Intranasal Corticosteroids Improve Asthma Symptoms in CRS

What is the prevalence of chronic rhinosinusitis (CRS) in the presence of asthma, and what is the impact of its treatment?

Background: CRS is seen in association with asthma in up to 80% of patients, while 88% of mild to moderate asthmatics have been shown to have abnormal sinus CT imaging. While addition of intranasal corticosteroids in patients with allergic rhinitis and asthma has previously been shown to improve asthmatic symptoms, the impact of this treatment in patients with CRS and asthma is less understood.

Study design: Multicenter, observational, cross-sectional survey.

Setting: Academic Health Center at University of Occupational and Environmental Health, Fukuoka, Japan.

Synopsis: A total of 160 Japanese asthmatic patients were enrolled. Nasal symptoms were identified in 82% of these patients, and CRS was identified in 67%; 20% of these patients had polyps. No difference in Lund-Mackay scores (LMS) were seen between patients who had CRS with polyps versus those who had CRS without polyps. Intranasal corticosteroids (ICS) consisting of mometasone furoate were administered to patients with CRS who had an asthma control test (ACT) score of less than 25 and an asthma control questionnaire (ACQ5) score of greater than 0. ACT scores improved significantly, from 20.3 +/- 4.1 to 22.9 +/- 2.5 (p<0.001), after the addition of ICS, and the ACQ5 scores also significantly improved, from 1.86 +/- 1.2 to 1.02 +/- 0.8 (p<0.01). Pulmonary function tests also showed a significant improvement in FEV1 (forced expiratory volume in one second). A trend toward improved total LMS scores was also noted after the addition of ICS, though these changes were not statistically significant.

Bottom line: For patients with asthma and CRS, the addition of intranasal corticosteroids improved asthma symptoms and control as well as FEV1.

Reference: Yatera K, Yamasaki K, Noguchi S, et al. Prevalence of sinusitis and efficacy of intranasal corticosteroid treatment on asthmatic symptoms in asthmatic patients with rhinosinusitis: a pilot study. Int Forum Allergy Rhinol. 2016;6:398-406.