Effect of Treating Allergic Rhinitis With Corticosteroids in Patients With Mild-to-Moderate Persistent Asthma

doi:10.1378/chest.128.5.3140

Chest

Volume 128, Issue 5, November 2005, Pages 3140-3147

https://doi.org/10.1378/chest.128.5.3140 Get rights and content

Study objectives: Rhinitis and asthma are considered to be synchronic or sequential forms of the same allergic syndrome. Treating the inflammation associated with allergic rhinitis influences the control of asthma. However, few studies have investigated the effect of treating perennial rhinitis on persistent asthma andvice versa. We determined the effects of inhaled or topical nasal beclomethasone dipropionate (BDP) administered separately or in combination on the control of asthma and bronchial hyperresponsiveness (BHR) in patients with the rhinitis/asthma association.

Design: A double-blind, parallel, three-group study.

Setting: Outpatient clinic of Pulmonary Division/Heart Institute (InCor) and the Division of General Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil.

Patients: Seventy-four patients with mild-to-moderate asthma and allergic rhinitis (median age, 25 years).

Interventions: Patients received nasal or inhaled BDP separately or in combination for 16 weeks after a 2-week placebo run-in period.

Measurements and results: Nasal and pulmonary symptoms, as well as pulmonary function and BHR, were compared among the three groups after 4 weeks and 16 weeks of treatment. Patients in all three groups demonstrated a progressive and significant decrease in nasal and pulmonary symptoms, which started after 4 weeks (p < 0.05) and continued through the end of treatment (p < 0.001). Clinical improvement was similar and parallel in the three groups. Asthma-related morbidity, evaluated by quantifying absence from work, emergency department visits, and nighttime awakenings, also decreased in the three groups (p < 0.05).

Conclusions: Failure to consider treatment of rhinitis as essential to asthma management might impair clinical control of asthma. Furthermore, these data suggest that asthma and rhinitis in some patients can be controlled by the exclusive use of nasal medication.

Section snippets

MATERIALS AND METHODS

Patients were recruited from the asthma outpatient clinic for an 18-week/120-day study period. Patients with mild-to-moderate persistent asthma and allergic rhinitis who had been corticosteroid naïve for at least 3 months were included. Asthma was diagnosed and classified according to the criteria of the Global Initiative for Asthma.¹⁶ Patients selected had the following: (1) FEV₁> 50% and < 80% predicted and a positive bronchodilator response as established by the American Thoracic Society,¹⁷

RESULTS

Although 74 patients were recruited, 15 patients were excluded because they attended < 4 weeks of treatment, 7 of them after randomization (nasal group [n = 1], pulmonary group [n = 3], nasal-plus pulmonary group [n = 3]). Of the remaining 59 patients, 21 patients received nasal BDP (nasal group), 18 patients received inhaled BDP (pulmonary group), and 20 patients received both drugs (nasal-plus pulmonary group). During the study, two patients were excluded due to severe asthma exacerbations

DISCUSSION

The initial hypothesis in the present study was that failure to treat rhinitis would impair the optimal management of asthma and that the asthma-rhinitis relationship could be evaluated based on improvements in pulmonary function and BHR after treatment. The results show that nasal BDP alone has a similar effect on the control of asthma symptoms as inhaled and combined applications of the drug, without a significant variation in either pulmonary function or BHR. Our findings also demonstrate

CONCLUSIONS

The present results suggest that the failure to consider treatment of coexisting rhinitis as essential to the management of asthma may impair clinical control of the latter. Despite the small number of patients in this study, they were followed up in a close manner for almost 4 months. When asthma is approached as an exclusively pulmonary disease, the patient may require higher doses of oral corticosteroids and might demonstrate higher morbidity. Conversely, the parallel and similar response to

ACKNOWLEDGMENTS

The authors thank Fabiane Polisel and Maria Aparecida Rodrigues (Gigi) for technical assistance, and Carine S. Redigolo, Maria Paula Z.C. Rosa, and Mariana Cury for assistance with the statistical analysis.

