Abstract
Because of their efficacy, intranasal corticosteroids (INCS) remain the cornerstone in the treatment of upper airway diseases. Although INCS are extremely efficacious, local and systemic adverse effects have been associated with their use. However, none of these effects is of sufficient frequency or magnitude to warrant a reduction in their use or any action more than careful drug and dose selection and monitoring when indicated. Recent publications focus on newer aspects of efficacy in rhinitis and on the adverse effects of growth suppression, cataract formation, and histologic effects on the nasal mucosa. Optimizing mucosal delivery of INCS is a major goal because of the need to maximize efficacy and minimize systemic bioavailability and potential risks. One recent study examined the bioavailability and metabolism of beclomethasone dipropionate. Another study examined the tendency of patients to overdose when using betamethasone drops. A third study compared the two different delivery systems of fluticasone propionate and budesonide, and their efficacy in treating perennial rhinitis. Other studies examined the effect of INCS on the treatment of nasal polyps (budesonide) and on the common cold (beclomethasone dipropionate). These studies have continued to define safety and efficacy aspects, and the important role of INCS in treating rhinitis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References and Recommended Reading
Dykewicz MS, Fineman S, Skoner DP, et al.: Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on practice parameters in allergy, asthma, and immunology. Ann Allergy Asthma Immunol 1998, 81:478–518.
Klossek JM, Laliberte F, Laliberte MF, et al.: Local safety of intranasal triamcinolone acetonide: clinical and histological aspects of nasal mucosa in the long-term treatment of perennial allergic rhinitis. Rhinology 2000, 39(1):17–22. This study demonstrates local safety with the 6 months’ use of an INCS. No significant differences were observed in the thickness or appearance of the nasal mucosa or mucociliary function when comparing subjects taking an INCS to subjects taking an antihistamine.
Derby L, Maier WC: Risk of cataract among users of intranasal corticosteroids. J Allergy Clin Immunology 2000, 105:912–916. From this large cohort under examination, there was no increased risk of cataract with only INCS use. The risk of cataract increased with only oral corticosteroid use. This study represents an important addition to an already reassuring database on the low risk of cataract with ICS treatment in asthma.
The Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med 2000, 343:1054–1063.
Schenkel EJ, Skoner DP, Bronsky EA, et al.: Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray. Pediatrics 2000, 105:E22. This is one of the first studies to look at a specific newer generation INCS and to assess its effect on growth after 1 year of use. No growth effects were observed.
Skoner DP, Rachelefsky GS, Meltzer EO, et al.: Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate. Pediatrics 2000, 105:E23. This study is one of the first studies to look at a specific older generation INCS and to assess its effect on growth. This study is the first to show a growth effect of an INCS after 1 year of use.
Agertoft L, Pedersen S: Effect of long-term treatment with inhaled budesonide on adult height in children with asthma. N Engl J Med 2000, 343:1064–1069. This study examined the long-term use of an orally inhaled CS for the treatment of asthma with 40 of the subjects using an INCS concomitantly. Although only limited data are available regarding the use of INCS in this study, no effect on adult height was observed in the 40 subjects using the INCS. This study supports long-term safety with INCS and ICS.
Daley-Yates PT, Price AC, Sisson JR, et al.: Beclomethasone dipropionate: absolute bioavailability, pharmacokinetics and metabolism following intravenous, oral, intranasal and inhaled administration in man. Br J Clin Pharmacol 2001, 51:400–409.
Patel RS, McGarry GW: Most patients overdose on topical nasal corticosteroid drops: an accurate delivery device is required. J Laryngol Otol 2001, 115:633–635.
Jankowski R, Schrewelius C, Bonfils P, et al.: Efficacy and tolerability of budesonide aqueous nasal spray treatment in patients with nasal polyps. Arch Otolaryngol Head Neck Surg 2001, 127:447–452. This study demonstrated that higher dosing with a specific INCS does not provide any significant additional efficacy in the treatment of nasal polyps versus the lowest effective dose. This study illustrates recommendations to use the lowest dose to maintain control in balancing safety and efficacy.
Kivisaari E, Baker RC, Price MJ: Comparison of once daily fluticasone propionate aqueous nasal spray with once daily budesonide reservoir powder device in patients with perennial rhinitis. Clinic Exp Allergy 31:855-863.
Qvarnberg Y, Valtonen H, Laurikainen K: Intranasal beclomethasone dipropionate in the treatment of common cold. Rhinology 2001, 39:9–12.
Skoner D: Balancing safety and efficacy in pediatric asthma management. Pediatrics 2002, 109:381–392.
Heuck C, Wolthers O, Kollerup G, et al.: Adverse effects of inhaled budesonide (800 micrograms) on growth and collagen turnover in children with asthma: a double-blind comparison of once-daily versus twice-daily administration. J Pediatr 1998, 133:608–612.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Krahnke, J., Skoner, D. Benefit and risk management for steroid treatment in upper airway diseases. Curr Allergy Asthma Rep 2, 507–512 (2002). https://doi.org/10.1007/s11882-002-0092-0
Issue Date:
DOI: https://doi.org/10.1007/s11882-002-0092-0