Edited by: Wytske Fokkens
Steroid sparing effects of intranasal corticosteroids in asthma and allergic rhinitis
Article first published online: 5 OCT 2009
© 2009 John Wiley & Sons A/S
Volume 65, Issue 3, pages 359–367, March 2010
How to Cite
Nair, A., Vaidyanathan, S., Clearie, K., Williamson, P., Meldrum, K. and Lipworth, B. J. (2010), Steroid sparing effects of intranasal corticosteroids in asthma and allergic rhinitis. Allergy, 65: 359–367. doi: 10.1111/j.1398-9995.2009.02187.x
- Issue published online: 3 FEB 2010
- Article first published online: 5 OCT 2009
- Accepted for publication 24 July 2009
- allergic rhinitis;
- unified airway
To cite this article: Nair A, Vaidyanathan S, Clearie K, Williamson P, Meldrum K, Lipworth BJ. Steroid sparing effects of intranasal corticosteroids in asthma and allergic rhinitis. Allergy 2010; 65: 359–367.
Background: Treating allergic rhinitis may have a downstream anti-inflammatory effect on the lower airways. We conducted a dose ranging study in asthma and persistent allergic rhinitis to evaluate if intranasal corticosteroids exhibit a sparing effect on the dose of inhaled corticosteroid.
Methods: Twenty five participants were randomized to receive two weeks of 100 μg/day (Low dose) or 500 μg/day (High dose) of inhaled fluticasone propionate both with intranasal placebo; or inhaled fluticasone 100 μg/day with intranasal fluticasone 200 μg/day (Combined) in a double-blind cross-over fashion.
Results: Low dose fluticasone produced a shift of 1.20 doubling-dilutions (95% CI, 0.63, 1.77); Combined fluticasone, 1.79 doubling-dilutions (95% CI, 0.77, 2.80) and high dose fluticasone, 2.01 doubling-dilutions (95% CI, 1.42, 2.61) in methacholine PC20 from respective baselines. There was a significant difference between high and low doses: 0.82 doubling dilutions (95%CI, 0.12, 1.50) but not between combined and low dose 0.58 doubling dilutions (95% CI, –0.78, 1.95). Combined treatment alone produced improvements in peak nasal inspiratory flow (P < 0.001), rhinitis quality of life (P = 0.004) and nasal NO (P = 0.01); reduced blood eosinophil count (P = 0.03), and serum eosinophil cationic protein (P = 0.02). All treatments significantly improved tidal NO, FEV1 and asthma quality of life.
Conclusions: High-dose fluticasone was superior to low dose fluticasone for methacholine PC20, demonstrating room for further improvement. Combined treatment was not significantly different from low dose fluticasone and we could not demonstrate a steroid sparing effect on methacholine PC20. Combined treatment alone produced improvements in upper airway outcomes and suppressed systemic inflammation but not adrenal function.