Effects of topical corticosteroid and combined mediator blockade on domiciliary and laboratory measurements of nasal function in seasonal allergic rhinitis

Background: Both domiciliary and laboratory measures of nasal function have been used to evaluate treatment response in allergic airways disease; howe ver, these measures have not been compared. Objective: To determine the relationship of domiciliary measures (daily sym ptoms, peak inspiratory nasal flow, and nasal oral index) and laboratory me asures (rhinomanometry, acoustic rhinometry) in assessing treatment respons e with topical steroids and specific inflammatory mediator blockage. Methods: Twenty-one patients with seasonal allergic rhinitis and asthma wer e enrolled into a single-blind, placebo-controlled, crossover study compari ng 2 weeks of 1) 400 mug inhaled plus 200 mug intranasal budesonide once da ily and 2) 10 mg montelukast plus 10 mg cetirizine once daily. Before each treatment, patients received 7 to 10 days of placebo period. Laboratory mea surements were made of nasal resistance by posterior rhinomanometry, and na sal volume between 0 and 5 cm by acoustic rhinometry after both placebo and active treatment periods. Daily domiciliary recordings were made of allerg ic rhinitis nasal symptoms scores and peak nasal and oral inspiratory flow rate (enabling the calculation of a nasal/oral index) throughout the study. Results: There were significant (P < 0.05) improvements for all allergic rh initis symptoms with both therapies, after factoring for pollen count. Spea rman's rank correlation for comparison among nasal symptoms and the objecti ve responses were: nasal inspiratory flow rate (R = -0.50, P = 0.02); nasal /oral index (R = -0.55 P = 0.01); rhinomanometry (R = 0.24, P = 0.30); and acoustic rhinometry (R = -0.21, P = 0.36). Conclusions: Both treatments were effective in managing allergic rhinitis s ymptoms. and patients' symptoms were more closely associated with domicilia ry measurements of nasal flow than laboratory measurements of nasal functio n.