Effect of nasal anti-inflammatory treatment in chronic obstructive pulmonary disease

• Published in: American journal of rhinology & allergy Vol. 27; no. 4; p. 273
• Main Authors: Callebaut, Ina, Hox, Valérie, Bobic, Sonja, Bullens, Dominique M A, Janssens, Wim, Dupont, Lieven, Hellings, Peter W
• Format: Journal Article
• Language: English
• Published: United States 01.07.2013
• Subjects: Administration, Intranasal; Adult; Aged; Aged, 80 and over; Androstadienes - administration & dosage; Anti-Inflammatory Agents - administration & dosage; Cough - drug therapy; Cough - etiology; Double-Blind Method; Female; Follow-Up Studies; Humans; Interleukin-8 - drug effects; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - immunology; Risk Factors; Smoking - adverse effects; Surveys and Questionnaires; Treatment Outcome
• ISSN: 1945-8932
• DOI: 10.2500/ajra.2013.27.3887

Sinonasal inflammation and symptoms are often underdiagnosed in chronic obstructive pulmonary disease (COPD) patients. So far, it is not known to what extent anti-inflammatory nasal treatment may reduce sinonasal symptoms in COPD patients. This study was designed to examine the effects of nasal anti-inflammatory treatment on sinonasal symptoms and cough in COPD patients. Thirty-three COPD patients on stable bronchial therapy (salmeterol/fluticasone propionate 50/500 mg b.i.d. for >6 weeks) were randomized to receive fluticasone furoate (FF) or placebo nasal spray at 110 μg once daily for 12 weeks. Sinonasal symptoms and cough were monitored at baseline, at 6 and12 weeks of treatment, and at 4 weeks after cessation of the treatment using a visual analog scale. Levels of cytokines were measured in nasal secretions. In contrast to the placebo group (n = 13), FF patients (n = 14) reported less nasal blockage (10.62 ± 4.21 mm versus 36.57 ± 8.01 mm; p = 0.0026), postnasal drip (1.46 ± 0.29 score versus 2.83 ± 0.38 score; p = 0.03), and nasal discharge (0.23 ± 0.12 score versus 1.77 ± 0.43 score; p = 0.01) after 6 weeks of treatment compared with baseline, which was still present at 12 weeks. FF patients reported less cough compared with baseline (25.54 ± 4.46 mm versus 36.79 ± 5.75 mm; p = 0.04), which was not the case in the placebo group (49.58 ± 10.44 mm versus 42.00 ± 8.05 mm; p = 0.38). Nine of 14 patients in the FF group (64%) reported slight to total relief of nasal symptoms, and this subgroup had a significant decrease in IL-8 levels in nasal secretions after 6 weeks of treatment (850.7 ± 207.2 pg/mL versus 1608 ± 696.5 pg/mL; p = 0.03) compared with baseline. Nasal FF treatment in COPD patients significantly reduced sinonasal symptoms, in parallel with reduced IL-8 in nasal secretion levels and cough.