DIFFERENT EFFECTS OF NASAL AND BRONCHIAL GLUCOCORTICOSTEROID ADMINISTRATION ON BRONCHIAL HYPERRESPONSIVENESS IN PATIENTS WITH ALLERGIC RHINITIS

Disorders of the upper respiratory tract, particularly allergic rhinitis, are commonly associated with bronchial hyperresponsiveness. The latter may be due to postnasal drip or to mediator or chemotactic factors into the lower airways that either directly alter airway reactivity or cause airway inflammation. The aim of this study was to compare the effect of an identical dose of nasal or bronchial corticosteroid administration on bronchial hyperresponsiveness in patients with allergic rhinitis. Eleven patients were studied. All of them were judged atopic on the basis of positive skin tests to common allergens. During control, spirometry, flow-volume curves, and specific airway conductance (SGaw) were measured. Bronchial challenges were then performed with increasing concentrations of carbachol, and dose-response curves were constructed. The concentration of carbachol that decreased SGaw by 35% from baseline (PD35) was determined by interpolating from the dose-response curve. Control measurements were repeated st 1-wk intervals to ensure that PD35 was stable in all the patients. Then the patients received for 2 wk, in a double-blind randomized crossover fashion, a topical administration of either an aerosol of 400-mu-g of beclomethasone dipropionate (B) into the nose (100-mu-g four times per day) or into the bronchi. During each trial period, identical sprays of placebo were used, the latter being administered into the nose when B was administered into the bronchi and vice versa. Measurements were then performed after 2 wk of intranasal administration and after 2 wk of intrabronchial administration. During both control periods all patients had normal baseline function data and showed marked and stable bronchial hyperresponsiveness, PD35 amounting to 30 +/- 7 and 31 +/- 6-mu-g of carbachol at first and second control periods, respectively (normal value > 160-mu-g). After 2 wk of intranasal B, PD35 increased markedly, averaging 75 +/- 12-mu-g (p < 0.001), whereas no significant change in PD35 was noted after 2 wk of intrabronchial B. No significant change in baseline lung function and SGaw (i.e., before bronchial challenge) was noted after intranasal or Intrabronchial B administration. These data show that topical intranasal administration of B has an Important protective effect on carbachol responsiveness In patients with allergic rhinitis, whereas the same dose of B administered into the lower airways had no effect.