Improvement In Nasal Congestion Research Articles

The ratio of total IgE level at week 16 to baseline significantly correlated with the clinical response to omalizumab in moderate to severe allergic rhinitis patients

ObjectiveTo analyze whether the ratio of total IgE level at week 16 to baseline could be used as an indicator to evaluate clinical efficacy of patients treated with omalizumab. MethodsWe retrospectively analyzed the clinical characteristics of 62 patients with moderate-to-severe allergic rhinitis treated with omalizumab, and compared the pre-and post-treatment nasal visual analog scale (n-VAS) scores, the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Rhinitis Control Assessment Test (RCAT), improvement in nasal congestion, number of acute episodes of rhinitis, and total IgE levels in serum. The relationship between the efficacy of treatment with omalizumab and the change in total IgE levels before and after treatment was further analyzed. ResultsThis study included 62 patients with moderate-to-severe allergic rhinitis, of which 48 demonstrated significant improvement after 16 weeks of omalizumab therapy; the results of 16 weeks’ omalizumab treatment in 14 patients did not show significant improvements in allergic rhinitis symptoms based on RACT scores. After 16 weeks of omalizumab treatment, the RQLQ score decreased from (36.6 ± 13.7) at baseline level to (9.1 ± 12.6) after 16 weeks treatment.The ratio of total IgE at week 16 to total IgE levels at baseline was (2.9 ± 1.4) KU/L in 62 patients. And the ratio of total IgE levels at week 16 to total IgE levels at baseline was (3.3 ± 1.4) KU/L for responders and (1.6 ± 0.5) KU/L for non-responders. ConclusionThe ratio of total IgE level at week 16 to baseline significantly correlated with the clinical response to omalizumab in moderate to severe allergic rhinitis patients, when the ratio of total IgE level at week 16 to baseline was ≥2.0. Omalizumab effectively treated patients with moderate-to-severe allergic rhinitis, and improved their quality of life.

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.

Association of Allergic Rhinitis With Change in Nasal Congestion in New Continuous Positive Airway Pressure Users

Nasal congestion occurring after continuous positive airway pressure (CPAP) treatment initiation impairs CPAP adherence. Allergic rhinitis is associated with worsening nasal congestion in patients who are exposed to nonallergic triggers. Use of CPAP presents potential nonallergic triggers (eg, humidity, temperature, pressure, and airflow). To compare nasal congestion among CPAP users with allergic rhinitis, nonallergic rhinitis, and no rhinitis. We hypothesize that CPAP patients with baseline allergic rhinitis are more likely to experience a worsening of nasal congestion (or less improvement in nasal congestion) compared with patients with no baseline rhinitis. This prospective cohort study included consecutive patients newly diagnosed with obstructive sleep apnea in a tertiary sleep center who were using CPAP therapy 3 months after diagnosis. Baseline rhinitis status was assigned as allergic rhinitis, nonallergic rhinitis, or no rhinitis, based on questionnaire responses and past allergy testing. Data were collected from 2004 to 2008 and analyzed from July 2019 to February 2020. At baseline before CPAP exposure and again 3 months later, subjective nasal congestion was measured with the Nasal Obstruction Symptom Evaluation (NOSE) scale and a visual analog scale (VAS), each scored from 0 to 100 (100 = worst congestion). Changes in nasal congestion were tested over 3 months for the whole cohort, within each rhinitis subgroup (paired t test), and between rhinitis subgroups (multivariate linear regression). The study cohort comprised 102 participants, of whom 61 (60%) were male and the mean (SD) age was 50 (13). The study included 23 (22.5%) participants with allergic rhinitis, 67 (65.7%) with nonallergic rhinitis, and 12 (11.8%) with no rhinitis. Nasal congestion improved from baseline to 3 months in the whole cohort (mean [SD] NOSE score, 38 [26] to 27 [23], mean [SD] change, -10 [23]; 95% CI, -15 to -6; mean [SD] VAS score, 41 [27] to 32 [28]; mean [SD] change, -10 [26]; 95% CI, [-15 to -4]) and in each rhinitis subgroup. Adjusted improvement in nasal congestion at 3 months was significantly less in the allergic rhinitis subgroup compared with the no rhinitis subgroup (positive difference means less improvement) compared with baseline: NOSE score 14 (95% CI, 1 to 28) and VAS score 15 (95% CI, 0 to 30). Initiation of CPAP was associated with improved subjective nasal congestion, but less improvement in patients with baseline allergic rhinitis. Baseline allergic rhinitis may predict which patients are more vulnerable to potential congestive effects of CPAP.

