過敏性鼻炎和氣喘

Allergic Rhinitis and Asthma

王凌峰(Ling-Feng Wang) ； 戴志峰(Chih-Feng Tai)

《台灣耳鼻喉頭頸外科雜誌》 46卷s_1期 (2011/07) Pp. 73-79

https://doi.org/10.6286/2011.46.s_1.73

摘要

氣喘和過敏性鼻炎的盛行率，近年來不論是在已開發國家或是在台灣，皆有明顯攀升的趨勢。過敏性鼻炎和氣喘常同時出現在同一病人身上，據統計，過敏性鼻炎的病人約10-40%會合併氣喘，至於氣喘的病人更有高達80%合併過敏性鼻炎。世界衛生組織所編著的「過敏性鼻炎及其對氣喘之影響」的指引中更提出「同一呼吸道，同一疾病」(One airway, one disease)的觀念。流行病學、病理生理學、免疫學和臨床之許多研究報告大多支持氣喘和過敏性鼻炎之間有密不可分之相關性。相關的致病機轉包括：鼻－氣管反射現象(naso-bronchial reflex)、吸人感染或發炎的分泌物、鼻塞之物理效應、及病人對過敏原經由鼻或（支）氣管黏膜吸收後，產生之發炎物質導致整個呼吸道之發炎反應。由於上述我們對過敏性鼻炎與氣喘病的最新瞭解，過敏性鼻炎及氣喘有相似之病理生理學表現，且經常出現同一病患身上，我們應調整對此兩種過敏性疾病的治療方法，包括強調抗過敏性發炎藥物的規則使用，配合環境中過敏原的避免，而非僅單純地治療症狀。且最新相關之診療指引亦強調，對於持續性鼻炎的病人要檢查是否有氣喘，反之亦然。於治療時必須同時考慮此兩種情況來選擇適當的治療方式，包括局部使用類固醇、過敏原特異性免疫療法(immunotherapy)、抗白三烯素(anti-leukotriene)和抗免疫球蛋白E單株抗體(anti-IgE monoclonal antibody)等。本文將就上述觀念做進一步詳述。

關鍵字

過敏性鼻炎 ； 氣喘 ； 抗白三烯素 ； 流行病學

並列摘要

In the past decades, the prevalence of allergic rhinitis and asthma is increasing in both developed countries and Taiwan. Epidemiologic studies have consistently shown that asthma and rhinitis often coexist in the same patients. Several cross-sectional studies have shown that there is a frequent association between allergic rhinitis and asthma. About 10-40% of allergic rhinitis patients had asthma; on the other hand, nearly 80% of asthmatic patients had allergic rhinitis. In the guideline of ”Allergic rhinitis and its Impact on Asthma (ARIA)” collaborated with WHO also emphasized the concept of ”One airway, one disease”.Most of the studies based on epidemiology, pathophysiology, immunology, and clinical outcome all supported the close relationship of allergic rhinitis and asthma. Moreover, allergic rhinitis might promote, trigger, maintain and even worsen asthma through several pathophysiologic mechanism: the naso-bronchial reflex or vagal reflex, the systemic release of mediators and cytokines, the irritant mechanism sustained by the postnasal drip and/or oral breathing, and the per continuum passage of allergic inflammation from the nose to bronchi. In viewing the concept of the unified airway, a combined strategy is required for optimal patient care. Treatment of patients with allergic rhinitis and asthma includes accurate diagnosis, avoidance measures, pharmacotherapy, and maybe allergen immunotherapy in some patients, tailored according to disease severity, co-morbidities, treatment availability and affordability, and patient preference. The ARIA guideline also emphasized that asthma patients be evaluated for allergic rhinitis, and that allergic rhinitis patients be evaluated for asthma.

並列關鍵字

allergic rhinitis ； asthma ； anti-leukotriene ； epidemiology