Benefit and risk management for steroid treatment in upper airway diseases

Because of their efficacy, intranasal corticosteroids (INCS) remain the cornerstone in the treatment of upper airway diseases. Although INCS are extremely efficacious, local and systemic adverse effects have been associated with their use. However, none of these effects is of sufficient frequency or magnitude to warrant a reduction in their use or any action more than careful drug and dose selection and monitoring when indicated. Recent publications focus on newer aspects of efficacy in rhinitis and on the adverse effects of growth suppression, cataract formation, and histologic effects on the nasal mucosa. Optimizing mucosal delivery of INCS is a major goal because of the need to maximize efficacy and minimize systemic bioavailability and potential risks. One recent study examined the bioavailability and metabolism of beclomethasone dipropionate. Another study examined the tendency of patients to overdose when using betamethasone drops. A third study compared the two different delivery systems of fluticasone propionate and budesonide, and their efficacy in treating perennial rhinitis. Other studies examined the effect of INCS on the treatment of nasal polyps (budesonide) and on the common cold (beclomethasone dipropionate). These studies have continued to define safety and efficacy aspects, and the important role of INCS in treating rhinitis.