Nasal decongestants in monotherapy for the common cold.

Nasal decongestants in monotherapy for the common cold.

Effectiveness of the leukotriene receptor antagonist pranlukast hydrate for the treatment of sleep disorder in patients with perennial allergic rhinitis

Conclusion: We found that addition of pranlukast to the conventional treatment for perennial allergic rhinitis may contribute to improvements in sleep disorder symptoms through a decrease in nasal congestion. Objective: We aimed to determine whether the leukotriene receptor antagonist pranlukast hydrate is effective in treating sleep disorder in patients with perennial allergic rhinitis. Methods: We conducted a questionnaire survey to determine the symptoms of rhinitis and sleep disturbances in 48 adult patients with perennial allergic rhinitis who visited the outpatient otolaryngology departments in hospitals in Yamaguchi Prefecture, Japan. The subjects presented with nasal symptoms and symptoms of sleep disorder during the last 2 weeks of treatment for allergic rhinitis that lasted for at least 1 month. A questionnaire based on the Pittsburgh Sleep Quality Index and Athens Insomnia Scale with some modifications was administered before and 4 weeks after the addition of pranlukast to the conventional treatment. Results: Addition of pranlukast improved the symptoms of perennial allergic rhinitis, with responses to all items of the questionnaire administered 4 weeks after pranlukast addition indicating significant improvements. Furthermore, the improvement in sleep disorder symptoms significantly correlated with improvement in nasal congestion, but not with improvements in sneezing and nasal discharge.

A randomized, double-blind, parallel trial comparing capsaicin nasal spray with placebo in subjects with a significant component of nonallergic rhinitis

To investigate the efficacy and safety of ICX72 or Sinus Buster, a proprietary homeopathic preparation of Capsicum annum and Eucalyptol, versus placebo administered continuously over 2 weeks in subjects with a significant component of nonallergic rhinitis (NAR). Forty-two consented subjects meeting inclusion/exclusion criteria were randomized to ICX72 (n = 20) or control (n = 22) administered twice daily over 2 weeks. The primary endpoint was change in total nasal symptom scores (TNSS) from baseline to end of study. Secondary endpoints included changes in individual symptom scores (ISS) over 2 weeks and average time to first relief. Mean TNSS and ISS were recorded after single dosing at different intervals over 60 minutes. Rhinitis quality-of-life, rescue medication, and safety endpoints were analyzed. ICX72 versus placebo subjects exhibited significant differences in changes from baseline to end of study for TNSS and each ISS (P < .01), had an average time to first relief of 52.6 seconds (P < .01), and improvement in nasal congestion, sinus pain, sinus pressure, and headache at 5, 10, 15, and 30 minutes, persisting at 60 minutes for nasal congestion and sinus pain (P < .05). No difference between groups in adverse events or rescue medication was observed. ICX72 versus placebo subjects experienced no rebound congestion or impaired olfaction at the end of the study. This is the first controlled trial demonstrating intranasal capsaicin, when used continuously over 2 weeks, rapidly and safely improves symptoms in rhinitis subjects with a significant NAR component.

