Steroid sparing effects of intranasal corticosteroids in asthma and allergic rhinitis
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. Treating allergic rhinitis may have a downstream anti-inflammatory effect on the lower airw...
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| description | 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. 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. 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. 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. 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. |
| doi_str_mv | 10.1111/j.1398-9995.2009.02187.x |
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Steroid sparing effects of intranasal corticosteroids in asthma and allergic rhinitis. Allergy 2010; 65: 359-367. 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. 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. 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. 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.</description><identifier>ISSN: 0105-4538</identifier><identifier>EISSN: 1398-9995</identifier><identifier>DOI: 10.1111/j.1398-9995.2009.02187.x</identifier><identifier>PMID: 19804441</identifier><identifier>CODEN: LLRGDY</identifier><language>eng</language><publisher>Oxford, UK: Oxford, UK : Blackwell Publishing Ltd</publisher><subject>Administration, Inhalation ; Administration, Intranasal ; Adrenal Cortex Hormones - administration & dosage ; Adult ; allergic rhinitis ; Allergies ; Androstadienes - administration & dosage ; Anti-Inflammatory Agents - administration & dosage ; Asthma ; Asthma - drug therapy ; Biological and medical sciences ; Breath Tests ; Chronic obstructive pulmonary disease, asthma ; Cross-Over Studies ; Dermatology ; Dose-Response Relationship, Drug ; Double-Blind Method ; Drug dosages ; Female ; Fluticasone ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Humans ; Inflammatory diseases ; Male ; Medical sciences ; methacholine ; Middle Aged ; Pneumology ; Quality of Life ; Respiratory Function Tests ; Rhinitis, Allergic, Perennial - drug therapy ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Steroids ; unified airway ; Young Adult</subject><ispartof>Allergy (Copenhagen), 2010-03, Vol.65 (3), p.359-367</ispartof><rights>2009 John Wiley & Sons A/S</rights><rights>2015 INIST-CNRS</rights><rights>Journal compilation © 2010 John Wiley & Sons A/S</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5967-85b0f837945e638b4f28a2143d83fb265c34ca448dce71d7681b47279b5848193</citedby><cites>FETCH-LOGICAL-c5967-85b0f837945e638b4f28a2143d83fb265c34ca448dce71d7681b47279b5848193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1398-9995.2009.02187.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1398-9995.2009.02187.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22405274$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19804441$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nair, A</creatorcontrib><creatorcontrib>Vaidyanathan, S</creatorcontrib><creatorcontrib>Clearie, K</creatorcontrib><creatorcontrib>Williamson, P</creatorcontrib><creatorcontrib>Meldrum, K</creatorcontrib><creatorcontrib>Lipworth, B.J</creatorcontrib><title>Steroid sparing effects of intranasal corticosteroids in asthma and allergic rhinitis</title><title>Allergy (Copenhagen)</title><addtitle>Allergy</addtitle><description>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. 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. 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. 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. 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.</description><subject>Administration, Inhalation</subject><subject>Administration, Intranasal</subject><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Adult</subject><subject>allergic rhinitis</subject><subject>Allergies</subject><subject>Androstadienes - administration & dosage</subject><subject>Anti-Inflammatory Agents - administration & dosage</subject><subject>Asthma</subject><subject>Asthma - drug therapy</subject><subject>Biological and medical sciences</subject><subject>Breath Tests</subject><subject>Chronic obstructive pulmonary disease, asthma</subject><subject>Cross-Over Studies</subject><subject>Dermatology</subject><subject>Dose-Response