EFFECTS OF ORALLY INHALED BUDESONIDE IN SEASONAL ALLERGIC RHINITIS

It has previously been demonstrated that topical nasal treatment with glucocorticosteroids has significant effects on the bronchial airways, Less is known about effects on nasal disease by topical bronchial tre atment with these drugs, The present study examined effects on nasal a llergic disease of inhaled budesonide (avoiding nasal deposition of th e drug). Patients with seasonal allergic rhinitis, but without asthma, were thus given inhalations of budesonide (600 mu g b.i.a) or placebo . The aim of the design was to allow the study of eosinophilic airway disease in a part of the airway other than the directly treated locus. Moderate to high birch pollen levels were recorded during the study s eason, and nasal symptoms were significantly increased in both treatme nt groups, although they were milder in patients receiving budesonide than in the placebo group (p<0.05). Nasal brush eosinophils and nasal lavage fluid levels of eosinophil cationic protein as well as blood eo sinophils were increased during the season (p<0.05), but these increas es were prevented by the inhaled budesonide. Nasal lavage fluid levels of alpha(2)-macroglobulin were particularly elevated in the placebo g roup but did not differ between patients receiving placebo and budeson ide, Budesonide prevented the seasonal development of increased bronch oconstrictor responses to methacholine challenge (p<0.05). In conclusi on, budesonide reduced the seasonal eosinophilia both in the circulati on and in the nose along with an attenuation of seasonal nasal symptom s, Hence, at a daily dose of 600 mu g b.i.d., known to cause no, or mi nimal, adverse effects, inhaled budesonide produces clinically signifi cant anti-inflammatory effects in the entire airways, including the na sal mucose, which is not exposed topically to the drug, We suggest tha t nasal and systemic anti-eosinophil actions are produced at commonly employed dose levels of orally inhaled budesonide.