title: Activity of budesonide on nasal neutrophilic inflammation and obstruction in children with recurrent upper airway infections. A preliminary investigation.
abstract: OBJECTIVE
  While it is widely accepted that inhaled glucocorticosteroids represent an effective treatment for allergic rhinitis, little is known on the specific effects of this therapeutic approach in other upper airway disorders of childhood. The aim of the study was to evaluate the improvement of clinical symptoms and changes in local cellular inflammatory reaction induced by budesonide inhalation suspension in children with recurrent nasal infections using budesonide inhalation suspension delivered by Rinowash, a nebulizer designed to treat upper airway structures.
  
  
  METHODS
  In a randomized, controlled-open study, 14 children (5.88+/-0.56 years of age) with recurrent upper airway infections and chronic nasal obstruction were enrolled and randomly treated for 7-10 days either with budesonide inhalation suspension (250 microg/bidie) (nine patients) or with saline solution (five patients). Before and after treatment, inflammatory cells in nasal brushing and nasal symptom score were evaluated.
  
  
  RESULTS
  Out of the nine patients treated with budesonide, two were excluded from the analysis because of acute respiratory infections requiring systemic antibiotic treatment. A significant decrease in nasal brushing neutrophil percentage was observed after treatment with budesonide (P=0.016) but not after saline solution treatment (P=1.00). No significant changes in nasal brushing mononuclear cell or eosinophil proportions were observed after treatment with budesonide inhalation suspension or saline solution (P=NS, each comparison). Treatment with budesonide, but not with saline solution, was associated with a significant reduction in nasal obstruction (P=0.016).
  
  
  CONCLUSIONS
  These preliminary data indicate that short-term treatment with budesonide inhalation suspension, used for an indication out of label, may significantly reduce local neutrophilic inflammation and nasal obstruction in children with recurrent upper airway infections.
authors.affiliation: U.O.C. di Pneumologia, I.R.C.C.S. G. Gaslini, Istituto G. Gaslini, Largo G. Gaslini, 5, 16147 Genoa, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Bellodi
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Tosca
authors.forename: Grazia
authors.initials: G
authors.lastname: Pulvirenti
authors.forename: Loredana
authors.initials: L
authors.lastname: Petecchia
authors.forename: Laura
authors.initials: L
authors.lastname: Serpero
authors.forename: Michela
authors.initials: M
authors.lastname: Silvestri
authors.forename: Federica
authors.initials: F
authors.lastname: Sabatini
authors.forename: Elena
authors.initials: E
authors.lastname: Battistini
authors.forename: Giovanni A
authors.initials: GA
authors.lastname: Rossi
mesh_terms: D000280:Administration, Inhalation; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D039741:Antigens, Dermatophagoides / Q000276:immunology; D019819:Budesonide / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007114:Immunization; D007073:Immunoglobulin E / Q000276:immunology; D008297:Male; D015508:Nasal Obstruction / Q000188:drug therapy* / Q000453:epidemiology*; D009504:Neutrophils / Q000378:metabolism*; D015995:Prevalence; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012221:Rhinitis, Allergic, Perennial / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000893:Anti-Inflammatory Agents; D039741:Antigens, Dermatophagoides; D007073:Immunoglobulin E; D019819:Budesonide