Fluticasone Furoate Nasal Spray Research Articles

A Real-World Observational Study to Evaluate the Safety and Effectiveness of Fluticasone Furoate-Oxymetazoline Fixed Dose Combination Nasal Spray in Patients with Allergic Rhinitis.

Allergic rhinitis (AR) has shown an increasing prevalence leading to a considerable medical and social burden. Nasal congestion is the cardinal symptom of AR, and the upper respiratory tract is most affected by this long-lasting ailment. Intranasal corticosteroids alleviate nasal congestion, along with other symptoms of AR, but their effect is not evident immediately. Oxymetazoline has a rapid onset of action, but its use should be limited to 3-5days. The study aimed to evaluate the safety and effectiveness of the fixed-dose combination nasal spray containing fluticasone furoate and oxymetazoline hydrochloride (FF+OXY) 27.5/50mcg once daily in patients with AR in a real-world clinical setting. The study was a prospective, open-label, single-arm, multicenter, real-world observational study conducted in patients with AR for a period of 28days. Patients (n=388) with a diagnosis of AR were treated with a combination of FF+OXY nasal spray. Total nasal symptom score (TNSS), total ocular symptom score (TOSS) and total symptom score (TSS) were documented at baseline and at the end of study period. The overall effectiveness of treatment with FF + OXY was rated by the investigators as very good/good/satisfactory/poor (4-point Likert scale) for each patient. Treatment with FF+OXY resulted in significant reduction in the TNSS, TOSS and TSS, from 7.18±3.38 at baseline to 0.20±0.84 (p<0.001), from 2.34±2.29 at baseline to 0.09±0.53 (p<0.001), from 9.51±4.94 at baseline to0.29±1.32 (p<0.001) at 28days respectively. With respect to effectiveness, the investigators reported very good effectiveness in 52.12% of patients. No serious adverse events were reported. The fixed-dose combination of once-daily fluticasone furoate and oxymetazoline hydrochloride nasal spray 27.5/50mcg was effective in relieving the nasal congestion and reduction of TNSS, TOSS and TSS in patients suffering from AR. The combination was safe and well tolerated with no rebound congestion throughout the treatment period.

Evaluation of Olfactory Thresholds in Patients of Allergic Rhinitis: Pre and Post Intranasal Steroid Therapy

characterized by one or more symptoms, including sneezing,itching, nasal congestion and rhinorrhoea along with usualsymptoms, and there is generally a decrease in the nasal airflowtherefore decrease in nasal air exchange, thereby decreasingthe rate of olfactory nerve ending stimulation hence decreasingthe perception of smell. We assessed the olfactory thresholdsin patients of allergic rhinitis using n-butanol solutions and theimpact of intranasal fluticasone furoate therapy on olfaction.Materials and methods: One hundred fifty patients withallergic rhinitis in the age group of 18 to 65 years were included.A total of 150 people from the general population as controls.In 6 weeks of fluticasone furoate nasal spray was administeredfor 6 weeks and olfactory threshold changes were observedat the end.Results: A significant change in n-butanol olfaction levels aftersteroid therapy was observed (p-value &lt; 0.05).Conclusion: Intranasal steroid therapy shows remarkablebenefit in the improvement of allergic rhinitis and therebyimproving olfaction.

PP06 Clinical Effectiveness Of Fluticasone Furoate Nasal Spray For Perennial Allergic Rhinitis In Children: A Systematic Review And Meta-Analysis

IntroductionAlthough previous studies suggest that fluticasone furoate nasal spray (FFNS) is superior to placebo in reducing symptoms in adolescents and adults with allergic rhinitis (AR), there is still uncertainty about its clinical effectiveness in the pediatric population. The aim of this study was to assess the clinical effectiveness of FFNS, compared with placebo, in reducing nasal symptoms in children with perennial AR.MethodsA systematic review was conducted of studies identified from the MEDLINE and Embase databases that were published up to January 2021. The population of interest was patients aged 2 to 12 years with perennial AR. Included studies were limited to randomized controlled trials (RCTs) comparing FFNS (110 μg once daily) with placebo. The outcomes of interest included the reflective Total Nasal Symptom Score (rTNSS) and safety. Meta-analyses were performed using RevMan 5.4. The Cohen’s guideline was used to assess the minimum clinically important difference for rTNSS; that is, if the pooled standardized mean difference (SMD) and the lower limit of the 95 percent confidence interval (CI) exceed -0.5, the treatment effect was considered clinically significant.ResultsThree RCTs (959 pediatric patients) were included. One study evaluated the short-term use of FFNS, one evaluated the long-term use of FFNS, and the third evaluated both the short- and long-term use of FFNS. FFNS produced a statistically significant reduction in rTNSS (SMD -0.35, 95% CI -0.63, -0.08; p&lt;0.001) relative to placebo in the long-term treatment studies, but not in the short-term studies. However, since the mean reduction did not reach the minimum clinically important difference (SMD -0.5), these results were not considered clinically relevant. The safety outcomes for FFNS were similar to placebo.ConclusionsThe currently available evidence suggests that FFNS does not produce a meaningful clinical effect on nasal symptoms in children with perennial AR, compared with placebo. In the past decade, however, some guidelines have unequivocally endorsed this treatment.

