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Bronchiectasis, persistent widening of short segments of air tubes of the lungs

(bronchi or bronchioles). Bronchiectasis is an irreversible condition resulting from
damage to the wall of the bronchi from long-term inflammation or obstruction.
Occasionally it is present at birth as congenital bronchiectasis.
In most cases the condition is due to bronchial infection or blockage of the tube
by a foreign body, a tumour, or enlarged lymph nodes. It may also result from other
infections of the lung, especially severe pneumonia, as a complication of measles or
whooping cough, or from inhaling irritant gases or injurious dust particles such as silica,
asbestos, or talc. It is common in cystic fibrosis. Bronchiectasis may follow chronic
bronchitis, the most important cause of which is smoking cigarettes. Inflammation of the
air tube walls causes softening and weakening and, especially in the presence of any
obstruction to air inflow, the respiratory expansion of the chest exerts an outward pull on
the wall, causing it to stretch.
Because of the resulting sac-like widening of the air tubes, the normal lung
secretions tend to be retained and to become infected. The result is partial obstruction to
the air flow, frequent coughing, and the production of much sputum, which may be
blood-stained. Other symptoms of bronchiectasis include bad breath, wheezy breathing,
reduced capacity for exercise, and club-shaped appearance of the finger ends.
The diagnosis of bronchiectasis formerly involved an X-ray procedure known as
bronchography, in which a fluid opaque to X-rays was sprayed into the lungs to outline
any swelling. This unpleasant method has now been replaced by computerized axial
tomography (CT) scanning. Treatment includes physiotherapy with chest pummelling to
assist in the removal of secretions, long-term antibiotic treatment and, in cases in which
the disease is reasonably well localized, the removal of an affected segment or lobe of the
lung by surgery. In cases of widespread bronchiectasis only antibiotics, physiotherapy
and sometimes the use of corticosteroid drugs, (compounds that are similar to cortisol) to
control inflammation are likely to help.
People suffering from bronchiectasis must avoid smoking and should not take
sedatives or other drugs that suppress coughing.

Asthma, Bronchial (Greek asthma,panting), respiratory disease in which spasm
and constriction of the bronchial passages and swelling of their mucous lining cause
obstruction of breathing, often due to allergy, particularly to dust, animal fur or feathers,
moulds, and pollen. Many people with allergic asthma, also called atopic or extrinsic
asthma, also suffer from hay fever. Asthma in adults is less likely to be caused by allergy,
and more likely to be associated with respiratory infections and emotional upsets. Nonallergic asthma is called intrinsic asthma.
The frequency and severity of asthma symptoms varies markedly from one person
to another. A typical attack, which often occurs at night, begins with coughing, wheezing,
and shortness of breath, but in some individuals a dry cough may be the only symptom.
Even without treatment, attacks usually subside after a few hours, with a change to a
moist cough that brings up large amounts of mucus. Attacks may recur in hours or
days, or may be absent for months or even years. Status asthmaticus, a prolonged
attack that persists despite treatment with drugs, is a particularly severe and sometimes
fatal form of the disease, and usually requires hospitalization. Some children with asthma
stop having attacks when they reach adulthood. In 2002 it was discovered that the gene
ADAM33, which is present in about 40 per cent of sufferers, plays a crucial role in
making the airways of the lungs highly sensitive, thus increasing the risk of asthma.
Asthma attacks can be treated or prevented by a variety of drugs. Inhalation of
bronchodilator drugs, such as albuterol or terbutaline, is the usual treatment, and can
bring relief within minutes. Severe attacks that do not respond to these drugs may require
treatment with corticosteroids. Drugs that can prevent asthma symptoms include
theophylline, which is usually taken in tablets, and cromolyn sodium, which is inhaled.
When asthma is associated with allergy to inhaled particles, avoidance of the
allergen responsible is generally recommended but often difficult to achieve. Feather
pillows and pets can often be avoided, but dust, moulds, and pollens often may not. Skin
testing may identify the offending allergens, and periodic desensitizing injections over
several years of small amounts of these substances may be helpful.
Respiratory disorders also can be affected by stress. Most common of these is
asthma, which may be caused by emotional upsets. Asthma attacks are characterized by
wheezing, panting, and a feeling of being suffocated.
Oxides of nitrogen and sulphur may have serious effects on asthma sufferers,
whose attacks are worse in conditions of high vehicle pollution, though the precise
medical explanation is not yet understood.
Bronchodilator, type of drug that is inhaled to relieve constriction of the bronchial
passages during asthma attacks. It relaxes the smooth muscles of bronchial airways by
stimulating specific receptors (adrenoreceptors) in the bronchial cells. Short-acting
adrenoreceptor stimulants (salbutamol and terbutaline) relieve symptoms immediately,
for up to six hours. They also prevent some of the inflammatory response that produces
asthmatic secretions, and are for use only when symptoms arise. Rapid-acting
bronchodilators (salmeterol and eformoterol) provide longer periods of relief (up to 12
hours) for children over 4 years of age, and are used to control symptoms at night or
following exercise-induced attacks. Bambuterol, taken orally, lasts up to 24 hours, but is
only for adult use.

