Intranasal steroids and the risk of emergency department visits for asthma

Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia.
Journal of Allergy and Clinical Immunology (Impact Factor: 11.25). 05/2002; 109(4):636-42. DOI: 10.1067/mai.2002.123237
Source: PubMed

ABSTRACT In patients with asthma, treatment for associated conditions, such as rhinitis, is recommended. It is unknown whether this treatment can reduce the risk for emergency department (ED) visits for asthma.
We sought to determine whether treatment with intranasal steroids or prescription antihistamines in persons with asthma is associated with a reduced risk for ED visits caused by asthma.
We performed a retrospective cohort study of members of a managed care organization aged greater than 5 years who were identified during the period of October 1991 to September 1994 as having a diagnosis of asthma by using a computerized medical record system. The main outcome measure was an ED visit for asthma.
Of the 13,844 eligible persons, 1031 (7.4%) had an ED visit for asthma. The overall relative risk (RR) for an ED visit among those who received intranasal corticosteroids, adjusted for age, sex, frequency of orally inhaled corticosteroid and beta-agonist dispensing, amount and type of ambulatory care for asthma, and diagnosis of an upper airways condition (rhinitis, sinusitis, or otitis media), was 0.7 (95% confidence interval [CI], 0.59-0.94). For those receiving prescription antihistamines, the risk was indeterminate (RR, 0.9; 95% CI, 0.78-1.11). When different rates of dispensing for intranasal steroids were examined, a reduced risk was seen in ED visits in those with greater than 0 to 1 (RR, 0.7; 95% CI, 0.57-0.99) and greater than 3 (RR, 0.5; 95% CI, 0.23-1.05) dispensed prescriptions per year.
Treatment of nasal conditions, particularly with intranasal steroids, confers significant protection against exacerbations of asthma leading to ED visits for asthma. These results support the use of intranasal steroids by individuals with asthma and upper airways conditions.

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    • "These results suggest that treatment of inflammation in the upper airways indirectly improves asthma symptoms and decreases bronchial hyperresponsiveness, which is not a direct effect of the intranasally administered corticosteroid on the lower airways (Watson et al., 1993). A 3-year retrospective cohort study conducted in 14 US centers evaluated whether treatment with intranasal corticosteroid (INS) in patients of 5 years or older with asthma was associated with a reduced risk of emergency room visits for asthma (Adams et al., 2002). Treatment of nasal conditions, particularly with INSs, appeared to prevent asthma exacerbations leading to emergency room visits. "
    Allergic Diseases - Highlights in the Clinic, Mechanisms and Treatment, 03/2012; , ISBN: 978-953-51-0227-4
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    • "These findings suggest that postnasal drip associated with sinusitis might trigger upper airway hyperresponsiveness and subsequently affect the lower airway through a pharyngeal-pulmonary reflex. This hypothesis is consistent with reports that demonstrate that treatment with intranasal corticosteroids can reduce the likelihood of acute exacerbations of asthma [49]. Finally, some data indicate that chronic sinusitis and asthma may both be manifestations of a generalized inflammatory disorder of the respiratory mucosa, thus explaining their frequent coexistence. "
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    • "En considérant la récente révision européenne de la nomenclature de la RA [15] et la nouvelle classification ARIA [5], nous notons que le 1/5 de nos patients rhinitiques a des tests d'allergie négatifs et que la RA est le plus souvent intermittente légère (45 %). Plusieurs études suggèrent qu'un traitement optimal de la RA améliore l'asthme [16] [17] [18] [19] [20]. La moitié de nos patients ne sont pas traités pour leur RA probablement parce qu'elle était sous-estimée. "
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