Effects of nasal anatomical characteristics and administration parameters on delivery of locally-acting drugs with suspension nasal sprays in adults

Large intersubject variability in local drug delivery to the target regions in the nose, the region posterior to the internal nasal valve (INV), was previously demonstrated in vitro by Manniello et al. (2021), using nasal airway models from a diverse group of adults (n = 20; 21–75 years old, 50% female and 50% ≥ 50 years old) across a number of suspension nasal drug products. Upon quantification of the range of posterior deposition (PD), three nasal models representing minimum, mean, and maximum PD were previously selected by Alfaifi et al. (2022) to represent a reasonable degree of intersubject variability for nasal suspension drug products. This study investigated whether any relationship exists between the anatomical characteristics of the nasal airways and PD. Anatomical characteristics of 20 healthy adult nasal airways were measured and their relationships with previously measured in vitro PD data with fluticasone propionate (FP) and fluticasone furoate (FF) nasal spray drug products, respectively, were evaluated. The stepwise regression method was used to automatically select the potential PD predictor variables. No individual anatomical or device-related airway dimensions showed a trend or strong correlation with drug PD. A strong correlation (r2 = 0.91) was found between the PD of the FP nasal spray and a combination of main effects and two-way interactions of ten variables, including some of the dimensions of the nasal airways and administration parameters. Similarly, a correlation was found between the PD of the FF nasal spray and six parameters, although the strength of the correlation (r2 = 0.61) was less compared with the correlation for FP (r2 = 0.91). The complexity of the identified correlations supports the continued development and use of characteristic in vitro nasal geometries and accurate CFD methods to predict regional nasal spray deposition across a wide range of subjects and spray products.

Efficacy and Safety of Fluticasone Furoate and Oxymetazoline Nasal Spray: A Novel First Fixed Dose Combination for the Management of Allergic Rhinitis with Nasal Congestion.

ObjectiveTo compare the efficacy and safety of a fixed dose combination of Fluticasone Furoate and Oxymetazoline Hydrochloride Nasal Spray 27.5/50 mcg (FDC) with Fluticasone Furoate Nasal Spray 27.5 mcg (Fluticasone) in the management of allergic rhinitis.Patients and MethodsA prospective, randomized, double-blind, two-arm, active-controlled, parallel, multicenter, comparative clinical study was conducted in patients with allergic rhinitis aged 18 years and above having moderate-to-severe nasal congestion.ResultsA total of 250 patients were randomized (1:1) to receive either the FDC or Fluticasone alone in a dose of two sprays in each nostril once daily at night. There was a significantly (P<0.001) greater reduction in night-time Total Nasal Symptom Score with the FDC as compared to Fluticasone at all the time points starting from as early as day 3 and sustained till the end of treatment (Day 28) (Day 3: −3.1 vs −2.2; Day 7: −4.0 vs −3.4; Day 14: −5.7 vs −5.0; Day 28: −7.0 vs −6.4). A significantly greater number of patients (P<0.05) had complete relief in Nasal Congestion with the FDC (44.7%) as compared to Fluticasone (26.8%). Both the study medications were well tolerated by all the patients. The proportion of patients showing worsening of symptoms (rebound congestion/rhinitis medicamentosa) after stoppage of medication was similar in both groups (P>0.05).ConclusionThe FDC was superior to Fluticasone alone in relieving the nasal congestion and reduction of Total Nasal Symptom Score in allergic rhinitis patients with moderate-to-severe nasal congestion when administered once daily in the evening. Oxymetazoline when used along with the nasal steroid in a once daily dose does not cause rebound congestion and rhinitis medicamentosa even after long-term continuous use of 28 days.

