveys in Europe. Asthma and rhinitis is frequently present in the same patient and nocturnal cough is an important symptom concomitant with nasal symptoms. Measures of lung function permitted the discrimination of adolescents with respiratory complaints.Rev Port Pneumol 2008; XIV (6): 747-768 Palavras-chave: Adolescentes, asma, rinite, estudos transversais, prevalência, tendência, Key-words: Adolescents, asthma, rhinitis, cross-sectional studies, prevalence, trends

Resumo: Introdução: Asma e rinite frequentemente coexistem no mesmo paciente. Parece existir uma condição que afecta o tracto respiratório como um todo e que pode produzir sintomas na via aérea inferior e/ou superior.Objetivo: Estudar as alterações funcionais das vias aéreas inferiores e superiores em pacientes em crise de asma antes e pós-curso de corticóide oral.Métodos: No período de Julho de 2000 a Agosto de 2002, dezasseis pacientes (69% do sexo feminino) em crise de asma com sintomas de rinite atendidos no pronto atendimento de pneumologia foram analisados por meio de um ensaio clínico observacional porquestionário de sintomas, exame físico, radiograma, espirometria, rinometria acústica e rinomanometria computadorizada.Resultados: Dezasseis pacientes apresentaram sintomas de comprometimento das vias aéreas superiores. Na espirometria, o VEF1, o VEF1 /CVF e o FEF25-75%, apresentaram diferenças estatísticas significativas. A rinometria acústica apresentou diferença estatística significativa na área variável transversal mínima 1 e 2 do lado esquerdo e volume total nasal, pós-intervenção medicamentosa.Conclusões: Nas avaliações funcionais de vias aéreas inferiores e superiores, foram observadas melhora do VEF1, VEF1 /CVF e FEF, medidos pela espirometria e do volume total nasal, analisado pela 25-75% rinometria acústica pós-intervenção de corticóide oral.Rev Port Pneumol 2005; XI (1): 35-46 Abstract: Introduction: Asthma and rhinitis frequently coexist in the same patient. It may exist a specific condition witch affects the general respiratory activity and also able to produce symptoms into upper and/ or lower airways.Purpose: To analyze the alteration and functional burst of upper and lower airways before and after oral corticoid.Methods: From July of 2000 to August of 2002, sixteen (69 % was female), acute asthmatics patients with rhinitis symptom assisted in the pneumology department, were analyzed through cross-sectional study using: symptoms questionnaire, physical examination, radiogram, spirometry, acoustic rhinometry, and rhinomanometry.Results: Sixteen patients presented compromising symptoms of the upper airways. In the spirometry, FEV1, FEV1 /FVC e FEF, presented major statistically differences. The acoustic rhinometry 25-75% presented important statistical differences in the minimal cross- sectional area 1 e 2 in the left side and total nasal volume, after medicine intervention.Conclusions: The functional evaluations upon lower and upper airways, improvements in FEV1, FEV1 / FVC e FEF, were observed through spirometry 25-75% and total nasal volume, analyzing the acoustic rhinometry after oral corticoid.Rev Port Pneumol 2005; XI (1): 35-46 Palavras-chave: Asma, rinite, rinometria, aústica, rinomanometria computadorizada, espirometria, Key-words: Asthma, rhinitis, acoustic rhinometry, rhinomanometry, spirometry