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Effect of an intranasal corticosteroid on exercise induced bronchoconstriction in asthmatic children
Elin T G Kersten1, Janneke C van Leeuwen, Paul L P Brand
1Department of Pediatrics, Medisch Spectrum Twente, Enschede, The Netherlands. elinkersten@gmail.com
Insights
Intranasal corticosteroid treatment for allergic rhinitis in children with asthma significantly reduced exercise-induced bronchoconstriction (EIB). This therapy also showed improvements in quality of life related to activity limitations.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Pharmacology
Background:
- Allergic rhinitis and exercise-induced bronchoconstriction (EIB) are prevalent in children with asthma.
- Effective management strategies are crucial for improving respiratory health in this population.
Purpose of the Study:
- To evaluate the protective effect of intranasal corticosteroid treatment for allergic rhinitis against EIB in asthmatic children.
- To assess the impact of treatment on lung function, asthma control, and quality of life.
Main Methods:
- A double-blind, randomized, placebo-controlled study involving 25 children (aged 12-17) with mild-to-moderate asthma and allergic rhinitis.
- Participants received either intranasal fluticasone furoate or placebo for approximately 22 days.
- Primary outcome: change in exercise-induced fall in FEV1; secondary outcomes: AUC, ACQ, PAQLQ, and FeNO.
Main Results:
- Intranasal fluticasone furoate significantly reduced the mean exercise-induced fall in FEV1 compared to placebo (P=0.04).
- The activity limitation domain of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) showed significant improvement within the fluticasone furoate group (P=0.03).
- No significant changes were observed in Asthma Control Questionnaire (ACQ) or exhaled nitric oxide (FeNO) between groups.
Conclusions:
- Treatment of allergic rhinitis with intranasal fluticasone furoate effectively reduces exercise-induced bronchoconstriction in asthmatic children.
- This therapeutic approach demonstrates a positive trend in improving the quality of life for affected children, particularly in managing activity limitations.
Rationale:
Allergic rhinitis and exercise induced bronchoconstriction (EIB) are common in asthmatic children. The aim of this study was to investigate whether treatment of allergic rhinitis with an intranasal corticosteroid protects against EIB in asthmatic children.
Methods:
This was a double-blind, randomized, placebo-controlled, parallel group study. Subjects aged 12-17 years, with mild-to-moderate asthma, intermittent allergic rhinitis and ≥ 10% fall in FEV(1) at a screening exercise challenge were randomized to 22 ± 3 days treatment with intranasal fluticasone furoate or placebo. The primary outcome was change in exercise induced fall in FEV(1) . Secondary outcomes were changes in the area under the curve (AUC), asthma control questionnaire (ACQ), pediatric asthma quality of life questionnaire (PAQLQ), and exhaled nitric oxide (FeNO).
Results:
Twenty-five children completed the study. Mean exercise induced fall in FEV(1) (± SD) decreased significantly (95% CI: 0.7-18.2%, P = 0.04) in the fluticasone furoate group from 28.4 ± 15.8% to 19.0 ± 13.8%, compared to the placebo group (27.4 ± 16.0% to 27.4 ± 19.2%). The change in AUC was not significantly different between treatment groups. However, within the fluticasone furoate group the AUC decreased significantly (P = 0.01). Although total PAQLQ score did not improve, the activity limitation domain score improved significantly within the fluticasone furoate group (P = 0.03). No significant changes were observed in FeNO and ACQ.
Conclusion:
Treatment of allergic rhinitis in asthmatic children with an intranasal corticosteroid reduces EIB and tends to improve quality of life.
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