G.Kunkel, K.Schierhorn
Allergy&Asthma-Clinic, Charite, Campus Virchow-Klinikum, Humboldt-University, Berlin, Germany

11. RHINITIS SYMPTOMS AND NASAL EOSINOPHYLIA IN PATIENTS WITH BRONCHIAL ASTHMA

V.Kvedariene, E.Jureviciene, A.Chomiciene, A.Blaziene
Clinic of Pulmonology and Allergology, Vilnius University Hospital, Vilnius, Lithuania

12. THE EFFICIENCY OF ALLERGODIL (AZELASTINE) IN THE TREATMENT OF PATIENTS WITH PERENNIAL ALLERGIC RHINITIS

V. Lozovskis, S. Purina
Riga Stradins University, Riga, Latvia

13. BRONCHIAL HYPERRESPONSIVENESS AND ALLERGY IN PERSONS WITH ASTHMA-RELATED SYMPTOMS

K.Malakauskas*, R. Sakalauskas**, B.Sitkauskiene*
* Lab ofPulmonology, Institute/or Biomedical Research
** Clinic ofPulmonology and Pthysiology, Kaunas University of Medicine, Kaunas, Lithuania

14. PSYCHOLOGICAL ASPECTS OF THE MANAGEMENT OF ASTHMA

A.Naudziunas, R.Aleknavicius
Kaunas Medical University, Lithuania

15. HALOTHERAPY IN MANAGEMENT OF ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

D.Noreikiene, LPIiuskiene, G.A.Norvaisas
Center of Halotherapy, Pulmonology Department, Klaipeda Hospital "Red Cross", Klaipeda, Lithuania

16. HALOTHERAPY IN MANAGEMENT OF ENDOGENIAL BRONCHIAL ASTHMA

G.A.Norvaisas, D.Noreikiene
Center of Halotherapy, Pulmonology Department, Hospital "Red Cross", Klaipeda, Lithuania

17. DISTANT RESULTS OF TREATMENT OF ACUTE OBSTRUCTIVE BRONCHITIS

G.A.Norvaisas
Lithuania Asthma Center, "Red Cross Hospital", Klaipeda, Lithuania

18. ALLERGIC AND PSEUDOALLERGIC VARIANTS OF FUNGAL BRONCHIAL ASTHMA

D.K.Novikov, E.A.Dotsenko, P.D.Novikov
Medical Institute, Vitebsk, Republic of Belarus

10. AIR POLLUTION AND THE DEVELOPMANT OF ALLERGY

G.Kunkel, K.Schierhorn
Allergy&Asthma-Clinic, Charite, Campus Virchow-Klinikum, Humboldt-University, Berlin, Germany

There is evidence that the incidence of allergic diseases such as asthma, rhinitis and eczema has increased. A number of epidemiological and laboratory-based studies have suggested, that air pollution (ozone, nitrogen dioxide and diesel exhaust particles) may play an important role in the clinical manifestation of allergic and non-allergic airway disease. Both in vivo and in vitro studies carried out in healthy normal subjects, patients and animals have show that exposure to air pollutants causes symptoms, impairment of lung function and airway inflammation as evidenced by an increase of inflammatory mediators. Several studies suggest that asthmatics may be more sensitive. The literature will be reviewed and own results presented.

11. RHINITIS SYMPTOMS AND NASAL EOSINOPHYLIA IN PATIENTS WITH BRONCHIAL ASTHMA

V.Kvedariene, E.Jureviciene, A.Chomiciene, A.Blaziene
Clinic of Pulmonology and Allergology, Vilnius University Hospital, Vilnius, Lithuania

The aim: To compare subjective symptoms of rhinitis and nasal eosinophylia in patients with allergic rhinitis and rhinitis and bronchial asthma.

Methods: 100 adults were studied. Most often symptoms of rhinitis: nose obstruction, watery discharge, itching and smell disturbances, - were appreciated by the patients according to the severity from 0 to 3. Nasal eosinophylia was estimated.

