Summarised work of rhinitis respiratory infection

1. MANAGEMENT OF RHINITIS

2. Allergic rhinitis
 Allergic rhinitis is a chronic inflammation of
the nasal mucous membrane due to
exposure to allergens.
 It is more common in children than adults.
 The condition runs in the family i.e.
affected person has a father or mother
who has the disease or other allergic
diseases such as asthma.

3. What happens?
Symptoms of allergic rhinitis occur when the
patient is exposed to allergens such as:-
 Grass pollens
 House dust mites
 Dust
 Cold weather

4. Natural history of allergic rhinitis
 Onset is common in childhood as low as 6
months.
 symptoms tend to disappear in adulthood
but may persist throughout life.
 Allergic rhinitis affects quality of life of the
patient.
 It may affects the child’s academic
performance because of absenteeism.

5. Signs and symptoms
 Repetitive sneezing especially in the
morning hours
 Itching of the nose, eyes, throat, or palate
 Nasal congestion(blocked nostrils)
 Post nasal dripping
 Dry cough
 Irritability

6. What triggers these symptoms?
Allergic rhinitis symptoms are aggravated
by irritants such as:-
 Cold air
 Tobacco smoke
 Perfumes
 Oil paint
 Insecticide sprays such as Doom.
 Dust

7. Classification of Allergic
Rhinitis
 Allergic rhinitis may be classified into 2
depending on the variation of symptoms.
 Seasonal allergic rhinitis
 Perennial allergic rhinitis
 This classification is based on the time
and duration of exposure to the offending
allergens.

8. Seasonal Allergic Rhinitis
 Symptoms of seasonal allergic rhinitis
occur during a particular period of the year
such as during rainy season.
 The symptoms affect the nose, eyes, and
the throat.
 The condition normally begins at the age of
6 years or older.
 These patients also develop allergic
conjunctivitis.

9. Signs and Symptoms
 Repetitive Sneezing especially in the
morning hours
 Nasal congestion
 Running nose
 Postnasal dripping
 Continuous clearing of the throat
 Itching of the eyes, nose, ears and throat
 Dry cough

10. Perennial allergic rhinitis
 The patients with perennial rhinitis have
symptoms throughout the year.
 This is due to the continuous presence of
allergens such as house dust mites in
carpets or blankets.
 Symptoms are localized to the nose and do
not affect other organs
 Patient has high chances of developing
polyps.

11. Sign and Symptoms
 Snoring
 Intense nasal obstruction
 Sneezing
 Disturbed sleep and mouth breathing
 Constant sniffing
 Nasal quality to the speech
 Loss of smell and taste
 Dull frontal headache
Note:
In perennial allergic rhinitis, itching of the eyes
and ears are rare.

12. Diagnosis
 History taking
 Nasal examination (concentrate around
the nose, eyes and throat)

13. Patient assessment
1. When did the symptoms begin?
2. How often do you get these symptoms and for
how long do they stay?
3. How severe are the symptoms?
4. Do symptoms affect the eyes, ears and the
throat as well?
5. Do you have other condition such as asthma,
eczema e.t.c?
6. Have you got any treatment, if yes how was
the response?
7. Is there any other family member with the
same problem?

14. Differences between allergic
rhinitis and common cold (flu)
Allergic rhinitis
 Symptoms last for
more than 2 weeks
 No fever
 Sneezing is repetitive
up to 10 times and
more severe in the
morning
 Associated with no
body pain.
Common cold
 Symptoms last for less
than 2 weeks even
without treatment
 Patients usually have
fever
 Sneezing is 1-2 times at
ago
 Patients usually
complain of body pain
and malaise.

15. Management of allergic rhinitis
Aim of therapy:-
 Symptomatic relief
 Prevention of future complications
 Improvement of quality of life patient.

