Good asthma management requires appropriate treatment of persistent stuffy nose or allergic rhinitis. It is important to treat rhinitis as part of asthma treatment because asthma can be controlled with a lower dose of inhaled steroid. Treating the inflammation associated with allergic rhinitis influences the control of asthma. However, few studies have looked at the effect of treating rhinitis on persistent asthma and vice versa. Researchers from the University of Sao Paulo School of Medicine, Brazil, evaluated the effects of treatment with inhaled or topical nasal beclomethasone dipropionate (BDP), a steroid, given separately or in combination, on various measures of asthma in 74 patients with mild-to-moderate asthma and allergic rhinitis. It was found that patients in all treatment groups experienced significant improvements in rhinitis and asthma symptoms. The nasal application of the steroid (BDP) reduced asthma symptoms much more than the reduction of rhinitis symptoms achieved with inhaled administration. All treatment groups showed a significant improvement in lung function and there were no differences in bronchial hyper-responsiveness (a symptom of asthma) between the groups. There were significant reductions in the number of emergency room visits; nighttime awakenings due to asthma and asthma-related absence from work in the combined treatment groups. The researchers concluded that failure to consider treatment of rhinitis as essential to asthma management might impair clinical control of asthma. Further, the data suggests that asthma and rhinitis in some patients can be controlled by the exclusive use of nasal medication. Different specialists usually treat allergic rhinitis and asthma, but this appears to be the wrong concept because they are two 'windows' of the same disease.
Chest,
December 2005