Results: 55 patients had rhinitis, 45 - rhinitis and bronchial asthma (33 had extrinsic bronchial asthma and 12 - intrinsic). We found 28 patients with nasal eosinophylia less than 5 percent. Mean value of nasal eosinophylia in patients with allergic rhinitis was 43.34 percent, with rhinitis and bronchial asthma - 33.5 percent. Rhinitis symptoms score sum in patients with seasonal allergic rhinitis was 7.0, in patients with perenial allergic rhinitis - 6.23, in patients with nonallergic eosinophylia rhinitis - 7.85. Nasal eosinophylia was accordingly:

59.1,20.0, and 57.5 percent. Patients with extrinsic bronchial asthma and allergic rhinitis had nasal eosinophylia 36.12 percent, rhinitis symptoms score sum was 6.42. In patients with intrinsic bronchial asthma and nonallergic eosinophylic rhinitis accordingly 26.42 percent and 7.42 (symptoms score sum).

Conclusions:

1. There were no statistically significant differences in rhinitis symtoms according to the type of rhinitis and presence of bronchial asthma.

2. Patients with seasonal allergic rhinitis and extrinsic bronchial asthma have the highest nasal eosinophylia.

3. The lowest nasal eosinophylia was in case of perenial allergic rhinitis and intrinsic bronchial asthma.

12. THE EFFICIENCY OF ALLERGODIL (AZELASTINE) IN THE TREATMENT OF PATIENTS WITH PERENNIAL ALLERGIC RHINITIS

V. Lozovskis, S. Purina
Riga Stradins University, Riga, Latvia

Background

Azelastine (AUergodil - ASTA Medica) a phthalazinone derivate, is the first selective and potent histamine-1 (HI) receptor antagonist which also inhibits histamine release from mast cells.

Patients

24 patients, average 22 years (range: 5-48 years) were tested during the period from January 1998 to April 1998. All the patients had a history of perennial allergic rhinitis with the diagnosis from 6 months to 8 years (medium: 3.2 years). The diagnosis was confirmed in all the cases by:

1. An elevated eosinophils count in the nasal mucosa;

2. A positive skin prick or intracutaneous testing;

3. A positive nasal provocation test.

6 patients also complained of the atopic asthma in the mild form of remission. All the antiasthmatic, antiallergic treatments, including immunotherapy were prohibited during the period of testing. The patients did not suffer from any other disease, which could have the least influence upon the results. In the course of the therapy 4 patients were excluded because of non-compliance (2 patients) and acute upper respiratory disease (2 patients).

Methods

Before having been treated with Allergodil, the active anterior rhinomanometry was done. The rhinomanometre of the Erich Jaeger Company with the programme Rhinoscreen was used.

In the course of the therapy the patients wrote their diaries, and fixed the 5 subjective symptoms: rhinorrhoea, sneezing, itchy nose, stuffy nose, the number of blows and adverse reactions. Each sign or symptom was estimated in accordance with a 4-point scale: 0-absent, 1-mild, 2-moderate, 3- severe. A total rhinitis symptom complex score with a range 0-15 was derived from the symptom grading.

The patients used Allergodil squirt of 0.14 mg per nostril twice a day (i.e. 0.56mg per day). The course of the treatment was 12-48 days (medium 22.2 days). After the treatment the anterior rhinomanometry was repeated in the same time as it was done in the first time +/ - 2 hours.

Results

Subjectively all the patients felt the improvement. The improvement appeared on the 3rd- 5th days, gradually reaching the maximum in the 2nd-3rd weeks. In the medium total rhinitis symptom complex score was 7.75 points before the therapy, and 3.5 points after the therapy. Estimating the data of rhinomanometry objectively, the nasal flow on the average had increased about 364.5 ml/sec (the range of flow "-"210 ml/sec-"+"1122ml/sec). The average range of the flow before the therapy was 588.2 ml/sec and it increased to 872.2ml/ sec after the therapy. 2 patients did not have any objective changes but subjectively they felt

the improvement; the range of the nasal flow to one patient was a little decreased "-"210 ml/sec and subjectively only minimal improvement was observed.