16. General measures
 Avoidance of exposure to allergens and
irritants if possible
 Do not allow smoking (if one does) at
home or in the car.
 Eliminate dust collecting items like
blankets, carpets.
 Wash bed sheets at least twice a week
 Remove cats from the house

17. Patient education
Patient education should focus on the
following:
 Disease
 Drugs used and rationale
 Need for compliance
 How to use nasal drops or spray
 When to expect a clinical response from
drugs

18. Patient education
 Name of the disease (allergic rhinitis)
 The disease is chronic and not curable
 Drugs relieve symptoms but don’t cure
 Name of the drug and how to take it
 Drug side effects and contraindications
 Need to comply with the treatment
 Possible complication if the disease is not
treated (conjunctivitis, sinusitis etc)

19. Drug treatment
 Antihistamines
 Nasal decongestants
 Mast cell stabilizers
 Topical steroids
 Oral corticosteroids

20. Antihistamines
 Most commonly used drugs for allergic
rhinitis.
 Control sneezing, nasal itching and running
nose
 Not effective in relieving nasal congestion
unless combined with decongestants
 More effective when given before exposure
to known allergens.

21. Classification of Antihistamines
 Promethazine
(Phenergan)
 Chlorpheniramine
(Piriton)
 Hydroxyzine
(Aterax)
 Cyproheptadine
 Cetirizine
 Loratadine
 Desloratadine
 Levocetirizine
 Ebastine
 Fexofenadine
Sedative antihistamines Non sedative antihistamines

22. Nasal Decongestants
 Decongestants reduce swelling of the
mucus membrane thus unblocking the
nostril.
Classification
Nasal decongestants are classified into 2:
 Topical nasal decongestants.
 Oral nasal decongestants.

23. Topical nasal decongestants
 They are used in form
of nasal drops
Examples
 Ephedrine (Isoryn)
 Xylometazoline
(Xylomepha)
 Phenylephrine
 Normal saline

24. Special instructions
 Are more effective than the oral
decongestants.
 Associated with less side effects since
action is localized to the nose.
 Should be used for a maximum of 7-10
days.
 Chronic use longer than 7 days may lead
to rebound congestion.

25. Oral decongestants
Examples.
 Pseudoephedrine
 Phenylephrine
 Have a delayed onset but with prolonged
duration of action.
 Are sometimes combined with antihistamines
(mosedine plus, Cirrus).
 Do not cause rebound congestion unlike
topical decongestants.
 Not recommended in patients with
hypertension and diabetes.

26. Topical Corticosteroids
Examples
 Beclomethasone (Beconase nasal spray)
 Mometasone furoate (Nasonex)
 Fluticasone ( Avammys,Flixonase)
 Budesonide (Rhinocort)
 They are the most effective in the
treatment of allergic rhinitis.
 Recommended in severe cases that have
not responded to other drugs.
 Should be used regularly at least for a
month

27. Common topical corticosteroids
and their dosages
Dosage
Brand
name
Drugs
Two sprays in each
nostril twice daily
Beconase
Beclomethasone
nasal spray
Two sprays in each
nostril once daily
Rhinocort
Budesonide nasal
spray
Two sprays in each
nostril once daily
Nasonex
Mometasone
furoate nasal
spray
Two sprays in each
nostril once daily
Avammys
Fluticasone nasal
spray

28. How to use a nasal spray

29. Oral Corticosteroids
Examples
 Prednisolone
 Dexamethasone
 Betamethasone (celestamine)
 Oral corticosteroids are very effective but
use limited by side effects.
 Usually recommended for short period
when safer drugs are not effective.
 Reduce the dose gradually when given for
more than 7 days.

30. Mast Cell Stabilisers
Example
 Sodium cromoglycate (Nasotal nasal drop)
 It is more effective in the treatment of
allergic rhinitis in children than adults
 It is safer than any other drug for allergic
rhinitis.
 It should be used before exposure to
allergens.
 Symptom control takes 1-3 weeks to be
realised.

31. Complications of allergic rhinitis
 Left untreated, allergic rhinitis can lead to more
serious conditions.
Otitis
media
Eczema Allergic Rhinitis Sinusitis
Asthma
Allergic
conjunctivitis
Nasal Polyps

32. Thank you!