Anticholinergic, group of drugs used to prevent types of muscular spasm. They

work by blocking the action of acetylcholine, a chemical released from nerve endings in
the autonomic nervous system that stimulates muscle contraction and increases mouth
and lung secretions. By combining with acetycholine, receptors on the surface of cells in,
for example, the lung, this stimulating action is closed down and the secretions reduced.
Anticholinergics are used to treat asthma (to reduce lung secretion), irritable bowel
syndrome (to lessen gut spasm), incontinence (to reduce bladder muscle contraction), and
as part of pre-medication (to relax the patient before surgery). They are no longer
prescribed for stomach ulcers.
Drugs for asthma are often made in an aerosol form for spraying down the throat
into the lungs. The insulin pump, a small battery-driven instrument strapped to the body,
delivers insulin continuously into the blood of a diabetic to imitate the natural release of
insulin from the pancreas of someone who is not diabetic. One form of intramuscular
injection is the depot preparation in which the drug is formulated to be released slowly
via the tissues into the blood capillaries. Some insulins, steroids, and contraceptives are
given in this way.
Caffeine is used in treating migraine because it constricts the dilated blood vessels
that are believed to be involved in the causation of migraine. It also increases the potency
of analgesics such as aspirin, and it can somewhat relieve asthma attacks by widening the
bronchial airways. Caffeine is produced commercially chiefly as a by-product in making
caffeine-free coffee.
Allergy, a condition of hypersensitivity in certain people or animals to substances
harmless to most individuals. Some people have characterized allergy as immunity gone
wrong. In the immune reaction, contact with a disease-producing micro-organism or a
toxin prompts an individual to build up antibodies (proteins related to globulin serum)
against the offending organism or toxin so that he or she will be protected against further
exposure. All normal people are able to produce such protective antibodies, but in some
the capacity to differentiate potentially harmful substances from harmless ones is absent.
These people produce antibodies against one or many inoffensive substances and thus are
said to be allergic. When an antibody reacts with an antigen (a substance that stimulates
the formation of antibodies) an allergic reaction results. The symptoms of that reaction
will depend on where it takes place. If it occurs in the nose, it may cause sneezing and
running of the nose, giving rise to hay fever. In the air passages it may cause contraction,
leading to wheezing, coughing, and difficulty in breathing, as in asthma. In the skin, it
may produce itching spots, hives, or welts (urticaria). If the reaction takes place in the
circulating blood, a severe reaction known as serum sickness may ensue. Rarely, it can
result in anaphylactic shock and a sudden severe fall in blood pressure, which can be life
threatening. The allergen, the substance producing the reaction, is usually a protein or
protein-carbohydrate complex. It may be inhaled, as dust or pollen; it may be eaten, as
eggs or shellfish; it may be injected, as penicillin; or it may act by mere contact, as wool,
adhesive tape, or metal.
The variety of substances to which a person may be allergic is almost infinite;
diagnosis involves discovering the particular substance or substances to which the patient
is hypersensitive (reacting excessively). A careful history of the development of the
allergic reaction may give a clue, particularly when it is seasonal, when it is associated
with an exposure to a specific substance, or when it occurs only in a particular place.
Often it is possible to remain unaffected merely by avoiding the particular allergen
concerned, but common allergens such as dust or pollen cannot easily be avoided.
An allergic individual may develop new hypersensitivities, or old
hypersensitivities may die out. Allergies usually first appear in childhood, adolescence, or
early adulthood, but may develop for the first time later in life. Sometimes psychological

