The effect of intranasal budesonide spray on mucosal blood flow measured with Laser Doppler flowmetry

Background: Recent reports have shown that, although rare, findings of muco sal ulcers and perforations of the nasal septum in some cases may be associ ated with the use of topical nasal glucocorticosteroids (GCS). It can been speculated that, a reduction in septal mucosal blood flow causing ischemia may eventually induce septal perforations. Aim: To evaluate whether a single dose of a potent nasal GCS given in a cli nically recommended dose may acutely reduce the mucosal blood flow on the n asal septum. Methods: Six healthy subjects received in a randomised double blind placebo controlled crossover procedure one dose of 64 mug budesonide (R) aqueous n asal spray (Rhinocort aqua (R), AstraZeneca R&D, Lund, Sweden) and placebo. One dose was delivered into each nasal cavity by means of a pump spray. As a positive control 140 mug of xylometazoline (Nezeril (R), AstraZeneca R&D , Lund, Sweden) was sprayed in the same way, but in an open fashion. A wash -out period of at least 3 days followed each session. Blood flow was measur ed on the nasal septum with Laser Doppler flowmetry up to 20 min after admi nistration. Results: Budesonide did not affect the nasal septal mucosal blood flow as c ompared to placebo, but xylometazoline reduced the septal mucosal blood flo w by 60.9 +/-7.1% measured from baseline values. Conclusion: A single dose of intranasal budesonide aqueous nasal spray has no acute effects on nasal septal mucosal bloodflow.