A radiofrequency vs topical steroid treatment of chronic nasal obstruction: A prospective randomized study of 84 cases

Conclusions: Nasal congestion caused by mucosal swelling and conch hypertrophy impairs breathing and causes snoring and headaches. Treatment of conch hypertrophy with radiofrequency (RF) allows reduction of mucosal swelling, minimization of hyperplasia, and decreased mucus production. This treatment provides a clinically significant improvement in snoring, headaches, and mouth breathing. Objective: To compare the efficacy of RF surgery to nasal steroid; each method used separately and both in combination. Methods: This was a consecutive randomized study, which included 84 patients with 3 outpatient visits, where the first visit included a complete medical history, assessment of ENT status, and skin tests. Nasal flow measured with rhinomanometry was done at the first visit and then before and after each treatment. Patients were asked to respond to a questionnaire at the first visit and after each subsequent treatment. Thereafter the variables were analyzed with established statistical methods. Results: Measurement of variables and patient questionnaire responses showed a clear improvement in several symptoms, such as sneezing and headache, and a clinically significant improvement in nasal congestion and snoring.

Objective Improvement in Nasal Congestion and Nasal Hyperreactivity with Use of Nasal Steroids in Persistent Allergic Rhinitis

Our objective was to evaluate the action of topical nasal steroid in nasal congestion and nasal hyper-reactivity in children and adolescents with persistent allergic rhinitis. Twenty atopic children and adolescents (6 to 18 years) with moderate-to-severe persistent allergic rhinitis (PAR) were treated with mometasone furoate (100 microg once a day) for 21 days. At the beginning and end of treatment, the following were recorded: a) nasal symptoms score; b) several parameters of nasal congestion measured by acoustic rhinometry (SRE 2000 Rhinometrics); c) degree of nasal hyper-reactivity to histamine (concentration of histamine necessary to induce at least 100% increase in total nasal resistance during nasal provocation test). Data were compared with those from 20 controls. Compared to controls, PAR patients had significantly higher score of symptoms, as well as higher degree of nasal hyper-reactivity and lower nasal volumes. After treatment, there was a significant decrease in the mean nasal symptoms score (8.0 versus 3.8; p < 0.001) and in the nasal hyper-reactivity (histamine concentration: 0.72 mg/ml versus 2.60 mg/ml; p < 0.001). Congestion improvement was observed by the increase in all acoustic rhinometry parameters. Among all studied volumes, the volume in the segment between 2 and 5 cm showed the highest mean increase (19.8%). Treatment with topical nasal steroid objectively reduced nasal congestion and nasal histamine hyper-reactivity in children and adolescents with PAR.

Desloratadine relieves nasal congestion and improves quality‐of‐life in persistent allergic rhinitis

Symptoms of allergic rhinitis (AR), particularly nasal congestion, can impair quality-of-life (QoL). However, only a modest correlation exists between these symptoms and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores, suggesting that both be evaluated for a complete assessment of health. Subjects with a > or =2-year history of moderate-to-severe AR to dust mite or cat dander were randomized to desloratadine 5 mg/day (n = 293) or placebo/day (n = 291) for 28 days. Primary endpoint was change from baseline in a.m./p.m. nasal congestion score. Secondary outcomes included change from baseline in total nasal symptom score, individual symptom scores and RQLQ scores (completed on days 1, 7, and 28). The Allergic Rhinitis and its Impact on Asthma criteria for persistent allergic rhinitis (PER) were fulfilled by 99% of subjects in the placebo arm. Between-treatment difference in a.m./p.m. nasal congestion score, observed from day 8 onward, significantly favored desloratadine (P = 0.0003). Desloratadine significantly improved a.m./p.m. nasal congestion and RQLQ scores after 1 week and at treatment end (P < 0.05). Improvements in 5 of 7 RQLQ domain scores exceeded the minimal important difference. On days 7 and 28, desloratadine was also significantly superior to placebo in mean change from baseline in a.m./p.m. total nasal symptom score and rhinorrhea score (both P < or = 0.01). Symptomatic benefit was primarily driven by improvement in nasal congestion and rhinorrhea. Desloratadine 5 mg/day significantly improved symptoms associated with PER, including nasal congestion, and provided significant improvement in QoL after 1 week of treatment.

