Asthma is a serious public health problem estimated to affect approximately 300 million people worldwide. It is a chronic inflammatory disease that can affect individuals of all ages, can be controlled with the right treatment, and can seriously limit daily activities when it cannot be controlled. Airways start from the mouth and nose and continue with the trachea. After the windpipe divides into two main branches (bronchi) in the lungs, right and left, it is divided into branchlets that become thinner and thinner like the branches of a tree. Asthma is a disease that manifests itself with narrowing of the airways and comes in attacks. Patients feel well between attacks. In asthma, there is a chronic, non-microbial inflammation in the airways. Therefore, the airway wall is edematous. This condition causes the lungs to become hypersensitive to stimuli.
Allergic rhinitis is a disease characterized by symptoms such as congestion, rhinorrhea, sneezing, itching, and postnasal drip, which develop as a result of inflammation of the epithelium covering the nasal cavity. When these symptoms are accompanied by tearing, redness and itching, it is defined as allergic rhinoconjunctivitis. In these clinical situations, inflammation develops due to the immune response to allergens via IgE.
The coexistence of asthma and rhinitis, among the common diseases in society, has been revealed by epidemiological, physiopathological and clinical studies. Among all atopic diseases, allergic rhinitis is most often seen together with asthma. In this case, it is accepted that allergic inflammation is not limited to a single target organ but involves the entire respiratory system, and the coexistence of rhinitis and asthma is also defined as a single airway disease. Nasal inflammation has a significant impact on the lower respiratory tract, and some patients with rhinitis not only develop nonspecific bronchial hypersensitivity, but also have a much higher risk of developing asthma.
Due to the relationship between asthma and allergic rhinitis, the risk of suffering from either of these two diseases is much higher. In people with symptoms, other clinical conditions must be investigated. This approach is valid for diagnosis as well as treatment.
While the prevalence of asthma was found to be below 2% in patients without rhinitis, asthma was reported in approximately 40% of patients with allergic rhinitis. . It has also been reported that rhinitis occurs in 60-80% of allergic asthmatics.
When there is narrowing in the airways;
• cough (usually dry),
• shortness of breath,
• feeling of pressure in the chest,
• symptoms such as wheezing. it occurs. Any one or more of these symptoms may occur together. These symptoms are not specific to asthma; they can also occur in other diseases. However, they are important for asthma when they are accompanied by the following features: Symptoms;
• They are recurrent and come in the form of seizures,
• They usually occur at night or in the morning,
• They get better spontaneously or with medications,
• They may vary seasonally.
Different factors may cause symptoms to occur depending on the person and the situation.
These factors that cause symptoms in asthma are called triggers. Factors that trigger asthma symptoms may be different for each patient. Therefore, patients should know well these factors that disturb them and stay away from them as much as possible. Allergens are important triggers that cause symptoms in sensitive asthmatics.
These allergens are substances that are abundant in our environment, are generally harmless, but can cause problems in sensitive people. Many allergens at home or outdoors can trigger asthma and allergic rhinitis symptoms.
The important ones are:
• Pollens
Weed pollens
Poplar
Grass pollen
• House dust mites
• Mold fungus spores
• Cockroaches
• Allergens such as cats and dogs.
Allergy While some people experience complaints throughout the year, others experience an increase in certain seasons. The complaints of people with seasonal allergic rhinitis occur in spring and autumn. The most common allergens are; grass, tree and weed pollens. House dust mites, mold fungi and animal dander are the most common allergens in those who suffer from year-round allergic rhinitis. On the other hand, studies showing that air pollution increases allergy complaints There are also studies.
Allergic rhinitis is rarely considered a serious problem. However, allergic rhinitis has significant social, clinical and economic harms. Frequently, half of the patients experience allergic rhinitis symptoms for more than 4 months a year, which seriously affects the quality of life. Moreover, the sleep quality of these patients is significantly impaired due to nasal congestion. As a matter of fact, allergic rhinitis is one of the important causes of obstructive sleep apnea syndrome, which progresses with attacks of airway obstruction during sleep.
Interrogation has an important place in the diagnosis of allergic rhinitis. The patient's age, the environments in which his/her complaints increase, which medications he/she has used before, and especially whether there is anyone else in his/her family with allergies should be examined. Since allergy is a genetic disease, having a history of allergies, asthma and rhinitis in other members of the family is very helpful in diagnosis. If the patient has these symptoms or a family history, the patient should be investigated in detail for allergic rhinitis and asthma, and skin tests should be performed to determine what the patient is sensitive to.