As-Needed Versus Regular Use of Fluticasone Furoate Nasal Spray in Patients With Moderate to Severe, Persistent, Perennial Allergic Rhinitis: A Randomized Trial

To compare the effectiveness of as-needed fluticasone furoate (FF) nasal spray (27.5 μg; 2 sprays once daily for 1 week, followed by as-needed use for 5 more weeks) with that of regular use of FF once daily for 6 weeks in patients with moderate to severe, persistent allergic rhinitis.Patients were at least 18 years of age living in Thailand with year-round allergic rhinitis characterized by symptoms occurring >4 days per week for at least 4 consecutive weeks that impaired daily activities, school or work, sleep, or quality of life. Patients were excluded if they had rhinosinusitis, nasal polyps, significant deviated nasal septum, asthma or chronic lung disease, recent upper respiratory tract infection, or previous allergen immunotherapy. Patients had a mean age of 30 years (SD: 8.4 years) and an average duration of symptoms of 15 years, and 95% were allergic to dust mites.Outcome assessors were single-blinded in evaluating outcomes of this 2-arm, parallel group randomized controlled trial conducted from October 2017 to June 2019 at a large tertiary care university hospital. The primary outcome evaluated was the total nasal symptom score (TNSS), measured by summing the score of 4 primary symptoms (congestion, rhinorrhea, sneezing, and itching) recorded on a 4-point severity scale from 0 (no symptoms) to 3 (severe symptoms). Secondary outcomes included nasal peak inspiratory flow and rhinoconjunctivitis quality of life-36 questionnaire (RCQ-36). The study was adequately powered (80%) to detect a 0.16 point TNSS treatment difference between groups.Disease burden, as measured by primary and secondary outcomes, improved in both groups. The intention-to-treat analysis evaluated all of 108 patients randomly assigned, revealing a nonsignificant trend in TNSS improvement for patients with regular FF use (difference: 1.21; 95% CI: −.08 to 2.49; P = .066). Although RCQ-36, nasal itching scores, and rhinorrhea scores were not significantly different between groups, the nasal peak inspiratory flow (difference: −19.2; P = .009), nasal congestion scores (difference: 0.42; P = .049), and sneezing scores (difference: 0.51; P = .13) favored regular use of FF. Notably, the cumulative dose of FF was far lower in the as-needed group than in that of daily groups (difference: 1920 μg; P < .001), and as-needed FF use was associated with a lower rate of acne (2.0% vs 7.7%).Patients using as-needed FF reported a 49% reduction in cumulative nasal steroid dose over the study period but experienced similar reductions in TNSS and RSQ-36 score.Previous studies of seasonal allergic rhinitis have revealed improved symptom control with regular, compared with as-needed, use of nasal corticosteroids (NCSs). However, adherence to regular use of NCSs challenges this treatment paradigm in the real-world, where less than one-third of patients regularly use NCS as prescribed. The perfect is not the enemy of the good, and, with this study, the researchers add to a body of literature that as-needed NCS use for allergic rhinitis can be a good option, particularly when considered through a lens of patient-preference–sensitive care and shared decision-making. Although this is not a pediatric study, the issue of adherence and cumulative dose of topical glucocorticoid is highly relevant to children. Considering improvements that are possible with as-needed NCS, this option can be a consideration for children who do not have adequate control with a nonsedating oral or nasal 1H-antihistamine. Still, for patients with inadequate control with an as-needed NCS strategy, regular NCS (with or without a nasal antihistamine) may be even more effective, and additional treatment options, such as specific allergen immunotherapy, remain considerations.