Working out the data statistically, the standartdeviation, the standartmistake of the average value and the Student's coefficient was determinated.

In conclusion we can assert that:

1. In accordance with the objective results the reliability that therapy has been successful is 99.9% (p<0.001)

2. In accordance with the subjective results the reliability that therapy has been successful is 95% (p<0.05). In the course of the therapy one patient complained of a bitter sense in the mouth 15-30 minutes after inhalation. Other adverse reactions were not observed.

Conclusions

1. In the treatment with Allergodil of the patients with perennial allergic rhinitis, a subjectively and objectively reliable improvement has been obtained.

2. The patients observed a subjective improvement beginning with the 3rd- 5th days, gradually reaching the maximum in the 2nd-3rd weeks.

3. The total nasal flow after 22 day therapy course on the average was increased by 62%.

4. The tolerance of Allergodil is positive.

13. BRONCHIAL HYPERRESPONSIVENESS AND ALLERGY IN PERSONS WITH ASTHMA-RELATED SYMPTOMS

K.Malakauskas*, R. Sakalauskas**, B.Sitkauskiene*
* Lab ofPulmonology, Institute/or Biomedical Research
** Clinic ofPulmonology and Pthysiology, Kaunas University of Medicine, Kaunas, Lithuania

Purpose. Bronchial hyperresponsiveness and manifestation of allergy is associated with bronchial asthma (BA) very closely. The aim of the study was to determine peculiarities of bronchial hyperresponsiveness and allergy in persons with asthma-related symptoms.

Methods. Clinical examination was performed to 72 persons (age 28.6 ± 3.4 years) who complained with paroxysmal breathlessness, wheezing and cough caused by provoking factors such as allergens, irritants, cold air, etc. and never had diagnosed BA. Ventilatory lung function was evaluated by spirometer "Custo vit M". Bronchial responsiveness was tested using methacholine and determination of provocative dose of methacholine causing
FEV₁, fall of 20% from baseline (PD₂₀) by reservoir method ("Provocations Test I, PART). Examination of allergic status included allergic anamnesis, allergic skin prick tests and eosinophils count in the blood.

Results. None of the persons had any clinical evidence of airways obstruction and their ventilatory function was normal. 67.4% had positive allergic anamnesis, 58.6% -positive allergic skin tests, 35.7% - eosinophilia. Bronchial hyperreactivity (BHR) (PD₂₀ = 0.199 ± 0.026 mg) was estimated for 58.3% persons (n=42): I° BHR - 26.2% (n=ll), II° BHR - 35.7% (n=15). III° BHR - 38.1% (n=16). Persons with asthma symptoms and increased bronchial reactivity were defined as having intermittent BA. In this group positive allergic anamnesis and skin tests were found more frequently (82.4%, p=0.046 and 80.8%, p=0.032, accordingly) compared with the group of persons having only asthma-related symptoms and normal bronchial responsiveness. There were found no significant differences in eosinophils count in the blood between groups with BHR and normal bronchial responsiveness.

1) in 58.6% cases asthma-related symptoms were associated with BHR;

2) more than 80% of patients with intermittent BA were associated with signs of allergy.

14. PSYCHOLOGICAL ASPECTS OF THE MANAGEMENT OF ASTHMA

A.Naudziunas, R.Aleknavicius
Kaunas Medical University, Lithuania

Asthma has long been considered one of the "psychosomatic" diseases by both patients and physicians. In ascribing asthma this notoriety, it has been implied that both patients and physicians have seen or experienced at least an association between patients' psychological and pulmonary functioning. The pathogenic can be hypothesized in the following causal sequence: childhood trauma leads to unconscious conflict over dependency, which leads to unacceptability of direct expression of conflict, which leads to somatic manifestation of conflict (asthma).Important psychological events are attributed meaning with correlates in brain-based physiological processes, which in turn result in changes in autonomic and immunologic activity; these changes in turn effect pathologic pulmonary events through humoral, cell-mediated, and autonomic pathways. The classic target organ responses then ensue:

bronchospasm (with wheezing on the clinical level), cough, and mucous production.