Desloratadine and pseudoephedrine combination therapy as a comprehensive treatment for allergic rhinitis and nasal congestion

Background: Allergic rhinitis (AR) is rapidly increasing in global prevalence. Symptoms of AR, particularly nasal congestion, can cause quality of life (QoL) impairment. Second-generation antihistamines are a recommended first-line therapy for AR but are not viewed as very effective for the treatment of congestion. Therefore, an antihistamine plus a decongestant, such as the combination of desloratadine and pseudoephedrine, is a convenient and efficacious treatment. Objective: To review the clinical evidence on the efficacy and safety of combination desloratadine/pseudoephedrine for the treatment of AR symptoms, particularly nasal congestion. Results: Four large studies found that improvement in nasal congestion is enhanced when patients are treated with combination desloratadine/pseudoephedrine. The combination drug significantly improved mean reflective nasal congestion scores in these studies compared with either component as monotherapy (p ≤ .009 for all). These improvements in congestion were observed by day 2. Mean reductions in nasal congestion scores were comparable between the once- and twice-daily dosing regimens of the combination drug. Conclusion: Comprehensive treatment of AR that effectively relieves nasal congestion can also improve patient QoL. Administration of the second-generation antihistamine desloratadine in combination with the decongestant pseudoephedrine may be regarded as an efficacious and convenient option for patients with AR who are particularly troubled by nasal congestion.

S101 – Mometasone Reduces Congestion in Acoustic Rhinometry Study

Objectives In a double-blind placebo-controlled study of ragweed-sensitive subjects with seasonal allergic rhinitis (SAR), mometasone furoate nasal spray (MFNS) was evaluated for improvement in nasal congestion, reportedly the most bothersome symptom of SAR. Methods On Day 1, 310 subjects were exposed to ragweed pollen in an environmental exposure chamber (EEC) for 2 hours pre-dose, given MFNS 200 mcg or placebo, and studied for 6 hours post-dose. Acoustic rhinometry (AcR) was used to measure congestion before and after exposure. Subjects (n=155) who received MFNS or placebo for 7 additional days returned to the EEC on Day 8 for 4 additional hours of pollen exposure at 24, 26, and 28 hours post-dose. Results On Day 1, after 2 hours of EEC exposure pre-dose, minimal cross-sectional areas (MCAs) of each nostril measured with AcR decreased significantly for all subjects. At 6 hours post-dose, MFNS significantly reduced congestion (increased nasal patency) vs. baseline (P equal to/less than 0.00001) and placebo (P equal to 0.005). On Day 8, MFNS significantly decreased congestion vs. placebo pre-EEC pollen exposure (P equal to 0.04) and at 2 and 4 hours (P equal to 0.01 and 0.0008, respectively). MFNS protected subjects against nasal congestion throughout EEC pollen exposure on Day 8, while congestion continued to increase in subjects receiving placebo. Conclusions A single treatment of MFNS demonstrated significantly reduced nasal congestion, as assessed by AcR, a sensitive, objective measure of nasal patency. MFNS effectively reduced allergen-induced nasal congestion, even at trough levels.

Efficacy and safety of montelukast in adults with asthma and allergic rhinitis

Several clinical studies have confirmed the effectiveness of montelukast 10mg orally in adults with both asthma and allergic rhinitis. The objective of this phase IV study was to investigate the efficacy and safety of montelukast 10mg in adults with both asthma and allergic rhinitis in a real-life setting. Data from 5855 patients (mean age: 42.8+/-15.4 years) were collected and analyzed following treatment for 4-6 weeks. Efficacy was analyzed by comparing baseline values of: general, day- and night-time improvement in asthma symptoms, need for rescue medication or inhaled corticosteroids (ICSs), general and specific improvement in allergic rhinitis symptoms, reduction in rhinitis medication use, and general and specific quality of life (QoL) improvement with values collected at the end of the observation period of 4-6 weeks. Following treatment with 10mg montelukast 86.5% (n=4547) of patients reported a strong or marked improvement in day-time asthma symptoms and 88.5% (n=4367) reported improvement in night-time symptoms. A similarly high proportion of patients had a strong or marked improvement in all symptoms of allergic rhinitis (i.e. sneezing/itching (84%), rhinorrhea (81.7%), nasal congestion (79.3%), watery eyes (78.4%) and red or burning eyes (77.7%). The use of asthma and rhinitis medication was also reduced. 92.3% (n=5685) of all patients intended to continue montelukast therapy. Overall QoL was "very good" or "good" in 85.2% of patients (n=4991) and a "strong" or "marked" improvement in each of the four domains of sleep, work, everyday life and physical activity. Montelukast was well tolerated. Adverse drug reactions occurred in 14 out of 6158 patients. None of the adverse events was serious. Accordingly, montelukast 10mg is a safe and effective treatment for patients with both asthma and allergic rhinitis.