As-needed fluticasone furoate for allergic rhinitis appears beneficial

Use of fluticasone furoate nasal spray on an as-needed basis for patients with moderate-to-severe, persistent perennial allergic rhinitis yielded similar improvements in nasal symptoms compared with scheduled once daily use, according to findings of a recent randomized controlled trial. “These results may not apply to other nasal steroids,” said Leslie Hendeles, PharmD, professor emeritus from the College of Pharmacy at the University of Florida, Gainesville. Fluticasone furoate (i.e., OTC Flonase Sensimist Allergy Relief—Glaxo-SmithKline) has greater affinity for the glucocorticoid receptor and has a longer duration of effect than fluticasone propionate (e.g., Flonase Allergy Relief nasal spray and various generic store names). In asthma, for example, Hendeles said that fluticasone furoate is more effective than placebo with once daily administration, whereas fluticasone propionate is no more effective than placebo when given once a day. Fluticasone propionate requires daily dosing twice a day. Allergic rhinitis is a common condition affecting nearly 50% of children and 40% of adults worldwide. Current guidelines for the management of patients with allergic rhinitis recommend the daily use of intranasal corticosteroids. However, previous data have suggested that intermittent or as-needed use of an intranasal corticosteroid may be an effective option for those with seasonal allergic rhinitis. This idea of as-needed use of therapies follows the most recent asthma guideline update. In December 2020, the National Asthma Education and Prevention Program (NAEPP) Coordinating Committee released a focused update to its 2007 asthma guidelines. One of the biggest changes is that NAEPP now recommends that patients aged 12 years and older with mild persistent asthma use low-dose inhaled corticosteroids either once daily or as needed along with a short-acting beta-agonist. Authors of the new study, published in the Journal of Allergy and Clinical Immunology: In Practice, conducted a single-blinded, randomized controlled trial with 108 adults who had moderate-to-severe, persistent perennial allergic rhinitis. The goal was to evaluate the efficacy of as-needed use compared with daily use of fluticasone furoate nasal spray (27.5 mcg/spray). In the as-needed group, patients ad-ministered two sprays once daily for 1 week, followed by as-needed use for 5 additional weeks. In the daily group, patients used two sprays once daily for 6 weeks. Study participants were instructed to record their 24-hour reflective nasal symptoms, such as congestion, rhinorrhea, sneezing, and itching, on a daily diary card using a 4-point rating scale from 0 (no symptoms) to 3 (severe, and sufficiently troublesome to interfere with normal daily activity or sleep). The summation of the four individual nasal symptoms comprised the total nasal symptom score (TNSS). After 6 weeks, researchers found that the mean change in the TNSS from baseline was not significantly different between the two groups from the first week to the sixth week. When assessing individual symptom scores, although the daily group showed more improvement in nasal congestion and sneezing at week 6, there was no difference in nasal itching and rhinorrhea between the groups. Both groups showed similar improvements in quality-of-life scores and the as-needed group used about half as much steroid as the daily cumulative group. Adverse events were comparable in both groups. This new research supports the use of as-needed fluticasone furoate for the management of moderate-to-severe, persistent perennial allergic rhinitis as a reasonable alternative to daily corticosteroids. Since adherence is often an issue with regularly scheduled use of intranasal corticosteroids for allergic rhinitis, the concept of as-needed use may be appealing to both patients and providers as a safe and effective treatment option. Additional studies are needed to confirm the efficacy of other intranasal corticosteroids used on an as-needed basis for those with moderate-to-severe, persistent perennial allergic rhinitis.

Nasal Polyposis and Its Association with Cardiac Functions

Objective: The aim of the study was to ascertain the effect of nasal polyposis on cardiac functions. Material and Methods: A prospective randomized interventional open-label endpoint-controlled study was conducted in an academic tertiary care hospital. Thirty-one patients with chronic rhinosinusitis with nasal polyposis were enrolled and administered fluticasone furoate nasal spray for 3 weeks before randomly segregation into surgical or medical group. The treatment continued for 3 months in both groups. The SNOT-22 (Sino-Nasal Outcome Test-22) score, polyp grade, and right ventricular and pulmonary arterial functions were recorded in both groups before and after 3 months of the intervention. Results: Both groups had significant improvement in SNOT-22 scores after 3 months of intervention. Both groups showed improvement in cardiac functions, but statistical significance was found only in subjects who underwent surgery. Conclusion: Nasal polyp affects cardiac functions, and this needs further evaluation and research through studies on large samples.

The effect of fluticasone furoate nasal spray on the intraocular pressure in patients of allergic rhinitis: A cross sectional study from eastern India

Background: Rhinoconjunctivitis is a common health problem that plagues the lives of children and adolescents alike with a significant impairment of the quality of life. Purpose: Aim of this study was to investigate the effect of intranasal corticosteroid, fluticasone furoate, on the change of IOP in allergic rhinitis patients. Materials and Methods: This was a prospective observational study carried at the Ophthalmology outpatient department of a Government Medical College in West Bengal involving all consecutive patients attending ENT OPD for allergic rhinitis of age group 12 years and above and prescribed fluticasone furoate nasal spray. The IOP of patients were measured before and after start of steroid nasal spray and follow up was done at regular interval. One and half year and follow up was done on 1st, 2nd, 4th, 8th and 12th week respectively. Results: A total of 108 patients were selected for the study, out of which 100 remained till the end of all follow ups. The IOP for each eye was compared with baseline IOP values (RE: 16.02±2.29, LE: 16.04±2.20) and at the end of the study the P value for each follow up was calculated. The t test revealed that there was no significant change (increase/decrease) in IOP in any eye over the course of time. r values shows that there was a strong positive linear correlation of IOP between and within the eyes at different levels of assessment after the starting of the treatment. Even after age group adjustment, there was no statistical difference in IOP between the eyes among the various age groups. Conclusion: The study demonstrates no statistically significant increase in IOP after the administration of fluticasone furoate nasal spray. We believe, therefore, that fluticasone furoate administered for a short time for the treatment of nasal allergy, is safe in terms of its effect on IOP in the Indian population. Keywords: Allergic rhinoconjunctivitis, Fluticasone furoate, Intranasal steroids, Steroid induced glaucom