Psychogenic pathogenesis, influence of psychosocial factors on etiology and course of children bronchial asthma, psychological peculiarities of patients life, principles of psychological defence have been considered. Psychosocial issues related to asthma mortality and morbidity : depression, anxiety, life crises, family conflict, psychological and social isolation. In stress
situations blood concentration of epinephrine and corticosteroids increase to the level as in the depressive disorders. Co operation of physician, patient and psychologist is very important for providing of psychological health for asthmatic patients. Asthmatic for psychological defence could use mechanisms of psychological defence: repression, sublimation, regression, projection and other.

15. HALOTHERAPY IN MANAGEMENT OF ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

D.Noreikiene, LPIiuskiene, G.A.Norvaisas
Center of Halotherapy, Pulmonology Department, Klaipeda Hospital "Red Cross", Klaipeda, Lithuania

Key words: halotherapy, asthma, COPD. Speleotherapy is a method of treatment by microclimate of natural salt caves. This method is known from the times of Ancient Creese.

Halotherapy is a method of treatment in halochamber simulating salt-caves microclimate, i.e. in aerodispersed medium saturated with dry sodium chloride aerosol containing the dominantly amount of 2 to 5 micron particles (2-9 mg/m³) allergen- free air environment and confortable temperature-humidity regime (humididy 45-55%, temperature 18-22°C). Halochambers were constructed by "Aeromed" (St.Petersburg, Russia, patent No 1793932).

251 children and 498 adults suffering from endogenous bronchial asthma (40,6% children and 28,8% adults) and COPD (33,5% adults) during two weeks spent daily 1 hour in halochamber.

The estimation of effectivness of halotherapy was based on clinical symptoms monitoring of peak expiratory flow( PEF), spirometry before and after treatment in halochamber.

Very good result -16,6% for children and 11,8% for adults, good result - 56,8% for children and 65,1% for adults, no changes- 5,6% for children and 2,9% for adults, became worse (due to accidental virus infection) - 0,6% for children and 2,1% for adults.

This our preliminary data let us to conclude that halotherapy may be helpful in the bronthial asthma and COPD management complex as supplement therapy.

16. HALOTHERAPY IN MANAGEMENT OF ENDOGENIAL BRONCHIAL ASTHMA

Key words: halotherapy, asthma

We wish to present an alternative method of treatment of asthma- halotherap, to evaluate supplementary clinical effect of halotherapy in asthma management.

Halotherapy is a method of treatment in halochamber simulating salt-caves microclimate, i.e. in aerodispersed medium saturated with dry sodium chloride aerosol containing the dominantly amount of 2 to 5 micron particles (2-9 mg/m³) allergen- free air environment
and confortable temperature-humidity regime (humididy 45-55%, temperature 18-22°C). Halochambers were constructed by "Aeromed" (St. Petersburg, Russia, patent No 1793932). Treatment consisted of 1 hour staying in halochember daily, 15 days. Placebo procedures was with 10 patientes. The same protocole was used, but no sodium chloride was dispersed in halochambers.

17 randomly selected patient (10 female and 7 males) aged from 16 to 65 years( average 48,6) suffering from bronchial asthma from 1 to 20 years (average 6,5) received halotherapy and 10 control group patients (7 female and 3 males, aged average 44,4)- placebo procedures as described above.

The estimation of effectivness of halotherapy was based on clinical symptoms (asthma attach frequency during 5 days before and 5 days after the treatment), monitoring of peak expiratory flow( PEP), spirometry before and after treatment.

