A comparison of nasal clearance after treatment of perennial allergic rhinitis with budesonide and mometasone.
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.


METHODS
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 (Delta 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.


CONCLUSIONS
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.


CONCLUSIONS
To determine the clinical significance of the small improvement in mucociliary transport will require large clinical trials.
Naclerio
Robert M
RM
Sections of Otolaryngology-Head and Neck Surgery and Nuclear Medicine, The Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637, USA. rnaclerio@surgery.bsd.uchicago.edu
Baroody
Fuad M
FM
Bidani
Nalini
N
De Tineo
Marcy
M
Penney
Bill C
BC
D000281:Administration, Intranasal; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D019819:Budesonide / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D000068656:Mometasone Furoate; D009079:Mucociliary Clearance / Q000187:drug effects*; D015508:Nasal Obstruction / Q000188:drug therapy* / Q000209:etiology*; D011244:Pregnadienediols / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D011788:Quality of Life; D012221:Rhinitis, Allergic, Perennial / Q000150:complications*
D000893:Anti-Inflammatory Agents; D011244:Pregnadienediols; D000068656:Mometasone Furoate; D019819:Budesonide