Effects of intranasal steroids on continuous positive airway pressure compliance among patients with obstructive sleep apnea.

Continuous positive airway pressure (CPAP) in the treatment of obstructive sleep apnea can produce troublesome nasal symptoms, especially congestion, which may affect the continuity of using CPAP. Intranasal steroids are often prescribed to reduce these side effects, although few recent studies exist supporting the benefits of this treatment for CPAP-induced nasal side effects. Eighty-three patients with OSA were enrolled in a prospective, randomized controlled study. All patients received CPAP treatment and were divided in two groups. The study group was prescribed fluticasone furoate nasal spray 55μg, and the compliance to CPAP for patients in both groups was recorded by device memory card. Total nasal symptom score was assessed using a questionnaire by direct interview, with follow-up performed at 30 and 90days after treatment. Compliance to CPAP increased in both groups with significantly greater compliance in the intranasal steroid group compared to the control group without intranasal steroid (P value = 0.002, 0.001, and 0.020, respectively) after 90days of treatment. No difference in nasal symptoms was found between the groups after 30days of treatment. However, adding an intranasal steroid resulted in decreased rhinorrhea and congestion symptoms (P value < 0.001 and < 0.001) after 90days of treatment. The addition of an intranasal steroid decreased the frequency of nasal symptoms, especially rhinorrhea and congestion, among patients with OSA initiating CPAP therapy and increased compliance to CPAP after 90days of treatment. IRB approval ID: R179h Clinical trial ID: TCTR20200715001.

As-Needed Versus Regular Use of Fluticasone Furoate Nasal Spray in Patients with Moderate to Severe, Persistent, Perennial Allergic Rhinitis: A Randomized Controlled Trial

Using intranasal corticosteroid (INCS) regularly is recommended for treating perennial allergic rhinitis. However, no studies have evaluated "as-needed" use. To compare the efficacy between as-needed and regular use of INCS in patients with moderate to severe perennial allergic rhinitis. In a 6-week randomized controlled trial, participants were assigned to either fluticasone furoate (FF) nasal spray, (27.5 μg) 2 sprays once daily for 1 week, followed by as-needed use (FF-as-needed) for 5 more weeks or 2 sprays once daily for 6 weeks (FF-regular). The primary outcome was a change in the total nasal symptom score (TNSS). The secondary outcomes were the change in nasal peak inspiratory flow, Rhinoconjunctivitis Quality of Life-36 Questionnaire score, and cumulative FF dose. In total of 108 patients, 53 and 55 patients were randomized to the FF-as-needed and FF-regular group, respectively. The difference in mean change in TNSS between the 2 groups was not significant at week 6 (1.21 points; 95% CI,-0.08 to 2.49; P= .066). The FF-regular group tended toward a greater improvement in TNSS. The FF-regular group had a higher mean change in nasal peak inspiratory flow than the FF-as-needed group at week 6 (-19.21 L/min; 95% CI,-33.54 to-4.89; P= .009). Both groups had similar improvement in Rhinoconjunctivitis Quality of Life-36 Questionnaire. The mean cumulative FF dose in the FF-as-needed group was 51% that of the FF-regular group. Both as-needed and regular use of INCS had similar improvement in TNSS and RCQ-36 score in patients with perennial allergic rhinitis. As-needed use had half of INCS exposure of the regular use.