factors, stemming from emotional conflicts, play an important role in allergy so that some
allergies can be classified as stress-related disorders.
The mechanism of allergic reactions is not fully understood. Most probably the
antigen becomes localized in a particular tissue, such as the cells lining the nasal passages
or the bronchial tubes. The antibody reacts with the antigen at these sites, causing the
release of certain chemical substances, including histamine, which mediates, or brings
about, the reaction. Sometimes, testing the skin with a wide variety of common allergens
can pinpoint the specific allergen or allergens that are causing the difficulties.
The simplest and best treatment is, when possible, to avoid contact with the
allergen. A person allergic to feathers, particular pollens, foods, or medicines, for
example, should avoid them. Where this is not feasible, because the allergen is unknown,
because it affects more than one part of the body, or because too many allergens are
present, drugs such as antihistamines or, in more serious cases, adrenal cortical steroids
may be used to decrease the reaction. In other cases desensitization (the process of
making the patient able to tolerate the antigen without having a reaction) may be
accomplished by giving injections of antigen, first in minute doses and then in gradually
increasing doses as tolerance builds up. Skin testing is always needed when
desensitization treatment is being considered. Symptomatic treatment, such as the
administration of drugs to relax spasms in the walls of the bronchi in asthmatics,
decongestants for hay-fever sufferers, or local ointments to relieve itching for hives may
also be useful. Anaphylactic shock is a medical emergency, requiring an injection of
Emphysema, progressive respiratory disease characterized by coughing, shortness
of breath, and wheezing, developing into extreme difficulty in breathing, and sometimes
resulting in disability and death. Although the exact cause is unknown, bronchial spasm,
infection, irritation, or a combination of the three seem to be contributory. The highest
degree of occurrence is among heavy cigarette smokers, especially those exposed to
polluted air. Children who suffer from bronchitis or asthma are also susceptible. In recent
years emphysema has become a serious public-health problem in terms of rapidly
increasing numbers of disabilities and deaths.
In the course of the disease the passages leading to the air sacs of the lungs
become narrowed. Air is trapped in the sacs, and the tissues of the lungs lose their natural
elasticity and undergo destructive changes. Symptoms akin to the common cold or
asthmatic wheezing may result. As the disease progresses the volume of residual air
trapped in the lungs increases, and the volume of each breath decreases. The lungs
increase in size, and in severe cases the patient develops a characteristic barrel chest.
The lungs become unable to supply enough oxygen to the body tissues. This reduction in
oxygen intake causes the heart to pump faster; consequently, the heart becomes strained.
Excessive carbon dioxide in the blood gives the patient a bluish skin colour.
Although the deterioration in the lungs brought about by emphysema is
permanent and irreversible, treatment can give relief and increase functioning capacity.
Abstention from smoking is essential, and change of occupation or residence may be
necessary if air pollution or occupational pollution aggravates the condition. Bronchial
dilators, special breathing exercises, and antibiotics are also helpful. Therapy is most
successful in instances when the disease is diagnosed at an early stage.
The term emphysema is also used to describe infiltration of air into connective
tissue and between air cells of the lungs.


Lungs, paired organs in the chest that carry on respiration. In the adult human, each

lung is 25 to 30 cm (10 to 12 in) long and roughly conical. The two lungs are separated by a
structure called the mediastinum, which contains the heart, trachea, oesophagus, and blood
vessels. They are covered by a protective membrane called the pulmonary pleura, which is
separated from the parietal pleuraa similar membrane on the chest wallby a lubricating
fluid. Inhaled air passes through the trachea, which divides into two tubes called bronchi; each
bronchus leads to one lung. Within the lungs the bronchi subdivide into bronchioles, which give
rise to alveolar ducts; these end in sacs called alveoli.

Human Lungs
Though the right lung has three lobes, the left lung, with a cleft to accommodate the heart, has only two.
The two branches of the trachea, called bronchi, subdivide within the lobes into smaller and smaller air
vessels. They terminate in alveoli, tiny air sacs surrounded by capillaries. When the alveoli inflate with
inhaled air, oxygen diffuses into the blood in the capillaries to be pumped by the heart to the tissues of the
body, and carbon dioxide diffuses out of the blood into the lungs, where it is exhaled.
Microsoft Corporation. All Rights Reserved.