Relationship, Drug</subject><subject>Double-Blind Method</subject><subject>Drug dosages</subject><subject>Female</subject><subject>Fluticasone</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Humans</subject><subject>Inflammatory diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>methacholine</subject><subject>Middle Aged</subject><subject>Pneumology</subject><subject>Quality of Life</subject><subject>Respiratory Function Tests</subject><subject>Rhinitis, Allergic, Perennial - drug therapy</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Steroids</subject><subject>unified airway</subject><subject>Young Adult</subject><issn>0105-4538</issn><issn>1398-9995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUtv1DAURi0EokPhL4CFBKwSfP2I7QWLquJRaaQu2llbjmNPPcokg50R7b_HIaMisUD1xpbu-e61fRDCQGoo6_OuBqZVpbUWNSVE14SCkvX9M7R6LDxHKwJEVFwwdYZe5bwjhEiqyUt0BloRzjms0OZm8mmMHc4Hm-KwxT4E76aMx4DjMCU72Gx77MY0RTfmBc6lhG2e7vYW26HDtu992kaH010c4hTza_Qi2D77N6f9HG2-fb29_FGtr79fXV6sKyd0IyslWhIUk5oL3zDV8kCVpcBZp1hoaSMc485yrjrnJXSyUdBySaVuheIKNDtHn5a-hzT-PPo8mX3Mzve9Hfx4zEYypoEBkYX8-F-yTNVM0KaA7_8Bd-MxDeUVBnSjgQrKCqQWyKUx5-SDOaS4t-nBADGzIbMzswgzizCzIfPHkLkv0ben_sd277u_wZOSAnw4ATY724eiwMX8yFHKiaCSF-7Lwv2KvX948gXMxXo9n0r-3ZIPdjR2m8qMzQ0lwAhIrXn5s9-HgLPf</recordid><startdate>201003</startdate><enddate>201003</enddate><creator>Nair, A</creator><creator>Vaidyanathan, S</creator><creator>Clearie, K</creator><creator>Williamson, P</creator><creator>Meldrum, K</creator><creator>Lipworth, B.J</creator><general>Oxford, UK : Blackwell Publishing Ltd</general><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>FBQ</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201003</creationdate><title>Steroid sparing effects of intranasal corticosteroids in asthma and allergic rhinitis</title><author>Nair, A ; Vaidyanathan, S ; Clearie, K ; Williamson, P ; Meldrum, K ; Lipworth, B.J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5967-85b0f837945e638b4f28a2143d83fb265c34ca448dce71d7681b47279b5848193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Administration, Inhalation</topic><topic>Administration, Intranasal</topic><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Adult</topic><topic>allergic rhinitis</topic><topic>Allergies</topic><topic>Androstadienes - administration & dosage</topic><topic>Anti-Inflammatory Agents - administration & dosage</topic><topic>Asthma</topic><topic>Asthma - drug therapy</topic><topic>Biological and medical sciences</topic><topic>Breath Tests</topic><topic>Chronic obstructive pulmonary disease, asthma</topic><topic>Cross-Over Studies</topic><topic>Dermatology</topic><topic>Dose-Response Relationship, Drug</topic><topic>Double-Blind Method</topic><topic>Drug dosages</topic><topic>Female</topic><topic>Fluticasone</topic><topic>Fundamental and applied biological sciences. 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Steroid sparing effects of intranasal corticosteroids in asthma and allergic rhinitis. Allergy 2010; 65: 359-367. 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. 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. 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. 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.</abstract><cop>Oxford, UK</cop><pub>Oxford, UK : Blackwell Publishing Ltd</pub><pmid>19804441</pmid><doi>10.1111/j.1398-9995.2009.02187.x</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Administration, Inhalation Administration, Intranasal Adrenal Cortex Hormones - administration & dosage Adult allergic rhinitis Allergies Androstadienes - administration & dosage Anti-Inflammatory Agents - administration & dosage Asthma Asthma - drug therapy Biological and medical sciences Breath Tests Chronic obstructive pulmonary disease, asthma Cross-Over Studies Dermatology Dose-Response Relationship, Drug Double-Blind Method Drug dosages Female Fluticasone Fundamental and applied biological sciences. Psychology Fundamental immunology Humans Inflammatory diseases Male Medical sciences methacholine Middle Aged Pneumology Quality of Life Respiratory Function Tests Rhinitis, Allergic, Perennial - drug therapy Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Steroids unified airway Young Adult |
| title | Steroid sparing effects of intranasal corticosteroids in asthma and allergic rhinitis |
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