The effect of intranasal steroid budesonide on sleep disturbance and daytime somnolence in patients with perennial allergic rhinitis

Rationale The objective of this study was to determine whether intranasal corticosteroid budesonide reduced complaints of nasal congestion, poor sleep, daytime fatigue, and somnolence in patients with perennial allergic rhinitis (PAR). Methods Following IRB approval, twenty-six subjects were enrolled in a double-blind, placebo-controlled, crossover study using Balaam's design. Patients were treated with intranasal steroid spray budesonide or placebo. Epworth Sleepiness Scale, daily diary, and questionnaires were used as tools for subjective data analysis, which focused on nasal symptoms, sleep quality, daytime somnolence, and fatigue. The results were summarized and compared by PROC MIXED in SAS. Results The daily diary data showed significant improvement in nasal congestion (p=0.04) and daytime sleepiness (p=0.01), and marginally significant reduction in daytime fatigue (p=0.08) in the budesonide group compared to the placebo group. The sleep measures demonstrated statistically significant improvement in total sleep measures score (p=0.04), “sleep compared with absolute” (p=0.01), and “refreshing and restorative” sleep (p=0.04) in the active group. Conclusions Nasal corticosteroid budesonide is effective in reducing nasal congestion, daytime somnolence, and daytime fatigue, and improving sleep quality and the PAR patients' quality of life.

Sleep apnea and the nasal airway.

Sleep apnea and the nasal airway.

Poor sleep and daytime somnolence in allergic rhinitis: significance of nasal congestion.

Patients with allergic rhinitis frequently present with symptoms of nasal congestion, runny nose, sneezing, daytime somnolence and fatigue associated with decreased cognitive performance and impaired quality of life. Recent research has suggested that daytime somnolence in allergic rhinitis can be attributed to chronic inflammation of the nasal mucosa leading to nasal congestion and obstructed nasal passageways resulting in disturbed sleep. Treating daytime somnolence due to allergic rhinitis requires a reduction in obstruction caused by nasal congestion. Currently available therapy for allergic rhinitis includes topical corticosteroids, sedating and nonsedating antihistamines, topical cromolyn sodium (sodium cromoglycate), decongestants, immunotherapy and topical ipratropium bromide. The effectiveness of antihistamines in patients with allergic rhinitis has long been established. However, results of placebo-controlled trials investigating the effects of azelastine on sleep and daytime somnolence have produced conflicting results. Sleep improved with azelastine therapy, but there was a lack of evidence that azelastine significantly affected daytime sleepiness, sleep severity and nasal congestion. Sedating antihistamines exacerbate daytime somnolence and should be avoided in patients with allergic rhinitis. In a separate study, desloratadine failed to benefit sleep, but did not worsen daytime somnolence. Topical nasal cromolyn sodium is inconvenient to use and is unlikely to have a major effect on nasal congestion. Decongestants do decrease nasal congestion but the effect this has on sleep has not been adequately studied. Recent research has shown that topical corticosteroids are an effective treatment for alleviating nasal congestion secondary to allergic rhinitis. However, few studies have assessed the effect of topical corticosteroids on daytime fatigue and sleep. In 20 patients with allergic rhinitis and symptoms of daytime sleepiness, flunisolide significantly improved sleep quality and congestion but daytime sleepiness was not significantly improved. A similar study with fluticasone propionate showed improvement in nasal congestion and sleep but there was no significant change in objective sleep measurements recorded on polysomnography. Further research involving objective measures of sleep quality is necessary to determine the efficacy of medications in the treatment of allergic rhinitis associated with fatigue and daytime somnolence.

