The impact of intranasal corticosteroids on lung function in children with allergic rhinitis

Subjects with allergic rhinitis (AR) suffer from impaired lung function, especially decreased FEF(25-75%). The purpose of this study was to examine lung function and the long-term response to INCS in AR patients with impaired lung function, and to characterize the phenotype of these children.

Two hundred two children with AR underwent an allergy evaluation including a skin prick test and spirometry. Children with impaired lung function were treated with daily nasal corticosteroids spray (INCS) and antihistamine as needed.

Fifty-three children out of 202 (26.3%) had impaired lung function: 34 of them (64.2%) had FEF(25-75%) values under 80% of predicted and normal FEV(1) values, and 19 individuals (35.8%), had both FEF(25-75%) and FEV(1) values below 80% of predicted. A positive correlation between FEV(1) and FEF(25-75%) values (r = 0.369, P = 0.007) and a reverse correlation between duration of nasal symptoms and FEF(25-75%) values (r = -0.364, P = 0.012) were found. Post-ronchodilation FEV(1) levels increased from 81.9 ± 8.0 to 87.7 ± 10.4 (P < 0.0001). Thirty-five of the 53 children complied with a continuous INCS treatment regimen over a period of 3-12 months, demonstrated increased FEF(25-75%) (84.4 ± 13.6 vs. 70.1 ± 7.1, P < 0.001) and FEV(1) (92.3 ± 10.9 vs. 84.4 ± 7.8, P < 0.0001) after INCS treatment. However, FEF(25-75%) values were still significantly lower compared to the group of AR children with normal lung function (84.4 ± 13.6 vs. 95.7 ± 8.8, P < 0.0001).

INCS improve FEF(25-75%) above 80% of predicted values in 2/3 of children with abnormal lung function. However, this improvement does not reach levels of AR children with normal lung function. Pediatr