REFERENCES (40)

FER Simons
Allergic rhinobronchitis: the asthma-allergic rhinitis link.
J Allergy Clin Immunol
(1999)
S Guerra et al.
Rhinitis as an independent risk factor for adult-onset asthma.
J Allergy Clin Immunol
(2002)
CE Reed et al.
Effects of topical nasal treatment on asthma symptoms.
J Allergy Clin Immunol
(1988)
WTA Watson et al.
Treatment of allergic rhinitis with intranasal corticosteroids in patients with mild asthma: effect on lower airway responsiveness.
J Allergy Clin Immunol
(1993)
C Bucca et al.
Are asthma-like symptoms due to bronchial or extrathoracic airway dysfunction?
Lancet
(1995)
C Bucca et al.
Extrathoracic and intra-thoracic airway responsiveness in sinusitis.
J Allergy Clin Immunol
(1995)
J Denburg et al.
Systemic aspects of allergic disease: bone marrow.
J Allergy Clin Immunol
(2000)
GJ Braunstahl et al.
Nasal allergen provocation induces adhesion molecules expression and tissue eosinophilia in upper and lower airways.
J Allergy Clin Immunol
(2001)
J Corren et al.
Changes in bronchial responsiveness following nasal provocation with allergen.
J Allergy Clin Immunol
(1992)
A Foresi et al.
Once daily intranasal fluticasone propionate (200 micrograms) reduces nasal symptoms and inflammation but also attenuates the increase in bronchial responsiveness during the pollen season in allergic rhinitis.
J Allergy Clin Immunol
(1996)

J Crystal-Peters et al.

Treating allergic rhinitis in patients with comorbid asthma: the risk of asthma-related hospitalizations and emergency department visits.

J Allergy Clin Immunol

(2002)

RJ Adams et al.

Intranasal steroids and the risk of emergency department visits for asthma.

J Allergy Clin Immunol

(2002)

J Grossman

One airway, one disease.

Chest

(1997)

J Bousqet et al.

Links between rhinitis and asthma.

Allergy

(2003)

P Chanez et al.

Comparison between nasal and bronchial inflammation in asthmatic and control subjects.

Am J Respir Crit Care Med

(1999)

G Passalaqua et al.

The nose-lung interaction in allergic rhinitis and asthma: united airways disease.

Curr Opin Allergy Clin Immunol

(2001)

AL Fuhlbrigge et al.

The effect of treatment of allergic rhinitis on asthma morbidity, including emergency departments visits.

Curr Opin Allergy Clin Immunol

(2003)

A Linneberg et al.

The link between allergic rhinitis and allergic asthma: a prospective population-based study. The Copenhagen Allergy Study.

Allergy

(2002)

J Bousquet et al.

Allergic rhinitis and its impact on asthma: ARIA Workshop Report.

J Allergy Clin Immunol

(2001)

Global Initiative for Asthma. Available at: www.ginasthma.com. Accessed October 18,...

Cited by (110)