In this life-supporting process, oxygen from incoming air enters the blood and carbon

dioxide, a waste gas from the metabolism of food, is exhaled into the atmosphere. The
exchange of gases takes place when air reaches the alveoli. These small sacs are only one cell
thick, and they are surrounded by blood capillaries that are also only one cell thick. Air diffuses
through these cells into the capillary blood, which carries the oxygen-rich air to the heart to be
distributed throughout the body. In the alveoli, at the same time, gaseous carbon dioxide
diffuses from the blood into the lung and is expired.
Air enters the lungs when the diaphragm, a strong muscle under the lungs, forcibly
lowers and enlarges the chest cavity in which the lungs are suspended. This causes the lungs
to expand, and the air to fill the enlarged lungs. When the diaphragm relaxes, the lungs
contract and the air is forced out. In times of greater oxygen need, the rib cage can also
expand, further enlarging the chest cavity for greater air intake. A healthy adult can draw in
about 3.3 to 4.9 litres (200 to 300 cu in) of air at a single breath, but at rest only about 5 per
cent of this volume is used. The lungs also excrete water as gas; store glycogen, a complex
carbohydrate (see Starch); and filter out incoming organisms and dangerous particles via hairs
called cilia.

A scanning electron micrograph reveals the tiny sacs known as alveoli within a section of human lung
tissue. Humans have a thin layer of about 700 million alveoli within their lungs. This layer is crucial to
respiration, exchanging oxygen and carbon dioxide with the surrounding blood capillaries.
Photo Researchers, Inc./CNRI


Common infectious lung diseases include pneumonia, which can be caused by bacteria

or viruses; and tuberculosis. Much more common now is cancer of the lung, whichwith the
rise of cigarette smokinghas become the leading killer among cancers in the Western
hemisphere. Smoking also contributes substantially to the rise of chronic bronchitis and
emphysema. In the latter condition the alveoli are gradually destroyed. Asthma (see Asthma,
Bronchial), a severe constriction of the bronchi, can be caused by sensitization to such natural
materials as pollen or to industrial chemicals. Fibrosis, or scarring, of the lungs is caused by
exposure to materials such as cotton dust (brown lung), coal dust (black lung), and asbestos

Smoker's Lung Tissue

The lungs are made up of approximately 350 million tiny sacs called alveoli, where carbon dioxide from the
body is exchanged for oxygen from the air. Various diseases that affect the lungs either destroy the alveoli
directly, as does emphysema, or impair the alveolis ability to exchange gases. This picture shows the
effects of emphysema (caused by smoking) on lung tissue.

Artificial Respiration, forcing of air into and out of the lungs of one person
by another person or by mechanical means. It is usually employed during
suspension of natural respiration caused by disease, such as poliomyelitis or
cardiac arrest; electric shock; an overdose of depressive drugs such as
barbiturates or alcohol; or suffocation resulting from drowning, breathing noxious
gases, or blockage of the respiratory tract. If the brain is deprived of oxygen for
five minutes, it may be permanently damaged; slightly longer periods without
oxygen usually result in death. The exception is near-drowning in very cold water,
in which the body's oxygen demand is greatly reduced; people have been revived
after being submerged for half an hour in cold water.
Because of the danger of even short periods without oxygen, artificial
respiration should always be started immediately. The mouth-to-mouth method,
shown to be superior to the back-pressure and arm-lift procedure, is now
recommended by the Red Cross and other first-aid organizations. In the mouthto-mouth method the unconscious person is placed on his or her back with the
head tilted as far back as possible to prevent the tongue from blocking the air
passages. The victim's nose is then pinched shut, the reviver's mouth is placed
tightly over the victim's, and the reviver gives four quick, deep breaths. It is
essential to check that the chest rises with each inflation. If breathing does not
resume, the reviver proceeds to give one breath every four to five seconds,
allowing the air to come out of the victim's lungs between breaths. This is
continued until the victim resumes breathing or until trained help arrives. If the
unconscious person is a baby or small child, both the mouth and nose are
covered with the reviver's mouth, and air is blown into the victim's lungs at the
rate of one puff every three seconds.
To restore breathing to a person who is choking, a rescuer gives five quick
blows between the shoulder blades with the heel of the hand. If this does not
dislodge the obstruction, the rescuer may use the stomach thrust, known as the
Heimlich manoeuvre. This should be applied as a last resort only, and in the case
of children, with far less force, as this manoeuvre can be damaging. The rescuer
places the side of the fist against the victim's stomach, below the ribs and above
the navel. Then, using the other hand, the rescuer thrusts the fist up into the
upper abdomen once, followed by backslaps. With children, a rescuer first turns
the child upside down and slaps the back.
Polio Patient in Iron Lung Poliomyelitis is an infectious viral disease that
sometimes results in paralysis of the muscles involved in breathing. In the early
half of the 20th century, paralytic patients were treated using an iron lung, or
respirator, a large cylinder that encased the patient in an airtight seal. Motors in
the iron lung forced air in and out of the patient's lungs, providing life-saving
support until recovery and rehabilitation restored the ability to breathe unaided.
Effective vaccination programmes have eradicated polio from the developed
world.Liaison Agency/Hulton Getty
A machine for the administration of artificial respiration consists of a
mechanical air pump connected by a flexible pipe to a tube passed into the
patient's windpipe via the mouth, or through an artificial opening in the neck
(tracheotomy). The pump rhythmically inflates, and allows passive deflation of,
the lungs. The rate can be adjusted. If the patient tries to breathe spontaneously,

