EPOS/ARIA

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Author:
esmond
ID:
165654
Filename:
EPOS/ARIA
Updated:
2015-06-29 11:28:41
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Rhinology
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EPOS Summary
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  1. Rhinosinusitis definition in adults
    • Inflammation nose & paranasal sinuses with 2+ symptoms incl
    • nasal blockage or discharge
    • +/- facial pain/pressure
    • +/- loss of smell

    AND

    endoscopic signs or CT changes
  2. Rhinosinusitis definition in children
    • 2 +symptoms incl
    • nasal blockage or nasal discharge
    • +/- facial pain
    • +/- cough

    AND

    endoscopic signs and/or CT changes
  3. Rhino sinusisits severity & time
    • MILD = VAS 0-3
    • MODERATE = VAS >3-7
    • SEVERE = VAS >7-10

    • Acute <12 weeks
    • Chronic >12 weeks
  4. Difficult to treat rhinosinusitis
    Persistent symptoms despite adequate medical/surgical treatment
  5. Acute rhinosinusitis
    • Acute viral rhinosinusitis - symptoms <10days
    • Acute post viral rhinosinusitis - increase in symptoms after  days 5 days or lasting >10 days <3 months

    • Acute bacterial rhinosinusitis - 3+ signs incl
    • -Discoloured discharge (with unilateral predominance)
    • -Severe local pain (with unilateral predominance)
    • -Fever (>38ºC)
    • - Elevated ESR/CRP
    • - ‘Double sickening’ (i.e. a deterioration after an initialmilder phase of illness).
  6. Chronic rhinosinusitis without nasal polyposis management
  7. Chronic rhinosinusiitis with nasal polyposis management
    • Doxycycline 200mg 1/7 then 100mg od for 19 days
  8. Chronic rhinosinusitis diagnosis
    • History
    • Examination
    • +/- CT scan
    • Allergy questionnaire - if +ve test
  9. Paediatric chronic rhinosinusitis differences
    • chronic cough = symptom
    • ?higher incidental ct findings
    • Diagnosis = 2+blockage and/or d/c +/- pain +/- cough
  10. Paediatric CRSsNP management
  11. Acute rhinosiunsitis
    • Adults 3-5/year
    • Children 7-10/year
    • 2% complicated by bacterial infection
  12. Acute rhinosinusitis aetiology
    • Environmental
    • Anatomical
    • Allergy
    • Immune related
    • Mucosal
    • Reflux
    • Anxiety,depression
    • Dental
    • Vasculitis
  13. ARIA questionnaire
  14. Symptoms suggestive allergic rhinitis
    • 2+ >1 hour most days
    • watery rhinorrhea
    • sneezing
    • nasal obstruction
    • nasal pruritis
    • +/- conjunctivitis
  15. Testing
    • GP - multiallergen test
    • ENT - SPT, RAST if -ve SPT & strong suspicion or SPT contraindicated
  16. Classification
    • Intermittent- <4 days/week or <4 consecutive weeks
    • Persistent > 4 days/week and >4 consecutive weeks

    • Mild - normal sleep, no impairement daily activities/work/school
    • Moderate/severe - sleep disturbance, impairment daily activitie/school/work,troublesome
  17. Treatment
    • Intermittent
    • Mild - oral or oral antihistmaines, LTRA, decongestant
    • Mod/severe also topical steroids 

    • Persistent
    • Same mod/severe intermittent
    • Mod/severe - preferred order
    • Intranasal CS
    • Antihistamine or LRTA
    • If no improvement
    • r/v dx
    • increase dose intranasal CS
    • Ipratrprium bromide for rhinorrhea
    • Short term decongestansts/oral steroids
    • If no improvement refer surgery

    • If conjunctivitis add oral/opthalmic antihistamine.
    • Consider specific immunotherapy
  18. Asthma screen
    • Wheezing attacks
    • Troublesome cough, sep at night
    • Cough/wheeze after exercise
    • Chest feel tight
  19. ARIA 2010 revision recommendations
    • Exclusive breast feeding 3/12
    • No ag avoidance diet pregnancy
    • Avoid tobacco smoke pregnancy/children
    • Infants and preschool children, we suggest multifaceted interventions to reduce early life exposure to house dust mite
    • adults and children with perennial/persistent allergic rhinitis, we suggest that clinicians do not administer and patients do not use intranasal H1-antihistamines until more data on their relative efficacy and safety is available
    • We suggest new generation oral H1-antihistamines rather than intranasal H1-antihistamines in adults with seasonal allergic rhinitis (conditional recommendation | moderate quality evidence) and in adults with perennial/persistent allergic rhinitis (conditional recommendation | very low quality evidence).We suggest new generation oral H1-antihistamines rather than intranasal H1-antihistamines in adults with seasonal allergic rhinitis (conditional recommendation | moderate quality evidence) and in adults with perennial/persistent allergic rhinitis (conditional recommendation | very low quality evidence).
    • We suggest oral leukotriene receptor antagonists in adults and children with seasonal allergic rhinitis (conditional recommendation | high quality evidence) and in preschool children with perennial allergic rhinitis (conditional recommendation | low quality evidence). In adults with perennial allergic rhinitis we suggest that clinicians do not administer and patients do not use oral leukotriene receptor antagonists (conditional recommendation | high quality evidence).
    • We suggest oral H1-antihistamines over oral leukotriene receptor antagonists in patients with seasonal allergic rhinitis (conditional recommendation | moderate quality evidence) and in preschool children with perennial allergic rhinitis (conditional recommendation | low quality evidence).
    • In patients with seasonal allergic rhinitis, we suggest intranasal glucocorticosteroids over oral H1-antihistamines in adults (conditional recommendation | low quality evidence) and in children
    • We suggest subcutaneous allergen specific immunotherapy in adults with seasonal (conditional recommendation | moderate quality evidence) and perennial allergic rhinitis due to house dust mites (conditional recommendation | low quality evidence).
    • In children with allergic rhinitis, we suggest subcutaneous specific immunotherapy (conditional recommendation | low quality evidence).
    • sublingual allergen specific immunotherapy in adults with rhinitis due to pollen (conditional recommendation | moderate quality evidence) or house dust mites
  20. CRS cause
    deranged interaction between host genetic and immunological factors and environmental and infectious agents

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