Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29403, USA.
Allergy. 2013;68(5):569-79. doi: 10.1111/all.12124.
Given the relationship between allergic rhinitis (AR) and asthma, it can be hypothesized that reducing inflammation in the upper airway with intranasal corticosteroid (INCS) medications may improve asthma outcomes. The goal of this study was to perform a systematic review with meta-analysis of the efficacy of INCS medications on asthma outcomes in patients with AR and asthma. Asthma-specific outcomes from randomized, controlled studies evaluating INCS medications in patients with AR were evaluated, including studies that compared INCS sprays to placebo, INCS sprays plus orally inhaled corticosteroids to orally inhaled corticosteroids alone, and nasally inhaled corticosteroids to placebo. Sufficient data for meta-analysis were retrieved for 18 trials with a total of 2162 patients. Asthma outcomes included pulmonary function, bronchial reactivity, asthma symptom scores, asthma-specific quality of life, and rescue medication use. The subgroup of studies comparing INCS spray to placebo had significant improvements in FEV1 (SMD = 0.31; 95% CI, 0.04-0.58), bronchial challenge (SMD = 0.46; 95% CI, 0.12-0.79), asthma symptom scores (SMD = -0.42; 95% CI, -0.53 to -0.30), and rescue medication use (SMD = -0.29; 95% CI, -0.58 to -0.01). Nasal inhalation of corticosteroids significantly improved morning and evening peak expiratory flow. There were no significant changes in asthma outcomes with the addition of INCS spray to orally inhaled corticosteroids. Thus, the results of this meta-analysis demonstrated that intranasal corticosteroid medications significantly improve some asthma-specific outcome measures in patients suffering from both AR and asthma. This effect was most pronounced with INCS sprays when patients were not on orally inhaled corticosteroids, or when corticosteroid medications were inhaled through the nose into the lungs. Overall, intranasal corticosteroid medications improve some asthma-specific outcome measures in patients with both AR and asthma. Further research is needed to clarify the role of INCS sprays as asthma-specific therapy, as well as the role of the nasal inhalation technique as a monotherapy in patients suffering from both asthma and AR.
鉴于变应性鼻炎 (AR) 和哮喘之间的关系，可以假设通过鼻腔内皮质类固醇 (INCS) 药物减轻上呼吸道炎症可能改善哮喘结局。本研究的目的是对评估 AR 伴哮喘患者 INCS 药物对哮喘结局影响的随机对照研究进行系统评价和荟萃分析。评估了评估 AR 患者 INCS 药物的随机对照研究的哮喘特异性结局，包括比较 INCS 喷雾剂与安慰剂、INCS 喷雾剂加口服皮质类固醇与单独口服皮质类固醇、鼻内皮质类固醇与安慰剂的研究。检索到足够的荟萃分析数据，共纳入 18 项试验，共计 2162 例患者。哮喘结局包括肺功能、支气管反应性、哮喘症状评分、哮喘特异性生活质量和急救药物使用。与安慰剂比较 INCS 喷雾的亚组研究在 FEV1（SMD=0.31；95%CI，0.04-0.58）、支气管激发试验（SMD=0.46；95%CI，0.12-0.79）、哮喘症状评分（SMD=-0.42；95%CI，-0.53 至 -0.30）和急救药物使用（SMD=-0.29；95%CI，-0.58 至 -0.01）方面有显著改善。鼻内皮质类固醇可显著改善晨晚呼气峰流速。INCS 喷雾联合口服皮质类固醇治疗对哮喘结局无显著影响。因此，这项荟萃分析的结果表明，鼻腔内皮质类固醇药物可显著改善 AR 伴哮喘患者的某些哮喘特异性结局指标。当患者未使用口服皮质类固醇或皮质类固醇药物通过鼻腔吸入肺部时，INCS 喷雾剂的效果最为明显。总的来说，鼻腔内皮质类固醇药物可改善 AR 伴哮喘患者的某些哮喘特异性结局指标。需要进一步研究以阐明 INCS 喷雾作为哮喘特异性治疗的作用，以及鼻内吸入技术作为 AR 伴哮喘患者的单一疗法的作用。