the machine will react so as to allow this. Severe breathing difficulties may
require help from such a mechanical ventilator. An external respirator called a
heart-lung machine is used to maintain oxygen saturation in the blood during
open-heart surgery. In this, a pump maintains the blood circulation and part of the
machine oxygenates the blood, which flows out of the body via tubes inserted in
the superior and inferior venae cavae of the heart. The oxygenated blood is
pumped back into a major artery, such as the femoral artery.

Bronchitis, acute or chronic inflammation of any part of the bronchi and

bronchial tubes. The bronchi are large, delicate tubes in the lungs that are
attached to the trachea and carry air to smaller tubes in the lungs. Acute
bronchitis is characterized by fever, chest pain, severe coughing, and often the
secretion of a mucoid expectorate (mucous material coughed up from the
respiratory tract).
The disease may be caused by the inhalation of irritant vapours or dust, or
develop from an upper-respiratory infection. Acute bronchitis affects the branches
of the bronchi and may develop into bronchial or lobular pneumonia.Chronic
bronchitis, a serious and incurable disorder, may result from repeated attacks of
acute bronchitis. Smoking is the main cause of chronic bronchitis and has also
been found to cause acute bronchitis.
The value of radiographs for diagnostic purposes is a consequence of the
penetrating properties of X-rays. Within a few years of their discovery, X-rays
were being used to locate foreign bodies, such as bullets, within the human body.
With the development of improved X-ray techniques, minute differences in
tissues were revealed by radiographs, and many pathological conditions could be
diagnosed by this means. X-rays provided the most important single method of
diagnosing tuberculosis when that disease was prevalent. Pictures of the lungs
were easy to interpret because the air spaces are more transparent to X-rays
than the lung tissues. Various other cavities in the body can be filled artificially
with contrasting media, either more transparent or more opaque to X-rays than
the surrounding tissue, so that a particular organ is brought more sharply into
view. Barium sulphate, which is highly opaque to X-rays, is used for the X-ray
examination of the gastrointestinal tract. Certain opaque compounds are
administered either by mouth or by injection into the bloodstream in order to
examine the kidneys or the gallbladder. Such dyes can have serious side effects,
however, and should be used only after careful consultation. The routine use of
X-ray diagnosis has in fact been discouraged in recent years as the risk of giving
the patient a dose of ionizing radiation that causes a cancer is small but
A recent X-ray device, used without dyes, offers clear views of any part of
the anatomy, including soft organ tissues. Called the body scanner, or
computerized axial tomography (CAT or CT) scanner, it rotates 180 around a
patient's body, sending out a pencil-thin X-ray beam at 160 different points.
Crystals positioned at the opposite points of the beam pick up and record the
absorption rates of the varying thicknesses of tissue and bone. These data are
then relayed to a computer that turns the information into a picture on a screen.
Using the same dosage of radiation as that of the conventional X-ray machine,
an entire slice of the body is made visible with about 100 times more clarity. The
scanner was invented in 1972 by the British electronics engineer Godfrey
Hounsfield, and was in general use by 1979.
For applications of radioisotopes that emit gamma rays, see Isotopic

