Medical treatment of adenoid hypertrophy with "fluticasone propionate nasal drops"

International Journal of Pediatric Otorhinolaryngology (Apr 2010)

Demirhan H, Aksoy F, Ozturan O, Yildirim YS, Veyseller B

BACKGROUND: Adenoid hypertrophy treatment for children is generally planned in accordance with the degree of airway obstruction and related morbidity. If surgical treatment is indicated, the individual risk/benefit analysis of patients should be assessed in terms of anesthetic and postoperative complications. Although there are few alternative treatment options, these may be considered as a nonsurgical approach in less serious cases. Accordingly, studies about intranasal steroid applications under various protocols have been presented.

STUDY DESIGN: The prospective, randomized, placebo-controlled study.

SETTING: Tertiary referral center.

PATIENTS AND METHODS: Patients indicated for surgery were randomly divided into two groups. The study group was treated by fluticasone propionate nasal drops (NSD-nasal steroid drops) of 400mug/day for 8 weeks. The control group was treated by normal saline (NS) in the same way. All the patients were called for follow-up every 4 weeks.

RESULTS: At the end of 8 weeks, statistically significant improvement (p<0.05) was observed in the NSD treated group compared to the NS treated group in terms of nasal airway obstruction, mouth breathing, speech abnormalities, apnea and night cough. At the end of 8 weeks, the average total symptoms score of the NSD treated group dropped from 13.7 to 2.9 while the NS treated group's score changed from 14.8 to 14.6. After 8 weeks of NSD treatment the initial adenoid/choana (A/C) rate had dropped from 87 to 56% and a total decrease of 35.6% was observed. After 8 weeks of NS treatment the A/C rate dropped from 87 to 85% and a total decrease of 2.2% was observed.

CONCLUSIONS: In this study, the effect of fluticasone propionate nasal drops on adenoid hypertrophy is examined for the first time. This method provides an effective alternative to surgical treatment in children with adenoid hypertrophy. With the protocol applied in this study 76% of the patients were eliminated the surgery and removed from the surgical waiting list.

Fluticasone Reverses Oxymetazoline Induced Tachyphylaxis of Response and Rebound Congestion

American Journal of Respiratory and Critical Care Medicine (Mar 2010)
Clearie K, Khan F, Lipworth B, Vaidyanathan S, Williamson P

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RATIONALE: Chronic use of intranasal decongestants like oxymetazoline leads to tachyphylaxis of response and rebound congestion, due to alpha-adrenoceptor mediated down-regulation and desensitization of response OBJECTIVES: We evaluated if tachyphylaxis can be reversed by intranasal fluticasone propionate, as well as the relative alpha1-/alpha2-adrenoceptor components of tachyphylaxis using the alpha1-antagonist prazosin. METHODS: In a randomized, double-blind, placebo-controlled, crossover design, 19 healthy subjects received intranasal oxymetazoline 200Amicrog tid for 14 days, followed by addition of fluticasone 200Amicrog bid for a further 3 days. At day 1, 14 and 17, participants received a single dose of oral prazosin 1mg or placebo with measurements made before and 2 hours later.
MEASUREMENTS AND MAIN RESULTS: Outcomes evaluated were peak nasal inspiratory flow, nasal resistance, blood flow and oxymetazoline dose-response curve (DRC). On day 14 vs. day 1, inspiratory flow decreased (mean difference, 95% CI) (â 47.9 L.min(-1);, â63.9 to â31.9, P<.001), the DRC shifted downward (24.8 L.min-1, 20.3 to 29.3, P<.001). On day 17 vs. day 14, after fluticasone, inspiratory flow increased (45.0 L.min(-1), 30.0 to 61.0, P<.001), the DRC shifted upward (26.2 L.min(-1), 21.7 to 30.7, P<.001). On day 1, prazosin reduced inspiratory flow (â52.6 L.min(-1), â19.2 to â86.0) compared to baseline. This effect was abolished on day 14 (7.9 L.min-1, â41.3 to 25.5).
CONCLUSIONS: Oxymetazoline induced tachyphylaxis and rebound congestion is reversed by intranasal fluticasone. Further studies are indicated to evaluate if combination nasal sprays of decongestant and corticosteroid are an effective strategy to obviate tachyphylaxis and rebound in rhinitis. Clinical trials registration information available at www.clinicaltrials.gov, i.d. #NCT00487032.

Overexpression of glucocorticoid receptor-beta in severe allergic rhinitis

Auris Nasus Larynx (Feb 2010)
Ishida A, Ohta N, Koike S, Aoyagi M, Yamakawa M;

OBJECTIVE: To clarify the role of glucocorticoid receptor-beta in resistance to glucocorticoid therapy for allergic rhinitis, we studied 37 tissue samples from 20 patients with severe allergic rhinitis, and samples from age-matched controls.
METHODS: Patients were treated with intranasal fluticasone for 6 months and inferior turbinectomy was performed for patients with poor response to glucocorticoid treatment. The expression of glucocorticoid receptor-alpha (GR-alpha), glucocorticoid receptor-beta (GR-beta), and nuclear factor-kappaB (NF-kappaB) in nasal mucosa was studied immunohistochemically.
RESULTS: GR-alpha and NF-kappaB were expressed to a similar extent in patients and controls, but GR-beta was expressed significantly more in patients, resulting in an increased GR-beta/GR-alpha ratio.
CONCLUSION: Our findings suggest that GR-beta plays an important role in resistance to glucocorticoid therapy for allergic rhinitis, and its expression might be used as an additional parameter indicating steroid resistance in allergic rhinitis