Intranasal fluticasone furoate in pediatric allergic rhinitis: randomized controlled study

BackgroundIntranasal corticosteroids are the most efficacious anti-inflammatory medications for allergic rhinitis (AR). However, the efficacy and safety of intranasal corticosteroids in children have not yet been subject to specific research in China. The aim of this study was to investigate the efficacy and safety of fluticasone furoate nasal spray (FFNS) in a Chinese pediatric population.MethodsIn this phase 4 randomized, double-blind, placebo-controlled, multicenter study, pediatric AR patients aged 2–12 years were randomized 1:1:1, receiving either FFNS 55 µg or 110 µg or placebo. Electronic diary cards were completed to record symptoms, rescue medication use, and treatment compliance. Anterior rhinoscopy and overall response to therapy were evaluated and recorded.ResultsPatients treated with FFNS at either dose experienced a significantly greater reduction in daily reflective total nasal symptom score compared with placebo. This was maintained in a younger subset of patients (2–6 years). Drug-related adverse events occurred in <20% of patients in all groups. FFNS was well tolerated at both doses.ConclusionsThis study demonstrates favorable efficacy and safety profiles for FFNS 55 µg or 110 µg in Chinese pediatric populations (2–12 years), supporting its use in clinical treatment for AR children, including younger children aged 2–6 years.ImpactThe aim of this study was to investigate the efficacy and safety of intranasal fluticasone furoate in Chinese pediatric allergic rhinitis.This research not only addresses the deficiency in efficacy and safety data for intranasal corticosteroids in very young patients (aged 2–6 years) worldwide but also demonstrates that fluticasone furoate nasal spray shows a favorable benefit/risk profile at different dose levels.Our data will be of interest to the broad readership of Pediatric Research and will positively contribute to the dialog regarding the treatment of allergic rhinitis in children aged 2–6 years.

0625 The Effects of Topical Nasal Steroids on Continuous Positive Airway Pressure Compliance in Patients with Obstructive Sleep Apnea

Abstract Introduction Continuous positive airway pressure (CPAP) for treatment of moderate to severe obstructive sleep apnea can produce troublesome nasal symptoms (i.e. congestion, rhinorrhea, sneezing, itching) that may affect the continuity and decrease the compliance of CPAP. Topical nasal steroids are often prescribed to reduce these side effects, although recent studies are scarce supporting any benefit of this treatment for CPAP-induced nasal side effects. Methods 80 patients who were previously diagnosed with OSA and pretreatment nasal symptoms were enrolled. All of them were selected for CPAP treatment and divided randomly into two groups. The study group was prescribed Fluticasone furoate nasal spray 55 ug daily before bedtime. The patients’ compliance to CPAP was recorded by the memory card in CPAP device. Total nasal symptom score was assessed using a questionnaire by direct interview. The follow-up was performed in 30 and 90 days after treatment. Results The compliance to CPAP (Percent days with usage, Average time usage and Percent of days with usage ≥ 4 hours) increased in both groups with higher significance in topical nasal steroid group (P-value=0.002, 0.001, 0.002) after 90 days of treatment. There was no difference in nasal symptom between both groups after 30 days of treatment. However, addition of topical nasal steroid resulted in decreased rhinorrhea and congestion symptom (P-value &amp;lt;0.001, &amp;lt;0.001) after 90 days of treatment. Conclusion The addition of topical nasal steroid decreased the frequency of nasal symptoms (esp. rhinorrhea and congestion) in OSA patients initiating CPAP therapy and increased the compliance to CPAP after 90 days of treatment. Support Keywords: Obstructive sleep apnea, Continuous positive airway pressure, CPAP, Topical nasal steroid

Comparison Between Effectiveness of Topical Mometasone Furoate Nasal Spray Versus Topical Fluticasone Furoate Nasal Spray in the Treatment of Chronic Rhinosinusitis: A One Year Hospital Based Study.

To compare the effectiveness between topical mometasone furoate nasal spray versus topical fluticasone furoate nasal spray in the treatment of chronic rhinosinusitis. Randomized control trial was conducted involving 70 patients. One group received topical mometasone furoate nasal spray and the other group received fluticasone furoate nasal spray for 3weeks. All patients were prescribed oral ciprofloxacin for 3weeks and were subjectively evaluated using the Lund and Mackay staging system and objectively using nasal endoscopy by the Lund and Kennedy scoring system. There was no inter group significance but all patients improved significantly after the administration of either of the steroid sprays. Following administration of steroid nasal sprays, there was clinically significant improvement in the symptoms and signs of chronic rhinosinusitis, but there was no statistical significance between the two study groups. Thus, steroid nasal sprays significantly improve the symptoms and resolution of signs of chronic rhinosinusitis. The choice of drug still remains uncertain to the clinician. However, long term studies with more sample size is needed to arrive at sound conclusions.

