Mygind N, Dahl R, Nielsen L P, Hilberg O, Bjerke T
Department of Respiratory Diseases, University Hospital of Aarhus, Denmark.
Allergy. 1997;52(40 Suppl):39-44. doi: 10.1111/j.1398-9995.1997.tb04883.x.
This paper gives an overview of placebo-controlled studies of the effect of corticosteroid treatment on nasal blockage, based on objective measurements of nasal airway patency. A few studies of perennial rhinitis have indicated that pretreatment with an intranasal corticosteroid has a moderate effect on nasal hyperresponsiveness, measured as the histamine-induced increase of nasal blockage. Whereas the effect on allergen-induced early-phase symptoms is variable, the effect on the late-phase blockage is almost complete. In seasonal allergic rhinitis, a few studies have shown an effect of intranasal steroids on nasal airway resistance, nasal peak flow and on acoustic rhinometry, but there are no reports on the effect in adults with perennial rhinitis. In children with perennial disease, intranasal treatment results in increased nasal patency and, in one study, also in reduced mouth breathing and in an increased threshold for exercise-induced bronchoconstriction. In patients with nasal polyposis, intranasal steroids have an effect on nasal airway resistance and on nasal peak flow both before and after polypectomy. There is convincing evidence that intranasal corticosteroids provide a better effect than antihistamine on nasal blockage. Amazingly, there does not appear to be any report on the effect of systemic corticosteroid treatment on nasal airway patency, and it is therefore difficult to recommend this treatment in a rational dosage. In conclusion, there is a fairly good documentation in support of the efficacy of intranasal steroid treatment on nasal airway patency in rhinitis. An objective measurement of nasal airway patency ought to be the routine in controlled rhinitis trials.
本文基于鼻气道通畅性的客观测量，概述了皮质类固醇治疗对鼻塞影响的安慰剂对照研究。一些关于常年性鼻炎的研究表明，鼻内皮质类固醇预处理对鼻高反应性有中度影响，鼻高反应性以组胺诱导的鼻塞增加来衡量。虽然对变应原诱导的早期症状的影响不一，但对晚期鼻塞的影响几乎是完全的。在季节性变应性鼻炎中，一些研究表明鼻内类固醇对鼻气道阻力、鼻峰值流量和鼻声反射测量有影响，但尚无关于对常年性鼻炎成人影响的报道。在患有常年性疾病的儿童中，鼻内治疗可增加鼻通畅性，在一项研究中，还可减少口呼吸并提高运动诱发支气管收缩的阈值。在鼻息肉患者中，鼻内类固醇在息肉切除术前和术后对鼻气道阻力和鼻峰值流量均有影响。有令人信服的证据表明，鼻内皮质类固醇在缓解鼻塞方面比抗组胺药效果更好。令人惊讶的是，似乎没有关于全身皮质类固醇治疗对鼻气道通畅性影响的任何报道，因此很难推荐合理剂量的这种治疗方法。总之，有相当充分的文献支持鼻内类固醇治疗对鼻炎患者鼻气道通畅性的疗效。在对照性鼻炎试验中，鼻气道通畅性的客观测量应该成为常规。
