EFFECT OF AN INTRANASALLY ADMINISTERED CORTICOSTEROID (BUDESONIDE) ON NASAL OBSTRUCTION, MOUTH BREATHING, AND ASTHMA

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Abstract
The effect of intranasally administered corticosteroid (budesonide) on nasal symptoms, mode of respiration (nasal vs. mouth breathing), and asthma was investigated in 37 asthmatic children who were mouth breathers because of chronic nasal obstruction. After a 2-wk run-in period, the children were allocated randomly to 4 wk of intranasal therapy with either budesonide (400 .mu.g/day) or placebo spray. A double-blind, parallel design was used. Diaries for peak expiratory flow, asthma, and rhinitis symptom scores and degree of mouth breathing were recorded at home. Nasal eosinophilia, nasal airway resistance at a flow of 0.2 l/s (NAR0.2), and lung function at rest and after exercise challenge were assessed at the clinic immediately before and at the end of the 4-wk treatment. Budesonide, when compared with placebo, significantly decreased nasal obstruction (P < 0.05), secretion (P < 0.01), and eosinophilia (P < 0.02) as well as NAR0.2 (P < 0.05) and mouth breathing (P < 0.01). The improvement in nasal obstruction correlated closely to the changes in mouth breathing (P < (r = 0.80, n = 17, P < 0.001). Furthermore, intranasally administered budesonide resulted in less exercise-induced asthma (EIA) (P < 0.02) and decreased cough and asthma severity significantly. Pulmonary mechanics were only marginally improved. Intranasally administered budesonide is evidently effective in the treatment of perennial allergic rhinitis. An attenuation of EIA and a tendency to less asthma after budesonide therapy suggest a decrease in bronchial reactivity, but the results gave no clear evidence of an association between nasal airway function and asthma.