PURPOSE OF THE STUDY.
To perform an updated systematic review with meta-analysis to assess the impact of intranasal corticosteroid (INCS) medications on asthma outcomes in patients with allergic rhinitis and asthma.
A systematic review and meta-analysis were performed on articles published before May 2012. Randomized controlled trials evaluating the efficacy of intranasal corticosteroids in children and adults were identified from PubMed, Cochrane, and Medline databases and were assessed for systematic bias. Studies were included if they assessed at least 1 asthma-specific clinical outcome and had 1 of the following interventions: (1) INCS spray versus placebo, (2) INCS spray plus orally inhaled corticosteroids versus orally inhaled steroids alone, and (3) nasally inhaled corticosteroids (deliver medication to both nasal and lower airway tracts) versus placebo.
Twenty-three clinical trials were identified, and 18 studies were included in the analysis (9 of them were pediatric or included children), for a total of 2162 individuals. When looking at the studies comparing INCS spray to placebo without concurrent treatment with inhaled corticosteroids, INCS spray significantly improved forced expiratory volume in 1 second, bronchial reactivity, asthma symptom scores, and rescue mediation use. However, there were no significant changes in asthma outcomes with the addition of INCS spray to inhaled corticosteroids.
The results of this systematic review and meta-analysis show that the use of INCS sprays improves some asthma-related outcomes in individuals with allergic rhinitis and asthma. This appears to be most efficacious when patients are not already on daily inhaled corticosteroids.
The 2010 Allergic Rhinitis and its Impact on Asthma guidelines recommended using INCS sprays for the management of allergic rhinitis, but did not find sufficient evidence to support their use for asthma. This study looked specifically at the impact of INCS on asthma symptoms and included data from several new studies that had been published since 2010. INCS sprays were found to improve some asthma outcomes, but this was most apparent in individuals who were not already on inhaled corticosteroids. Inhaled corticosteroids remain the mainstay of treatment of asthma.
- Copyright © 2013 by the American Academy of Pediatrics