Results. 5 patients in treatment group were able to reduce their use of methylxanthines.
2 patients were able to stop oral corticosteroides and 7 to reduce their oral or inhaled steroids by 33-50%. No drug reduction was possible in placebo group. PEF during the course of treatment increased from 423,53 L/min to 498,24 L/min. In placebo group from 338,0 L/min to 380,0 L/min.

This our preliminary data let us to conclude that halotherapy may be helpful in the bronthial asthma management complex as supplement therapy. Our experience show positive effect of halotherapy, but results are far less convincing in comparison with those of Russian authors (A.B.Chervinskaya, S. I.Konovalov, 1994).

17. DISTANT RESULTS OF TREATMENT OF ACUTE OBSTRUCTIVE BRONCHITIS

G.A.Norvaisas
Lithuania Asthma Center, "Red Cross Hospital", Klaipeda, Lithuania

The causes, frequency and prophylaxis of chronisation of acute obstructive bronchitis (AOB) are not yet established.

We present data of distant results analysis of patients treated in pulmonology department due to AOB. There were 72 patients treated during 1991-1992. Mean patients age 34.8 ± 14.5 yr., 25 man and 47 women. Diagnosis has been established according to clinical and spirographical findings. Latent obstruction was found in 68.2% of cases, positive acetylcholine test in 72% of cases. Combined treatment consisted of methylxanthines (95.8%), inhaled steroids (18%), intal (6.5%), and antibiotics (37.5%). Mean duration of treatment was 16.5 day. Control physical examination and spirometry was performed in 1995 (after 3-4 yr.). 52
patients had come and there were found among them only 28% healthy, 24% had COPD and 48% had asthma. It has become clear that patients had not received appropriate treatment since the discharge from hospital.

Our study indicates that chronisation of AOB is frequent. One of possible causes is insufficient medical supervision of such patients after hospital treatment. Further investigations required to determine other causes of chronisation of AOB and to establish the strategy of treatment.

18. ALLERGIC AND PSEUDOALLERGIC VARIANTS OF FUNGAL BRONCHIAL ASTHMA

D.K.Novikov, E.A.Dotsenko, P.D.Novikov
Medical Institute, Vitebsk, Republic of Belarus

The main goal of our work was to estimate the role of allergic, pseudoallergic and immunodeficient mechanisms in fungal bronchial asthma development.

It is well-established, that in regions with moist moderate climate (as Belarus) there is a high concentration of allergeneic fungal spores in the air. Such kind of atopy was determined in 14,1% of bronchial asthma (BA) patients using skin tests and allergen-specific IgE and IgG ELISA. Allergy to Rhysopus nigricans, Penicillium tardum and Altemaria tenuis was widely
spreaded among 120 patients. In parallel investigations we have found IgG antibodies to fungal allergens on the neutrophiles surface in these patients. It demonstrates the direct participation of neutrophiles in hypersensitivity development. According to the test of IL-2 receptor measurement on T-cells we discovered that T-cell fungal sensibilisation exists not only in patients with slow skin hypersenstivity but in patients with IgE reactions as well.

It was found that leucocytes of patients with non-allergic variant of fungal asthma developed an increased sensitivity to hypotonic solutions, cold treatment and other membrane-destabilizing agents. It was confirmed with degranulation tests and potassium efflux determination. Fungal infection and candidosis was connected with immune insufficiency and with pseudoallergic stimulation of all leucocytes. Immune disorders of patients with non-IgE of fungal bronchial asthma are very heterogeneous. We found dis gammaglobulinaemia, secretory IgA and IgG3 deficiency, phagocytosis and NST insufficiencies and so on. They were combined with decreased and insufficient antibody production to fungals antigens, pneumococcal polysaccharides and several viruses. Immunoregulation index (CD4/CD8) was diminished. Lymphocyte lypopolysaccharide receptors expression was decreased too. IL-2 receptors expression levels varied depending from the variant of disease. So we conclude that different patients may develop allergic, pseudoallergic or immunodefficiency variants of fungal BA or their combinations as well.