One-year evaluation of combined treatment with an intranasal corticosteroid and montelukast for chronic rhinosinusitis associated with asthma.
OBJECTIVE
Chronic rhinosinusitis associated with asthma is often difficult to treat effectively with intranasal corticosteroids alone. Thus, the aim of this study was to evaluate the effectiveness of combination treatment with an intranasal corticosteroid and a leukotriene-receptor antagonist (montelukast) in reducing the size of nasal polyps.


METHODS
The subjects of this study were 20 patients with chronic rhinosinusitis associated with adult-onset asthma, which was being treated with inhaled corticosteroids. All patients were treated with intranasal fluticasone propionate, 200 microg/day, and montelukast, 10 mg/day, for 1 year. The size of nasal polyps and the score of sinus shadows were assessed with nasal endoscopy and computed tomography (CT), respectively, before and after treatment. The peripheral blood eosinophil counts were also evaluated before and after treatment.


RESULTS
Nasal polyps were significantly smaller after both 6 months (p<0.01) and 12 months of treatment (p<0.01) than before treatment. The decrease in the shadow score was statistically significant after both 6 months (p<0.01) and 12 months of treatment (p<0.01). Significant reductions in peripheral blood eosinophil counts were also seen after both 6 months (p<0.05) and 12 months of treatment (p<0.01). A significant correlation was found between the rate of change in the peripheral blood eosinophil count and that in the CT score after both 6 months (r=0.578, p=0.012) and 12 months (r=0.625, p=0.007).


CONCLUSIONS
Combined treatment with intranasal fluticasone propionate and montelukast, for at least 1 year, is effective for chronic rhinosinusitis associated with adult-onset asthma.
Department of Head & Neck and Sensory Organ Science, Graduate School of Medicine, Nippon Medical School. nonaka@nms.ac.jp
Manabu
M
Nonaka
Atsuko
A
Sakanushi
Kaoru
K
Kusama
Nozomu
N
Ogihara
Toshiaki
T
Yagi
D000085:Acetates / Q000008:administration & dosage*; D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage*; D018926:Anti-Allergic Agents / Q000008:administration & dosage; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D002908:Chronic Disease; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D004804:Eosinophils / Q000166:cytology; D005260:Female; D000068298:Fluticasone; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000000981:diagnostic imaging; D011804:Quinolines / Q000008:administration & dosage*; D012221:Rhinitis, Allergic, Perennial / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012852:Sinusitis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013440:Sulfides; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000085:Acetates; D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D018926:Anti-Allergic Agents; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D000068298:Fluticasone; C093875:montelukast