Intransal 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: 11.48). 05/2002; 109(4):636-42. DOI: 10.1067/mai.2002.123237
Source: PubMed


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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    • "Oral drugs acting on asthma and rhinitis have an effect on both sites.46 Research has also shown that the addition of nasal topical corticosteroids to standard asthma treatment reduces severe exacerbations of asthma by almost 50%.79 Allergen-specific immuno-therapy in patients with AR has a prolonged preventive effect on the development of asthma when stopped.76 "
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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. "

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    • "However, neuronal and inflammatory pathways have been implicated.23,24 Treatment of the upper airway with intranasal steroids, antihistamines, and leukotriene receptor antagonists (LTRA) have been shown to improve asthma control.25–27 Control of GERD with proton pump inhibitors, H2 blockers and surgery has also been shown to improve asthma symptoms and reduce doses of controller agents required.28,29 "
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