気管支喘息症例に対する鼻腔内ステロイド療法

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  • Intranasal glucocorticoid therapy in asthmatic patients with mucosal abnormalities of sinonasal cavity

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Bronchial asthma is often accompanied with allergic rhinitis or chronic sinusitis. Mucosal abnormalities of sinonasal cavity may influence lower respiratory responses in patients with asthma. We experienced a case of 72-year-old woman with asthma, who had dyspnea on exertion and a large volume of expectoration of more than 100mℓ a day. Furthermore she had nasal symptoms (nasal obstruction and rhinorrea) with prominent post-nasal discharge. Computed tomography (CT) scans of sinonasal cavity revealed marked thickness of nasal mucosa. Although her asthma symptoms such as wheezing and dyspnea improved by administration of bronchodialators, antiallergic agent, and beclomethason di isocyanate (BDI) accompanied with spa therapy after admission, the volume of expectoration revealed no decrease and her peak expiratory flow (PEF) didn't increase. The volume of expectoration and the PEF showed marked improvement after starting of intranasal glucocorticoid therapy. It is suggested from her clinical course that treatment with intranasal glucocorticoids is very important in asthmatic patients with mucosal abnormalities of sinonasal cavity.

気管支喘息症例には,アレルギー性鼻炎や慢性副鼻腔炎の合併が認められる｡鼻腔内への吸入ステロイド投与が喘息症状を改善したという報告も存在し,鼻腔病変が下気道の反応に何らかの影響を及ぼしている可能性が考えられる｡今回,気管支喘息にて入院した72才の女性の症例を呈示する｡労作性呼吸困難と多量の喀痰排出が認められ,入院後の投薬や温泉療法にて呼吸困難は改善したが,喀痰排出は減少せず,ピークフロー値も上昇が認められなかった｡明らかな後鼻漏が認められ,CTにて両側鼻腔粘膜の著明な肥厚の所見が見られたため,鼻腔内吸入ステロイド投与を開始した｡開始後,喀痰排出量,ピークフロー値は著明な改善を示した｡この症例のように,鼻腔あるいは副 鼻腔に対する治療が喘息症状を改善する症例が存在する可能性が考えられた｡

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