Greiff L, Andersson M, Svensson C, Linden M, Wollmer P, Brattsand R, Persson C G
Dept of Otorhinolaryngology, Head & Neck Surgery, University Hospital, Lund, Sweden.
Eur Respir J. 1998 Jun;11(6):1268-73. doi: 10.1183/09031936.98.11061268.
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.
先前已经证明，局部鼻腔应用糖皮质激素对支气管气道有显著影响。而这些药物经局部支气管治疗对鼻腔疾病的影响则了解较少。本研究检测了吸入布地奈德（避免药物在鼻腔沉积）对鼻腔过敏性疾病的影响。因此，给予季节性变应性鼻炎但无哮喘的患者吸入布地奈德（600微克，每日两次）或安慰剂。该设计的目的是能够在未直接治疗的气道部位研究嗜酸性气道疾病。在研究季节记录到中到高浓度的桦树花粉水平，两个治疗组的鼻腔症状均显著增加，不过接受布地奈德治疗的患者症状较安慰剂组轻（p<0.05）。研究季节期间，鼻腔刷检嗜酸性粒细胞、鼻腔灌洗液中嗜酸性粒细胞阳离子蛋白水平以及血液嗜酸性粒细胞均增加（p<0.05），但吸入布地奈德可防止这些增加。安慰剂组鼻腔灌洗液中α2-巨球蛋白水平特别升高，但接受安慰剂和布地奈德治疗的患者之间无差异。布地奈德可防止对乙酰甲胆碱激发试验支气管收缩反应增加的季节性发展（p<0.05）。总之，布地奈德可减少循环系统和鼻腔内的季节性嗜酸性粒细胞增多，并减轻季节性鼻腔症状。因此，每日剂量600微克、每日两次的吸入布地奈德已知不会引起或只会引起极小的不良反应，可在整个气道包括未局部接触该药物的鼻黏膜产生具有临床意义的抗炎作用。我们认为，口服吸入布地奈德常用剂量水平可产生鼻腔和全身抗嗜酸性粒细胞作用。
