Antiasthmatic effects of mediator blockade versus topical corticosteroids in allergic rhinitis and asthma

To compare the antiasthmatic efficacy of inflammatory mediator blockade ver sus topical corticosteroid therapy in patients with seasonal allergic rhini tis (SAR) and asthma, 14 patients were enrolled into a single-blind, double -dummy, placebo-controlled crossover study comparing 2 wk therapy of (1) 40 0 mu g orally inhaled budesonide plus 200 mu g intranasal budesonide (BUD) or (2) 10 mg oral montelukast plus 10 mg oral cetirizine (ML + CZ). Before each treatment period, patients received 7 to 10 d placebo washout. All tre atments were given once daily in the morning. Throughout the study, patient s recorded the following domiciliary measures: peak expiratory flow (PEF), rescue inhaler requirement, asthma symptoms, and daily activity score. Labo ratory measurements were made at trough of adenosine monophosphate (AMP) br onchial challenge and exhaled nitric oxide (NO). Compared with pooled place bo (PL), there were significant (p < 0.05) improvements in all domiciliary measures with both treatments (mean PEF [L/min] PL: 463; BUD: 478; ML + CZ: 483). For geometric mean AMP PC20 (mg/ml), there was an improvement (p < 0 .05), compared with PL (47), for ML + CZ (133) but not for BUD (51); wherea s for NO (ppb) there was significant suppression with BUD (7.6) but not ML + CZ (11.5) compared with PL (13.6). In conclusion, both combined mediator blockade and combined topical corticosteroids are equally effective antiast hma therapy in patients with asthma and SAR.