| Background:Previously, masses of research had reported that inhaled corticosteroid combined with intranasal corticosteroids can effectively improve bronchial hyperresponsiveness, reduced the rate of emergency and hospitalization with regard to patients with allergic rhinitis and asthma. Nevertheless,it is few research that whether or not the intranasal corticosteroids alone had a protective effect on the lower airway in patients with perennial allergic rhinitis, and what about this protective effect.Objective:In our research, we attempted to assess the effect of intranasal corticosteroids on the lower airway by means of non-invasively detective method of airway inflammation, looking forward to providing scientific evidence of the clinical monitoring and early intervention about asthma for allergic rhinitis patients.Methods:This research adopted randomized, double-blind, placebo control study, sixty patients enrolled were recruited in Department of Otolaryngology-Head and Neck Surgery of our hospital from september 2012 to may 2013, the diagnostic criteria referred to ((Allergic Rhinitis and its impact on asthma)) guide. All patients enrolled this research were categorized into two groups, the treatment group and the control group, removed the patients lost to follow-up, residual fifty-first patients. The treatment group received budesonide nasal spray combined with saline nasal irrigation, budesonide nasal spray:twice a day,256 u g per day;saline nasal irrigation:twice a day,300 ml per day. The control group received placebo nasal spray combined with saline nasal irrigation, placebo nasal spray:twice a day,256 μg per day;saline nasal irrigation:twice a day,300 ml per day. The primary end point was the methacholine induced fall in FEV1、the concentration of exhaled nitric oxide and the percentage of eosinophil in the induced sputum after treatment, the secondary end point was the change in visual analogue scale、rhinoconjunctivitis quality of life questionnaire and the eosinophil count in the nasal fluid after treatment, observe period lasted for twelve weeks. By comparing the laboratory indexes and symptom scores before and after treatment of the two groups, we will assess the effect of intranasal corticosteroids on the lower airway in patients with perennial allergic rhinitis. The hospital ethics committee approved this research(The certificate no.2012NKY-012), the patients consented to this research.Results1. The two groups both had no significant statistical difference with each other in age、the constituent ratio of gender, height、weight、IgE、the proportion of eosinophil in nasal secretion、the proportion of eosinophil in peripheral blood、the lung function、 the count of eosinophil in nasal fluid、the grade of VAS and RQLQ、the positive rate of bronchial provocation test、FeNO、the proportion of eosinophil in induced sputum (p>0.05);2. The two groups both had no significant statistical difference bewteen inter-group in FeNO before and after treatment (p>0.05);3. Between the inter-group, the proportion of eosinophil in induced sputum of the two groups had no significant statistical difference with each other in baseline(p> 0.05), but the proportion of eosinophil in induced sputum of the two groups had significant statistical difference with each other after treatment (p<0.05); Between the intra-group, the proportion of eosinophil in induced sputum of the treatment group after treatment both had significant statistical difference with that in baseline(p<0.05), the proportion of eosinophil in induced sputum of the control group after treatment both had no significant statistical difference with that in baseline(p>0.05); The other cells in induced sputum of the two groups both had no significant statistical difference bewteen the intra-group and inter-group before and after treatment (p>0.05);4. Between the inter-group, the two groups had no significant statistical difference with each other before and after treatment of 4weeks, but the two groups had significant statistical difference with each other after treatment of 12 weeks (p< 0.05);Between the intra-group, the count of eosinophil in nasal fluid of the treatment group after treatment both had significant statistical difference with that in baseline(p<0.05), the count of eosinophil in nasal fluid of the control group after treatment both had significant statistical difference with that in baseline(p<0.05);5. Between the inter-group, the two groups had no significant statistical difference with each other in baseline (p>0.05), but the two groups had significant statistical difference with each other after treatment (p<0.05);Between the intra-group, the scores of VAS of the treatment group after treatment both had significant statistical difference with that in baseline(p<0.05), the scores of VAS of the control group after treatment both had significant statistical difference with that in baseline(p<0.05);6. Between the inter-group, the two groups had no significant statistical difference with each other in baseline and after treatment of 12 weeks(p>0.05), but the two groups had significant statistical difference with each other after treatment of 4 weeks and 8 weeks(p<0.05);Between the intra-group, the scores of RQLQ of the treatment group after treatment both had significant statistical difference with that in baseline(p<0.05), the scores of VAS of the control group after treatment of 8 weeks and 12 weeks both had significant statistical difference with that in baseline(p<0.05);7. The two groups both had no significant statistical difference bewteen the intra-group and inter-group in the positive rate of bronchial provocation test before and after treatment (p>0.05);8. Before and after treatment,there was no significant statistical correlation between the eosinophil count of nasal fluid and the eosinophil of induced sputum with two groups (p>0.05);Conclusion1. The treatment of intranasal corticosteroids of 12 weeks 256 μg/d could effectively reduce the inflammation of the upper airway, meanwhile could improve the symptom and its impact on the quality of life.2. The treatment of intranasal corticosteroids of 12 weeks 256μg/d could not effectively reduce bronchial hyperresponsiveness and FeNO of perennial allergic rhinitis;3. The treatment of intranasal corticosteroids of 4 weeks 256μg/d could effectively reduce the proportion of eosinophil in induced sputum of perennial allergic rhinitis, and effectively control the EOS inflammation of the lower airway, which had a protective effect on the lower airway;4. Our research could not confirm what is the protective effect mechanism of INCS on the lower airway, and this mechanis still need the further research;... |
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