Computerized Axial Tomography



Computerized Axial Tomography (CT or CAT), non-invasive diagnostic technique using a type of
X-ray device that provides a clear view of soft internal organ tissues in the body. CT is used to
diagnose various conditions, in particular cancer. A CT scan is the computer analysis of a

sharply limited, thin X-ray beam passed circumferentially through an area of the body,
producing a cross-sectional image, or slice.
The modern CT scanner comprises five major parts. A high-speed X-ray tube cooled by oil, air,
and water forms the X-ray source. Its X-ray detector, normally a bank of about 1,000 solid
state-crystal microprocessors coated with caesium iodide, receives the attenuated X-ray signal
as it passes through the various tissues and bones of the patient being examined. The signal is
electronically converted to binary data, which is read by the computerthe heart of the CT
imaging system. The CT has a gantry, a framework that is mounted in such a way that it
surrounds the patient in a vertical plane, and contains a rotating sub-frame on to which the Xray source and detectors are mounted. A patient table (or couch) is positioned perpendicular
and axial to the gantry so that it is able to travel along that axis.



The invention of CT is accredited to two individuals who worked independently: Godfrey

Newbold Hounsfield, a British electronics engineer, and Allan Cormack, an American nuclear
physicist. They shared the 1979 Nobel Prize for Physiology or Medicine for their work.
Hounsfield and the electronics company EMI had created a practical scanner in 1972 following
work started in 1967. By the late 1970s there were hundreds of CT scanners in a number of
countries. Today, in developed countries, a CT scanner can be found in many major hospitals.



Topographic images are produced by using an X-ray source and a detector moving in a coupled
way relative to the patient. In CT a thin fan beam of radiation rotates in a circular or spiral
motion around the patient. Thousands of projected X-ray signals are reconstructed by
computer algorithms to produce digital CT images, displayed by a high-resolution monitor. In
this way the whole body can be imaged from head to toe.
Patients can be scanned on an outpatient basis, without the need to stay in hospital. For a
whole body scan a gown is worn; if the gastrointestinal tract is scanned a contrast agent, such
as barium, is administered, for which the patient has to fast before admission. As with standard
X-ray procedure diagnosis of pregnant patients would not be carried out using CT.



Whereas an X-radiograph gives 30 grey scales related to the amount of film exposure, the CT
image can differentiate to over 200 grey scales; because of this greater sensitivity, there is
greater discrimination between tissue types, thereby making cancerous cells, tumour sites,
small, fine bones, and arterial blockages easier to identify. Furthermore, because of CTs high
resolution, grey matter in the brain can be differentiated from white matter and from
cerebrospinal fluid; soft organs like the pancreas can also be easily defined. All this would not
be possible using conventional procedures. CT is used particularly for defining malignancy and
its extent.
A further benefit of the CT scanner is the availability of a data set for an entire person. With
powerful computers it is possible to re-format the image data to produce body slices in any
orientation. Three-dimensional reconstruction techniques pinpoint the locality, size, shape, and
orientation of an organ or lesion; these techniques are of immeasurable value to the surgeon.


Like CT, magnetic resonance imaging (MRI) and positron-emission tomography (PET) are
scanning techniques that produce tomographic imaging and use powerful computers to give
anatomical data sets. However, MRI differs from CT and PET in that it does not use ionizing
radiation and has superior contrast resolution for examining areas of the head where soft and
hard tissue meet. PET scanning is preferred for providing information about the function of
specific internal organs or tissue metabolism and is used to highlight diseased or injured areas,
particularly in the brain, by digitally displaying the rate of radioisotope uptake.

Rhinitis, inflammatory disorder of the mucous membrane of the nose;
nasal catarrh. Rhinitis is characterized by a watery discharge from the nose often
associated with congestion and difficulty in breathing through the nose. Many
cases are caused by the common cold. Others may be due to nasal allergies,
irritation from breathing irritants and pollutants, use of certain drugs, or other
Treatment involves administration of nasal-decongestant medication to
shrink and dry the swollen mucous membranes and local use of nasal sprays
and drops, although excessive use of these may dry the membranes and
damage them. Antihistamines are effective in treating allergic rhinitis.