A novel inhaled corticosteroid technique; out through the nose

Published Online: December 24, 2015

Eosinophilic chronic rhinosinusitis (ECRS) is characterized by refractory chronic rhinosinusitis with eosinophil-enriched nasal polyps. For the treatment of ECRS, endoscopic sinus surgery and topical nasal steroid treatment are currently considered standard therapies. However, there remain limitations including risks of recurrence, adverse events and incomplete treatment responses. In addition, because ECRS and asthma often occur concomitantly, simple and simultaneous treatments would be advantageous for their management.

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Hamada et al. described a technique for the nasal exhalation of inhaled beclomethasone hydrofluoroalkane-134a (HFA-BDP) particles.

First, they showed a case with aspirin-exacerbated respiratory disease and ECRS, who was not willing to use nasal steroids or antileukotrienes. Besides instruction for effective inhalation technique, she was instructed to exhale inhaled HFA-BDP particles through the nose, which was associated with marked improvement in her condition with control of both upper and lower airway disease. Next, using a laser-based visualization system, Hamada et al. demonstrated the presence of inhaled HFA-BDP particles in the nasally exhaled breath after breath-holding.

The simple use of nasal exhalation of inhaled corticosteroids may have substantial utility in simultaneously controlling upper and lower airway inflammation in a cost-effective manner.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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