Effect of nasally exhaling budesonide/formoterol dry powder inhaled at "fast" inspiratory flow on eosinophilic chronic rhinosinusitis .

Abstract

Budesonide (BUD)/formoterol (FM) dry powder inhaler has a feature that the fine particle fraction output is dependent on users' inspiratory flow rate. The aim of this study was to assess the amount of nasally exhaled BUD/FM inhaled in the different inspiratory flow rate. We also examined the effect of nasal exhalation of BUD/FM dry powder inhaled on radiographic evidence of sinonasal inflammation in asthmatic patients with eosinophilic chronic rhinosinusitis (ECRS). The quantitative amount of nasally exhaled BUD/FM was analyzed by high-performance liquid chromatography in 3 healthy subjects. We retrospectively evaluated the effect of nasal exhalation of BUD/FM dry powder inhaled at >60L/min on radiographic evidence of sinonasal inflammation, which was assessed according to the Lund-Mackay staging (LMS) system, in 7 consecutive patients with asthma and ECRS. The amount of nasally exhaled BUD in the setting of inhaling BUD/FM dry powder inhaler at 60L/min (subject 1: 25.8ng/mL; subject 2: 37.3ng/mL; subject 3: 30.0ng/mL) was high compared to at 30L/min (subject1: 9.3ng/mL; subject 2: 4.1ng/mL; subject 3: 9.2ng/mL) in each healthy subject. Nasal exhalation of BUD/FM dry powder significantly reduced total (p=0.018) and ethmoid LMS scores (p=0.0077). Nasal exhalation technique of BUD/FM dry powder inhaled at "fast" inspiratory flow has a potential of simultaneously treating asthma and ECRS. .