Effects of orally inhaled budesonide in seasonal allergic rhinitis

Abstract

It has previously been demonstrated that topical nasal treatment with glucocorticosteroids has significant effects on the bronchial airways. Less is known about effects on nasal disease by topical bronchial treatment with these drugs. The present study examined effects on nasal allergic disease of inhaled budesonide (avoiding nasal deposition of the drug). Patients with seasonal allergic rhinitis, but without asthma, were thus given inhalations of budesonide (600 microg b.i.d.) or placebo. The aim of the design was to allow the study of eosinophilic airway disease in a part of the airway other than the directly treated locus. Moderate to high birch pollen levels were recorded during the study season, and nasal symptoms were significantly increased in both treatment groups, although they were milder in patients receiving budesonide than in the placebo group (p<0.05). Nasal brush eosinophils and nasal lavage fluid levels of eosinophil cationic protein as well as blood eosinophils were increased during the season (p<0.05), but these increases were prevented by the inhaled budesonide. Nasal lavage fluid levels of alpha2-macroglobulin were particularly elevated in the placebo group but did not differ between patients receiving placebo and budesonide. Budesonide prevented the seasonal development of increased bronchoconstrictor responses to methacholine challenge (p<0.05). In conclusion, budesonide reduced the seasonal eosinophilia both in the circulation and in the nose along with an attenuation of seasonal nasal symptoms. Hence, at a daily dose of 600 microg b.i.d., known to cause no, or minimal, adverse effects, inhaled budesonide produces clinically significant anti-inflammatory effects in the entire airways, including the nasal mucosa, which is not exposed topically to the drug. We suggest that nasal and systemic anti-eosinophil actions are produced at commonly employed dose levels of orally inhaled budesonide.

Prevalence of nasal symptoms and their relation to self-reported asthma and chronic bronchitis/emphysema

“…These data agree with the high prevalence of asthma among subjects with allergic rhinitis [3,24,25]. Importantly, the association between asthma and rhinitis may also be re¯ected by bene®cial effects on both conditions by treatment of only one of the two diseases [2,26,27]. Likely due to nonallergic mechanisms, nasal symptoms evoked by damp/cold air and stress [28] were signi®cant risk factors for both asthma and CBE in the present study.…”

Pediatric Allergic Rhinitis and Asthma: Can the March be Halted?

“…Less is known about the effects on nasal disease of inhaled (intrabronchial) corticosteroid treatment [1]. In adults with seasonal AR without asthma, a study [68] examining the effects of inhaled budesonide on their AR concluded that in addition to nasal symptoms it also ameliorated the seasonal increase in blood and nasal eosinophils, and eosinophil cationic protein nasal lavage levels. If the systemic and nasal treatment effects in this study are due to pulmonary absorption of budesonide [68], these data suggest that inhibition of allergic eosinophilia could be interpreted towards an inhibition of the allergic march.…”

“…In adults with seasonal AR without asthma, a study [68] examining the effects of inhaled budesonide on their AR concluded that in addition to nasal symptoms it also ameliorated the seasonal increase in blood and nasal eosinophils, and eosinophil cationic protein nasal lavage levels. If the systemic and nasal treatment effects in this study are due to pulmonary absorption of budesonide [68], these data suggest that inhibition of allergic eosinophilia could be interpreted towards an inhibition of the allergic march. Still, one can't disregard discouraging study outcomes pointing out that early use of inhaled corticosteroids for wheezing preschoolers had no effect on the natural history of asthma/ wheeze later in childhood, and did not prevent lung function decline or reduce airway reactivity [69][70][71].…”

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…A study examined the effects on nasal allergic disease of inhaled budesonide (avoiding nasal deposition of the drug) in patients with seasonal allergic rhinitis, but without asthma (2026). During the birch pollen season, budesonide reduced the seasonal eosinophilia both in the circulation and in the nose along with an attenuation of seasonal nasal symptoms.…”