Role of intranasal fluticasone furoate spray in modifying quality of life of children with adenoid hypertrophy

Introduction: Symptoms of adenoid hypertrophy is commonly seen among the pediatric age group. Since the surgical approach for this on immunity is controversial, the study was planned out to appraise the outcome of intranasal Fluticasone Furoate spray use.&#x0D; Objective:To find out the efficacy of Fluticasone Furoate nasal spray in reducing clinical symptoms due to enlarged adenoid.&#x0D; Methods: The prospective observational study was conducted in the Rangpur Medical College Hospital between April 2017 to August 2017 among 64 patients aged 4-15 years. Improvement on clinical symptoms was assessed by the structured OSA-18 questionnaire.&#x0D; Results: At the end of 4 weeks, statistically significant improvement (p &lt; 0.001) was observed in nearly all the domains of among the 64 participants. The average total score showed improvement from 60.95 to 46.37.&#x0D; Conclusion:The use of fluticasone furoate nasal spray considered to be useful in reducing clinical symptoms of adenoid hypertrophy among children.&#x0D; Bangladesh J Otorhinolaryngol; April 2018; 24(1): 22-28

RECURRENT COUGH SYNCOPE (CS) DUE TO TRACHEOBRONCHOMALACIA SUCCESSFULLY MANAGED WITH PREGABALIN

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: CS is an extremely infrequent but often disabling clinical presentation. Several disorders have been associated with its presentation. We describe a case of recurrent CS, most likely related to tracheobronchomalacia. The patient was subsequently started on Pregabalin, with complete resolution of these episodes. CASE PRESENTATION: A 68-year-old Caucasian male presented to the clinic with a one-year history of repeated episodes of syncope. Loss of consciousness would occur after fits of significant dry coughing. He denied having palpitations or chest discomfort prior to syncopal events. He had recently suffered a small right frontal intraparenchymal hemorrhage due to head trauma sustained during his last episode. The patient was a bus driver. He was a lifelong nonsmoker. Past medical history consisted of moderate obstructive sleep apnea on continuous positive airway pressure therapy, well-controlled gastroesophageal reflux disease, upper airway cough syndrome, dyslipidemia, hypertension, and hypothyroidism. His medications included pantoprazole, fluticasone furoate nasal spray, atorvastatin, bisoprolol, amlodipine, chlorthalidone, and levothyroxine. He came to the clinic wearing a helmet, out of fear of future post-syncopal head trauma. On examination, blood pressure was 134/77 mm of mercury, heart rate 68 beats per minute and oxygen saturation was 97% on room air. Body mass index was 37. Bilateral expiratory wheezing was present on respiratory auscultation. Cardiac examination was unremarkable. Bloodwork was noncontributory. Chest imaging was unrevealing, aside for a stable 9 mm right lower lobe pulmonary nodule seen on computed tomography. Spirometry was within normal limits, and methacholine challenge testing was negative. A recent echocardiogram was unremarkable aside for mild diastolic dysfunction. Holter monitoring and Persantine myoview stress test were both normal. Bronchoscopy revealed tracheobronchomalacia, with approximately 80% endobronchial narrowing on simple exhalation; cultures performed were negative. The patient was subsequently started on Pregabalin, with a gradual increase of the total daily dose to 300 mg. Dramatic improvement in regards to cough frequency and severity was rapidly seen. CS did not recur, and he was subsequently able to resume commercial driving. DISCUSSION: CS has been described with several different underlying pulmonary disorders including asthma, cystic fibrosis, pertussis, influenza, and tracheobronchomalacia. It seems to most commonly occur in middle-aged men, often overweight or obese. (1) Pregabalin appeared to be potentially helpful in patients with chronic refractory cough in a small trial. (2) CONCLUSIONS: Recurrent CS is an uncommon presentation, with possibly devastating consequences on patient quality of life. A trial of Pregabalin proved extremely beneficial in this case and should be contemplated in severe refractory chronic cough. Reference #1: Dicpinigaitis, Lim, & Farmakidis. (2014). Cough syncope. Respiratory Medicine, 108(2), 244-251. Reference #2: Vertigan, Kapela, Ryan, Birring, Mcelduff, & Gibson. (2016). Pregabalin and Speech Pathology Combination Therapy for Refractory Chronic Cough: A Randomized Controlled Trial: A Randomized Controlled Trial. Chest, 149(3), 639-648. DISCLOSURES: No relevant relationships by Roland Sabbagh, source=Web Response No relevant relationships by Mathieu Saint-Pierre, source=Web Response

Determining an Appropriate Time to Start Prophylactic Treatment with Intranasal Corticosteroids in Japanese Cedar Pollinosis.

