RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS
( IN BLOCK LETTERS) / Dr. ANAND K.S.S.
POST GRADUATE STUDENT
DEPT. OF PHYSIOLOGY
K.V.G.MEDICALCOLLEGE & HOSPITAL
KURUNJIBHAG SULLIA-574327
2 / NAME OF THE INSTITUTION / K.VG.MEDICALCOLLEGE & HOSPITAL
KURUNJIBHAG SULLIA-574327
3 / COURSE OF SYUDY AND SUBJECT / M.D. PHYSIOLOGY
4 / DATE OF ADMISSION TO COURSE / 29-04-2008
5 / TITLE OF THE TOPIC / THE STUDY OF PULMONARY FUNCTION TESTS IN NORMAL HEALTHY AND ALLERGIC RHINITIS PATIENTS OF SULIA.

6.BRIEF RESUME OF THE INTENDED WORK

6.1NEED FOR THE STUDY:-

Allergic rhinitis is a common disorder and there is a close link exists between allergic rhinitis and asthma. Allergic rhinitis patients may have abnormal airway function as demonstrated by an obstruction in small airways and increased bronchial reactivity to inhaled non specific provocative agents. By this study we will be able to compare Pulmonary Function Tests (PFT) of normal healthy subjects with allergic rhinitis patients of Sullia. Also we want to study whether allergic rhinitis patients of Sullia are having an early development of Small Airway Disorder (SAD) or not, so that remedial measures may accordingly be initiated to prevent further damage of Pulmonary Functions.

6.2REVIEW OF LITERATURE :-

A close link exists between allergic rhinitis and asthma.1,2,3 Small airway diseases defined by a reduction in the Forced Expiratory Flow (FEF) at 25 - 75 % of the pulmonary volume (FEF25-75) and normal Spirometry. Normal Forced Expiratory Volume at one second (FEV1), Forced Vital Capacity (FVC) and FEV1/FVC ratio may be a marker for early allergic or inflammatory involvement of the small airways in subjects with allergic diseases and no asthma4. Sensitization to common indoor and outdoor allergens was noted by Boullet L.P et al5. Forty seven(87%) subjects were sensitized, 47% mono sensitized and 53% poly sensitized. Allergic rhinitis was diagnosed in 25 subjects FVC and FEV1 values were normal, where as FEF 25-75 values were reduced (61.8+14.8% of predicted)5,6. Rhinitis patients may have abnormal airway function as demonstrated by an obstruction in lung or small airways and increased bronchial reactivity to inhaled non specific provocating agents7,8.

The non specific Bronchial Hyper Reactivity (BHR) is particular in allergic patients. Ciprandi G et al has shown that there was a relationship between BHR degree and FEF25-75 values only during the pollen season, there was an impairment of Spirometric parameters that can be observed in patients with seasonal allergic rhinitis alone during the pollen season9.

Bavek s et alreported that FEV1/FVC, FEF25-75, FEF50-FEF75 values significantly lower in allergic rhinitis cases. Rhinitis patients may have abnormal airway function as demonstrated by a obstruction in large or small airway and increased bronchial reactivity to inhaled nonspecific provocative agents2. Gross man J has shown that Maximum Mid Expiratory Flow Rate (MMF) and the Maximum Terminal Flow (MTF) may be used to assess degree of small airway obstruction. In allergic rhinitis patients abnormal base line for MMF and MTF was observed. J. CCeldon in 2001 showed association between skin test reactivity to aero allergens and either asthma or rhinitis in main-land China and they have correlated dust mite allergen with rhinitis (OR=1.3, 95% C.I.-1.0-1.8, P=0.04).These findings suggest that rhinitis is less common in asthma patients in rural China than in industrial countries with western life style6. In the recent experiment by S. Kaur, V.K. Gupta have shown that elevated levels of Mannan-Binding Leptin (MBL) and eosinophilia in patients of bronchial asthma and allergic rhinitis and allergic bronchio pulmonary aspergelosis is associated with a nobel intronic polymorphism inMBL10.

