Response to intranasal steroids in a child with snoring
DOI:
https://doi.org/10.18203/2349-3291.ijcp20231783Keywords:
Allergic rhinitis, Intranasal steroids, Diagnosis, Severe OSA, IntranasalAbstract
Background: Snoring is a common symptom of underlying conditions, such as allergic rhinitis, Aden tonsillar hypertrophy, or obstructive sleep apnea. It is important to take it into account and examine the situation to prevent the development of severe OSA and its related co-morbidities. Intranasal steroids aid in lowering airway inflammation, which lowers upper airway resistance while you sleep. Early steroid intervention aids in the development of OSA from habitual snoring, but delayed diagnosis is associated with higher OSA recurrence.
Methods: Parents of children with snoring aged 4-15 were given a questionnaire and asked if they were willing to pursue treatment. The questionnaire included the patient's history of snoring, breathing abnormalities, symptoms of mouth breathing, and daytime tiredness. The mother and child started using intranasal fluticasone spray twice daily for six weeks.
Results: The study examined 40 individuals between November 2008 and February 2010, with 65% of the participants being men and 35% being women. The age distribution of the study group was 21 kids aged 4 to 7, with 12 children aged 8-11 making up 30% and 7 children aged 12-15 making up 17.5%. The average age was 8.3 years. Intranasal steroids were effective in treating AR symptoms, but some kids had a high likelihood of treatment failure. Allergic symptoms can be prevented by avoiding allergens, and medical anti-allergic medication is essential for reducing nasal and OSA symptoms.
Conclusions: Older age and prevalence of AR symptoms are linked risk factors for intranasal Steroid treatment failure in older children.
References
Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:242-52.
Muzumdar H, Arens R. Diagnostic issues in pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:263-73.
Goldbart AD, Veling MC, Goldman JL, Li RC, Brittian KR, Gozal D. Glucocorticoid receptor subunit expression in adenotonsillar tissue of children with obstructive sleep apnea. Pediatr Res. 2005;57:232-6.
Kheirandish-Gozal L, Serpero LD, Dayyat E, Kim J, Goldman JL, Snow A et al. Steroids suppress in vitro tonsillar proliferation in children with obstructive sleep apnoea. Eur Respir J. 2009;33:1077-84.
Brouillette RT, Manoukian JJ, Ducharme FM, Oudjhane K, Earle LG, Ladan S et al. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr. 2001;138:838-44.
Alexopoulos EI, Kaditis AG, Kalampouka E, Kostadima E, Angelopoulos NV, Mikraki V et al. Nasal Steroids for children with snoring. Pediatr Pulmonol. 2004;38:161-7.
Kheirandish-Gozal L, Gozal D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics. 2008;122:e149-55.
Chan CC, Au CT, Lam HS, Lee DL, Wing YK, Li AM. Intranasal Steroids for mild childhood obstructive sleep apnea--a randomized, placebo-controlled study. Sleep Med. 2015;16:358-63.
Jung YG, Kim HY, Min JY, Dhong HJ, Chung SK. Role of intranasal topical steroid in pediatric sleep disordered breathing and influence of allergy, sinusitis, and obesity on treatment outcome. Clin Exp Otorhinolaryngol. 2011;4:27-32.
Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140:950-8.
Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. AJR Am J Roentgenol. 1979;133:401-4.
Chinratanapisit S, Suratannon N, Pacharn P, Sritipsukho P, Vichyanond P. Prevalence and risk factors of allergic rhinitis in children in Bangkok area. Asian Pac J Allergy Immunol. 2019;37:232-9.
Cao Y, Wu S, Zhang L, Yang Y, Cao S, Li Q. Association of allergic rhinitis with obstructive sleep apnea: a meta-analysis. Medicine (Baltimore). 2018;97:e13783.
Poddighe D, Gelardi M, Licari A, Del Giudice MM, Marseglia GL. Non-allergic rhinitis in children: epidemiological aspects, pathological features, diagnostic methodology and clinical management. World J Methodol. 2016;6:200-13.
Modrzynski M, Zawisza E. An analysis of the incidence of adenoid hypertrophy in allergic children. Int J Pediatr Otorhinolaryngol. 2007;71:713-9.
Bozkurt G, Dizdar SK, Korkut AY, Coşkun BU. Adenoid vegetation in children with allergic rhinitis. Turk Arch Otorhinolaryngol. 2015;53:168-72.
Said SA, Mchembe MD, Chalya PL, Rambau P, Gilyoma JM. Allergic rhinitis and its associated co-morbidities at Bugando Medical Centre in Northwestern Tanzania; A prospective review of 190 cases. BMC Ear Nose Throat Disord. 2012;12:13.
Colavita L, Miraglia Del Giudice M, Stroscio G, Visalli C, Alterio T, Pidone C et al. Allergic rhinitis and adenoid hypertrophy in children: is adenoidectomy always really useful? J Biol Regul Homeost Agents 2015;29(2-1):58-63.
Marseglia GL, Caimmi D, Pagella F, Matti E, Labó E, Licari A et al. Adenoids during childhood: the facts. Int J Immunopathol Pharmacol. 2011;24(4):1-5.
Chervin RD, Weatherly RA, Garetz SL, Ruzicka DL, Giordani BJ, Hodges EK et al. Pediatric sleep questionnaire: prediction of sleep apnea and outcomes. Arch Otolaryngol Head Neck Surg. 2007;133:216-22.