Acoustic rhinometry findings in patients with mild sleep apnea.

Nasal obstruction may contribute to the development of obstructive sleep apnea (OSA). Acoustic rhinometry (AR) measures nasal patency and congestion, which are useful parameters in objectively evaluating nasal obstruction. The nasal obstruction produced by allergic rhinitis may contribute to the development of OSA and can be easily assessed with AR. This study was undertaken to assess the degree of nasal obstruction seen in allergic patients with and without OSA. This study was a retrospective data analysis from a tertiary referral center. The AR data from 10 patients with and 40 patients without mild OSA were compared. The mean congestion factors at the first cross-sectional area (CSA1) on the AR graph were found to be significantly higher in the OSA group than in the non-OSA group (P = 0.03). The classification of change in congestion factors demonstrated significant differences at CSA1, CSA2, and CSA3 and in volume (t distributions <0.001, 0.0312, <0.001, and <0.001, respectively). The non-OSA patients noted a significant subjective improvement in nasal congestion after topical nasal decongestion, whereas the OSA patients did not (P <or= 0.0001 and 0.064, respectively). Although the role of nasal obstruction in OSA is controversial, our study lends evidence to the thought that the nasal obstruction associated with allergic rhinitis is associated with the presence of mild OSA. Whether allergic rhinitis is a direct cause of OSA is debatable, but we have shown that greater nasal congestion is related to the presence of OSA in a population of patients with allergic rhinitis.

鼻過敏症に対するＭＳアンチゲンネビュライザー療法の臨床効果について

The clinical effects of MS-A nebulizer therapy were evaluated in 23 patients with nasal hypersensitivity: 13 with nasal allergy (NA) and 10 with vasomotor rhinitis (VMR). The patients received 2 ampules once or twice a week for a total of 8 times.The efficacy rate was 61.5% for NA and 60.0% for VMR. The rate of improvement in nasal congestion was 46.2% for NA and 60.0% for VMR. Rhinorrhea decreased in 61.5% of these with NA and 70.0% of those with VMR. Percentages of patients showing a decrease in the number of sneezing attacks was 61.5% for NA and 57.1% for VMR. In half of the patients, the effects of MS-A nebulizer therapy were noted by the 5th application. There was no side effect observed in any subject.MS-A nebulizer therapy was considered to be effective for the treatment of nasal hypersensitivity.

Nasal airway inspiratory resistance.

The relationship between transnasal pressure and nasal flow is markedly curvilinear during tidal breathing in man, and there is poor agreement among the results of various methods used to define this characteristic with a single number. We used Rohrer's equation (P = K1 V + K2 V2), where P = pressure and V = flow, and calculated values for K1 and K2 from 474 nasal inspiratory pressure/flow curves obtained from 34 human subjects by a standard method of posterior rhinometry. Nasal airway inspiratory resistance at an air flow of 0.4 liter per sec (NAIR0.4) was also calculated. Rohrer's equation was found by regression analysis to fit each curve well (0.86 less than r less than 0.9999; mean, 0.983). There was a strong correlation between NAIR0.4 and K2: NAIR 0.4 = 0.91 K2 + 0.39 (r = 0.97). Nasal congestion induced in 7 normal subjects with histamine resulted in larger changes in K2 and NAIR0.4 than K1. Patients given an intranasal corticosteroid aerosol (beclomethasone dipropionate) in a double blind crossover trial showed symptomatic improvement in nasal congestion (P less than 0.01) and significant decreases in K2 (P less than 0.02) and NAIR 0.4 (P less than 0.05), but no change in K1 (P greater than 0.2).