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A Comparison of Nasal Clearance after Treatment of Perennial Allergic Rhinitis with Budesonide and Mometasone

2003; Wiley; Volume: 128; Issue: 2 Linguagem: Inglês

10.1067/mhn.2003.70

1097-6817

Robert M. Naclerio, Fuad M. Baroody, Nalini Bidani, Tineo Marcy De, Bill C. Penney,

Asthma and respiratory diseases

OBJECTIVE Evidence in vitro suggests that benzalkonium chloride, a preservative in many intranasal preparations, interferes with ciliary function and thus could potentially interfere with mucociliary transport, the mechanism for clearing secretions from the nasal cavity. STUDY DESIGN We performed a parallel randomized study with 10 subjects in each arm comparing Rhinocort AQUA (an intranasal steroid (budesonide) spray without benzalkonium chloride) and Nasonex (an intranasal steroid (mometasone furoate) spray with benzalkonium chloride). Before and after 2 weeks of treatment, subjects completed a Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and underwent a measurement of nasal clearance of a radioactive colloidal spray into the nose. RESULTS The groups were matched at entry for nasal clearance, even though there was variability among subjects. The amount of change after 2 weeks of treatment (Δ before versus after treatment) showed a significant difference in nasal clearance favoring budesonide. After 2 weeks of treatment, both budesonide and mometasone demonstrated overall improvement in quality of life as assessed by the RQLQ. Both treatments were well tolerated. CONCLUSION Our study extends the observation in vitro that demonstrates the adverse effect of benzalkonium chloride on cilia to a measurement in vivo of clearance. The effects after 2 weeks might not reflect changes after longer periods of treatment. SIGNIFICANCE To determine the clinical significance of the small improvement in mucociliary transport will require large clinical trials.