United Airway Disease-courtasy Mdcurrent India

United airway disease

By mdCurrent-India staff | Published: JUL 2013

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United Airway Disease (UAD) is a term used for the combination of two well-known diseases, allergic rhinitis and bronchial asthma. Until recently, these two diseases were treated separately, but now there is an increasing awareness that these two entities are manifestation of the same disease affecting two parts of the same airway. Anatomically, nasal and respiratory mucosas are in continuity. 70% of asthmatic patients have allergic rhinitis, and 30% of allergic rhinitis patients develop asthma at some point during the disease.

mdCurrent Pearl: Allergic rhinitis and asthma go hand-in-hand. If a patient comes to us with one condition, we should actively look for the other. Treating the co-existing asthma or allergic rhinitis improves the quality of life of the patient.

Allergic diseases increase as a country becomes more developed. India is developing fast, and allergic diseases are increasing at an alarming rate. This phenomenon is partially explained by the hygiene hypothesis, which states that the lack of early childhood exposure to common childhood infections, symbiotic organisms, and parasites leads to an increased susceptibility to allergic disease in later life.

Allergic rhinitis is the most common of all atopic diseases affecting 10-20% of the population. It can develop at any age; most patients report the first episode before the age of 30 and suffer a poor quality of life during the most productive span of their lives. There is increased awareness about its impact on the patient’s life since the publication of ARIA Report 2010 (Allergic Rhinitis and its Impact on Asthma, a WHO initiative).

Clinically, allergic rhinitis patients present with persistent sneezing without a trigger, watering from the nose, itching of nose and eyes, and nasal blockage. In the Indian scenario, where patients go directly to the specialist without referral from a primary physician, they will go to an ENT, Ophthalmologist, or pulmonologist. The condition is considered mild if not interfering with activities of daily living, or moderate to severe if impairing the patient’s daily activities or sleep, and creating problems at work or school. Proper history and clinical examination should be done to unmask any associated asthma and sinusitis. If asthma is suspected, a Spirometry test should be ordered to unmask airway obstruction.

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“It has now been well documented that allergic rhinitis, if not cared for or not treated properly, can lead to development of asthma in later life. One has to treat allergic rhinitis aggressively. Montelukast is well-tolerated and proved to be very efficacious in delaying this.”
-Dr. Pragnesh Vachharajani, MBBS, PGDMCH, Ahmedabad, Gujarat, India, mdCurrent-India Advisory Board Member.

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Patients with Bronchial Asthma will have a chronic cough, shortness of breath, and chest tightness. These symptoms are more evident at night and early morning. Apart from history and examination, a Spirometry test should be done to establish the diagnosis. All asthmatics should be evaluated for the presence of allergic rhinitis, as it is a common cause for poor control of asthma and poor quality of life in asthmatic patients.

Treatment
The main mode of treatment for both of these conditions should be a topical steroid. For allergic rhinitis, prescribe a nasal spray, and inhalers for Bronchial asthma. If a patient comes with one condition, we have to actively look for the other and give treatment for both if required. All patients should be educated thoroughly about the use of nasal sprays and inhalers. If the technique is not proper, the patient will not get the desired effect and will blame the medications for not getting better. Montelukast and an anti-histamine combination can be used initially for quick control of symptoms and should be tapered off slowly or should be shifted to Montelukast alone. The need for a long-term treatment and follow up should be discussed with the patient, otherwise they are likely to miss their follow-up