Prophylactic treatment with intranasal corticosteroids is effective for pollen-induced seasonal allergic rhinitis. However, the appropriate time to start this treatment remains unclear. We performed a double-blinded, randomized, placebo-controlled trial. Starting on 1 February 2014, patients with Japanese cedar pollinosis received either fluticasone furoate nasal spray (FFNS) for 8 weeks (Group A: n = 24), placebo nasal spray for 2 weeks followed by FFNS for 6 weeks (Group B: n = 23), or placebo for 4 weeks followed by FFNS for 4 weeks (Group C: n = 23). The primary endpoint was comparison of the total naso-ocular symptom score (TSS). Secondary endpoints including the increment cost effective ratio (ICER) were also determined. Continuous pollen dispersion began on the 24th of February. Therefore, Group A and Group B received 3-weeks and 1-week of prophylactic treatment, respectively, whereas Group C received post-onset treatment. During the peak pollen-dispersal period, significant differences in TSS were seen between the groups, particularly between Group A and C. The ICER of Group B vs. Group C was lower than that of Group A vs. Group C. These results suggest that long-term prophylactic treatment with FFNS is clinically the most potent treatment, whereas short-term prophylactic treatment is cost effective for pollen-induced allergic rhinitis.

The correlation between allergic rhinitis with hyperactive lower airway disorders and effect of management of allergic rhinitis on lower airway

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Allergic rhinitis and brochial asthma are interrelated diseases because of the shared respiratory epithelium and the common allergens affecting both the areas. The treatment of both these conditions is often overlapping. Although no treatment modality is perfect in treating the disease, corticosteroids are the mainstay of the treatment for both the conditions. This study was conducted to quantify strength of association between allergic rhinitis and hyperactive lower airway disorders and to study the effect of topical intranasal steroid Fluticasone on Bronchial hyperactivity in patients with allergic rhinitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Patient with moderate to severe allergic rhinitis presenting to ENT OPD with symptoms of lower airway hyperactivity were subjected to pulmonary function tests. After all routine investigations, the patients were started on fixed dose of intranasal fluticasone furoate nasal spray for a period of 2 months and the pretreatment and post treatment FEV&lt;sub&gt;1&lt;/sub&gt; and PEFR were compared and statistically analysed for the effect. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Approximately 50% of patients with allergic rhinitis showed associated lower airway hyperreactivity. There was statistically significant improvement in pulmonary function test readings after 2 months therapy with intranasal fluticasone spray.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study showed that the treatment of inflammation in the upper airways indirectly improves the symptoms of hyperactive lower airway disorders and decreased bronchial hyperactivity.&lt;/p&gt;

Efficacy of snakehead fish (Channa striatus) in subjects with allergic rhinitis: a randomized controlled trial

Allergic rhinitis is a prevailing chronic inflammatory respiratory disorder that affects 10–30% of the population globally. Channa striatus (Channa) is a snakehead, freshwater fish that has been used traditionally to enhance wound healing and relief post-operative pain. This study evaluates the efficacy of oral Channa extract on allergic rhinitis subjects on total nasal symptom score and serum immunoglobulin E (Ig E). A randomized, double-blind, placebo-controlled trial was conducted by comparing the oral Channa extract 500 mg/day and placebo among allergic rhinitis subjects for a 6-week intervention period. Subjects aged 18–50 years old, diagnosed with allergic rhinitis based on total symptoms score, naso-endoscopy findings, and positive skin prick test were included in this trial. All subjects were treated with antihistamine (levocetrizine) and local corticosteroid nasal spray (fluticasone furoate nasal spray). Laboratory-based blood tests were used as safety measures. A total of 70 subjects were randomized. Channa group showed significant improvement in nasal blockage (p < 0.05), nasal itchiness (p < 0.05), eye itchiness (p < 0.05) and general symptoms (p < 0.05) compared to the placebo groups. Serum Ig E were significantly lowered in Channa group compared to placebo (p < 0.001). No significant differences were found between the groups in terms of nasal discharge, sneezing, palate itchiness, and smell score. No serious adverse events were reported. In conclusion, Channa has a beneficial role in improving nasal symptoms and reduction in serum Ig E in allergic rhinitis subjects.

PRS3 - Efficacy and Safety of Fluticasone Furoate Nasal Spray for Perennial Allergic Rhinitis in Adults and Adolescents: A Systematic Review

PRS3 - Efficacy and Safety of Fluticasone Furoate Nasal Spray for Perennial Allergic Rhinitis in Adults and Adolescents: A Systematic Review