Allergic Rhinitis, Rhinosinusitis, and Asthma: Connections Across the Unified Airway
2024, Otolaryngologic Clinics of North America
Allergic Rhinitis
2021, Encyclopedia of Respiratory Medicine, Second Edition
Allergic rhinitis is a bothersome condition and has a high world-wide prevalence. It is commonly associated with allergic asthma. There is, therefore, an urgent need to accurately diagnose and promptly treat this disease. This article outlines the important epidemiology and clinical features of allergic rhinitis. Accurate diagnosis and documentation of disease severity is emphasized. The broad-based treatment approach needed is discussed. The link with allergic asthma is explored.
The Role of Allergy in Phonation
2019, Journal of Voice
Allergies are among the most common chronic conditions worldwide affecting 10%–30% of adult individuals and 40% of children. Phonation can be affected by different allergic conditions in various ways. The role of allergy in phonation has been under-researched and poorly understood and the respective literature is poor. Several studies have investigated the role of certain allergic diseases in phonation. In this review, we tried to include all allergic conditions that can affect voice production.
We conducted a bibliography review looking for allergic conditions that can affect phonation. Allergic asthma, allergic laryngitis, allergic rhinitis and sinusitis, oral allergy syndrome, and angioedema were included in our search.
The literature on the impact of allergy in phonation remains poor and many key questions concerning basic information for epidemiology, pathophysiology, and larynx pathology in allergic patients with phonation problems still remain unanswered.
The role of allergy in voice production remains underinvestigated and many basic questions still remain open. Further research is needed to improve our understanding for these very common conditions.
Manifestations of Inhalant Allergies Beyond the Nose
2017, Otolaryngologic Clinics of North America
A Systematic Approach to Evaluating Difficult to Control Asthma: A Little Goes a Long Way
2017, Journal of Allergy and Clinical Immunology: In Practice
Efficacy of nasal mometasone for the treatment of chronic sinonasal disease in patients with inadequately controlled asthma
2015, Journal of Allergy and Clinical Immunology
Chronic sinonasal disease is common in asthmatic patients and associated with poor asthma control; however, there are no long-term trials addressing whether chronic treatment of sinonasal disease improves asthma control.
We sought to determine whether treatment of chronic sinonasal disease with nasal corticosteroids improves asthma control, as measured by the Childhood Asthma Control Test and Asthma Control Test in children and adults, respectively.
A 24-week multicenter, randomized, placebo-controlled, double-blind trial of placebo versus nasal mometasone in adults and children with inadequately controlled asthma was performed. Treatments were randomly assigned, with concealment of allocation.
Two hundred thirty-seven adults and 151 children were randomized to nasal mometasone versus placebo, and 319 participants completed the study. There was no difference in the Childhood Asthma Control Test score (difference in change with mometasone − change with placebo [ΔM − ΔP], −0.38; 95% CI, −2.19 to 1.44; P = .68; age 6-11 years) or the Asthma Control Test score (ΔM − ΔP, 0.51; 95% CI, −0.46 to 1.48; P = .30; age ≥12 years) in those assigned to mometasone versus placebo. In children and adolescents (age 6-17 years) there was no difference in asthma or sinus symptoms but a decrease in episodes of poorly controlled asthma defined by a decrease in peak flow. In adults there was a small difference in asthma symptoms measured by using the Asthma Symptom Utility Index (ΔM − ΔP, 0.06; 95% CI, 0.01 to 0.11; P < .01) and in nasal symptoms (sinus symptom score ΔM − ΔP, −3.82; 95% CI, −7.19 to −0.45; P = .03) but no difference in asthma quality of life, lung function, or episodes of poorly controlled asthma in adults assigned to mometasone versus placebo.
Treatment of chronic sinonasal disease with nasal corticosteroids for 24 weeks does not improve asthma control. Treatment of sinonasal disease in asthmatic patients should be determined by the need to treat sinonasal disease rather than to improve asthma control.

View all citing articles on Scopus

Medication and placebo was supplied by Farmalab-Chiesi Co.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

View full text

Chest

Clinical InvestigationsEffect of Treating Allergic Rhinitis With Corticosteroids in Patients With Mild-to-Moderate Persistent Asthma

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

CONCLUSIONS

ACKNOWLEDGMENTS

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Lancet

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

One airway, one disease.

Chest

Links between rhinitis and asthma.

Allergy

Comparison between nasal and bronchial inflammation in asthmatic and control subjects.

Am J Respir Crit Care Med

The nose-lung interaction in allergic rhinitis and asthma: united airways disease.

Curr Opin Allergy Clin Immunol

The effect of treatment of allergic rhinitis on asthma morbidity, including emergency departments visits.

Curr Opin Allergy Clin Immunol

The link between allergic rhinitis and allergic asthma: a prospective population-based study. The Copenhagen Allergy Study.

Allergy

Allergic rhinitis and its impact on asthma: ARIA Workshop Report.

J Allergy Clin Immunol

Clinical Investigations
Effect of Treating Allergic Rhinitis With Corticosteroids in Patients With Mild-to-Moderate Persistent Asthma