Влияние интраназального флутиказона пропионата на респираторную обструкцию при пыльцевой аллергии

Abstract

Background. Allergic rhinitis (AR) remains the most common manifestation of pollen allergy, with nasal congestion as the leading symptom. About half of patients with AR have comorbidity with bronchial asthma (BA). Intranasal corticosteroids (INC) have a positive effect on the manifestations of rhinitis and concomitant comorbid pathology. The choice of adequate treatment, rejection of ineffective combinations, polypharmacy remains a widely demanded area of research in real clinical practice. Aim. To evaluate the effect of monotherapy of INC with fluticasone propionate (FP) on nasal and bronchial obstruction in pollen comorbid AR and BA and the possibility of obtaining therapeutic benefits from additional administration of systemic antihistamines (AH). Materials and methods. A prospective 5-week, double-blind, placebo-controlled study of monotherapy with INC FP and combined therapy of FP with the non-sedative AH loratadine in patients with concomitant AR and BA was carried out. The study included 72 patients with the first diagnosis of AR, with existing BA and sensitization to plant pollen. Two comparable patient groups were formed with different therapeutic approaches. Examination, allergy testing, ECHRS questionnaire, symptom severity scale were used to assess symptoms. Active anterior rhinomanometry and spirometry were used to assess the level of obstruction of the upper and lower airways. Results. A high level of polysensitization was found in the examined persons with comorbid pathology. Significant reduction in nasal congestion was found both in the group receiving FP and in the group with combination therapy. However, the use of antihistamines in addition to FP did not significantly affect on congestion symptom. After treatment, there was a decrease in nasal resistance in both groups. The total nasal volumetric flow significantly increased in both groups. The change in the parameters of external respiration is shown. Significant changes in peak expiratory flow rate and forced expiratory volume in the first second after the completion of treatment were found in both groups. Conclusion. A high incidence of polysensitization has been shown in patients with AR and BA. The efficacy and safety of FP has been proven by subjective assessment and objective instrumental methods for studying upper and lower airway obstruction. The addition of AH did not significantly change the effectiveness of therapy.