Long‐term study of flunisolide treatment in perennial rhinitis with special reference to nasal mucosal histology and morphology

Abstract

Summary Ten patients with allergic perennial rhinitis completed a 3‐month course of treatment with flunisolide nasal spray†. Biopsy of the nasal mucosa was carried out before the initiation of treatment and at the end of the treatment period. The flunisolide was administered as a 0.025% solution twice daily at a total daily dose of 200μg. No histological abnormalities which could have been attributed to the effects of the drug were found in the post‐treatment biopsies. Comparison of the pre‐ and post‐treatment histological features showed either that there had been no apparent changes or that there had been a reduction in the oedema and/or cellular infiltration which had been present initially. All except one patient improved clinically and in this case the pre‐treatment nasal biopsy demonstrated features of atrophic rhinitis.

Intranasal budesonide spray as an adjunct to oral antibiotic therapy for acute sinusitis in children

“…However, Druce [4] and Druce and Slavin [5] indicated that this does not occur when topical corticosteroids are administered concurrently with antibiotics. In other studies Sahay et al [19] found that topical corticosteroids did not cause any perivascular hemorrhage or obvious damage to the walls of blood vessels and any evidence of infection after 12 weeks of treatment.…”

“…However, Sahay et al [19] showed that prolonged use of topical corticosteroids did not change plasma steroid levels. Budesonide possesses a high topical and very low systemic activity in contrast to other topical corticosteroids [7,8,10].…”

“…Furthermore, Sahay et al [19] showed that topical corticosteroids led to a reduction in edema and/or cellular infiltration. Since inflammation and edema of the mucosa of the nasal turbinates and sinus ostia cause obstruction to sinus drainage, it can be theorized that a topical steroid may promote drainage and increase aeration of the sinuses, hasten the elimination of infection, and decrease the frequency and severity of recurrences by decreasing the inflammatory response and reducing mucosal swelling [16].…”

“…Topical corticosteroids offer the theoretical advantage of a localized therapeutic action in nasal tissues without the occurrence of undesirable systemic effects [19]. Previous reports have indicated that prolonged use can reduce the inflammatory component of sinusitis without changing the surface structure of the nasal mucous membranes [16,23].…”

Diagnosis and management of acute rhinosinusitis in children

“…Whether nasal steroid therapy can suffi ciently decrease nasal infl ammation and improve mucociliary transport to the point at which the ostiomeatal complex becomes competent is unknown. Topical corticosteroids offer the theoretical advantage of a localized therapeutic action in nasal tissues without the occurrence of undesirable systemic effects [42]. A theoretical concern exists regarding the potential spread of infection in acute sinusitis.…”