Skin tests, which are frequently used together with the patient's history in the diagnosis of allergic diseases, are important in both confirming the diagnosis and determining the allergens that cause the disease. Skin tests are performed to demonstrate sensitivity to a specific allergen. The selection and number of allergens to be used during testing should be determined according to the patient's clinical history. If not done properly, false positive and negative results can occur. Positive reactions are only meaningful when they are compatible with clinical findings.
Identification and reduction of exposure to triggering factors: Factors that trigger asthma symptoms should be identified specifically for the individual and recommended to avoid exposure to these factors or at least reduce exposure to reduce asthma symptoms and attacks. Measures to prevent its development should be implemented wherever possible.
Once the allergens to which the person is sensitive are identified, a program to protect people from these allergens is created.
In asthma and allergic rhinitis. How should we be protected from triggering allergens?
Allergens:
E v dust mites → Mites are small, invisible insects that live in house dust. They live in moist, dark and hot environments; They feed on human skin debris. Essentially, their feces are allergenic. These sticky fecal particles stick to various items and are constantly released into the air. They are mostly found in bedding, duvets, pillows, carpets, fabric-covered furniture and feathered toys.
How to Protect?
- Ventilation should be increased, humidity should be prevented (humidity rate should fall below 40%).
- Instead of fabric upholstered items, those made of leather, wood or plastic should be preferred.
- Mask can be used while doing housework - Cleaning should be done with a powerful vacuum cleaner at least once a week.
- Carpets should not be used, especially in the bedroom.
- Furry and stuffed toys should be removed.
- Bedding should be washed at least once a week and above 60o C. - Bedding, duvets and pillows can be covered with special covers.
Pollens → The pollen dissemination period is different for each plant and may vary depending on the climate. Tree pollens generally appear between February and March, grass pollens from April to mid-July, and weed pollens generally appear in late summer and autumn. It is not possible to completely avoid pollen, but exposure can be reduced.
How to Protect?
- The person should avoid outdoor activities as much as possible during the spreading period of the pollen to which he is allergic.
- Air conditioners with pollen filters are useful for cars.
- Mask and glasses can be worn outdoors during periods when pollen spread is intense.
- Doors and windows should be kept closed during periods when pollen spread is intense.
- When you come home from outside, you should take a shower and change your clothes.
Fungal spores → Ideally, they live in an environment of 20°C temperature and 60% humidity. Fungal growth in a place is called mold growth. The places where they breed most are basements, dark and poorly ventilated places, window sills, bathroom curtains, cellars, garbage dumps, barns, fields, gardens, leaky wall corners, wallpapers, and pots of house plants. Mold grows in houses with stoves It has more flour.
How to Protect?
- Humidity in the house should be reduced,
- If possible, all rooms of the house should be heated in winter and laundry should not be dried inside the house, - Old carpets, beds, furniture and moldy-smelling materials should be thrown away,
- Large amounts of potted plants should not be kept,
- Mold should not be kept at home as mold can easily grow around aquariums and bird cages,
- Areas with water leaks should be repaired,
- Mold-covered surfaces should be cleaned with bleach, but this process should not be done by the patient.
Animal hair and dander → All furry animals can cause allergies. Allergens are found in the urine and saliva of animals and stick to their fur. There is no relationship between the amount and length of hair and the level of allergy. There are no significant differences between different species within the same animal genus. For example, if there is an allergy to one type of cat, it is expected that it will also be allergic to another type. It takes 6-12 months for allergy to develop in sensitive people and may continue for months or even years after the animal is removed.
How to Protect?
- If there is an allergic person at home, it is best not to take that animal into the house.
- In cases where the animal cannot be sent home, it is recommended to wash it frequently, not to allow it into the bedroom, and to reduce the use of carpets and fabric-covered furniture in the house.
- Since cat and dog allergens can be carried by clothes, clothes should be changed after contact.
- No method is as effective as removing the animal. Cockroaches → It is an important problem especially in public housing in cities. - Under-door gaps, cracks and pipe surrounds that may be entrance areas should be reviewed and repaired. It is not possible for other measures to be effective without this process.
- They can be destroyed with special chemicals. Meanwhile, the asthmatic patient should not be in the same environment.
- All mitigating measures (not leaving open food items, keeping garbage covered, etc.) should be taken in the house and apartment.
Studies show that allergic rhinitis and allergic asthma are closely related to each other, and those with respiratory allergies Almost half of people experience both of these conditions. treatment
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