6.3OBJECTIVES OF THE STUDY :-

  1. To compare the Lung Function Tests in normal healthy subjects and patients of allergic rhinitis.
  2. To predict the early development of small airway disease in allergic rhinitis patients with impairment of Lung Function Tests.
  1. MATERIALS AND METHODS

7.1SOURCES OF DATA:-

  1. Normal healthy subjects (50) from medical students and staff of K.V.G. Medical college, Sullia.
  2. Allergic rhinitis patients (50) taken from ENT Dept. of K.V.G. Hospital, Sullia.

7.2METHOD OF COLLECTION OF DATA:-

The questionnaires will be prepared on the basis of subjects-

  • Name
  • Age
  • Sex
  • Address
  • Educational Qualification
  • Present History
  • Past History
  • Family History
  • In Females - Menstrual History
  • Informal consent from patient will be taken to do Pulmonary Function Tests (PFT).

INCLUSION CRITERIA

Normal healthy subjects of either sex from 18 – 45 years of age group and all patients diagnosed as allergic rhinitis in the same age group.

EXCLUSION CRITERIA

Patients of allergic rhinitis also having other pulmonary diseases or any other allergic disorder.

CONTROLS

Normal healthy subjects without any pulmonary disease and other allergic disorder.

FOLLOW UP

Patients with abnormal Pulmonary Function Test will be informed to ENT dept. for appropriate treatment.

7.3DOES THE STUDY REQUIRE ANY INVESTIGATION / INTERVENTION TO BE CONDUCTED ON PATIENTS / HUMANS / ANIMALS ? IF SO PLEASE DESCRIBE BRIEFLY.

1GENERAL EXAMINATION :-

  • Pulse Rate, Blood Pressure, Respiratory Rate.

2SYSTEMIC EXAMINATION ;-

  • Cardio Vascular System
  • Respiratory System
  • Abdominal Examination
  • Central Nervous System Examination.

3LAB INVESTIGATION :-

a)Hematological investigation-Hb%, TLC, DLC, Absolute eosinophil Count.

b)Pulmonary Function Tests.

c)Peak Flow Rate.

4EAR NOSE AND THROAT EXAMINATION.

7.4HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3 ?

Yes ( Copy Enclosed ).

8.REFERENCES

  1. Bousquet, H. A. Bouchet et al, Characteristics of Patients with Seasonal Allergic Rhinitis and Community Asthma. Wally Inter Science34(6);897-903 June-2004
  2. Grossman J, Putnam JS, Jr Allergy Clinical Immunology, 55(1);49-55,1975.
  3. Prieto L et al. Variability of peak expiratory flow rate in allergic rhinitis. Annl allergy asthma immunology 80(2);151-158, 1998
  4. BavekS et al, Pulmonary function parameters in patients with allergic rhinitis. Jr invest. Allergal Clinical Immunology. 13(4);252-258, 2003.
  5. Boullet LP, Turcotte H et al ; Comparative degree and type of sensitization to common indoor and out door allergens in subjects with allergic rhinitis and or asthma. Willy inter science; 27;52-59, 1996.
  6. Celdon et al. Asthma, rhinitis and skin test reactivity to aero allergen in Anging China. Am Jr of respiratory med; 163(5);1108-1112, 2001
  7. Cirillo et al. Bronchial hyper reactivity and spirometric impairment in patients with allergic rhinitis. Manaldi arch chest disease, 63(2);79-83, 2005.
  8. Domnic V et al; Hyper responsiveness of trachio bronchial tree in previously allergic rhinitis patients; Lippincott Williams and Wilkins, 72(8);64-68,2006.
  9. Ciprandi G et al. Bronchial hyper reactivity and spirometric impairment in patients with seasonal allergic rhinitis. Respiratory med; 98(9); 826-831, 2004.
  10. Kaur S, Gupta V.K. Elevated level of Mannan – Binding Leptin and eosinophilia in patients of bronchial asthma and allergic rhinitis and allergic bronchopulmonary aspergelosis associated with a nobel intronic polymorphisim in MBL.Clinical experimental immunology, 143(3); 414-419, 2006

1