title: Replacement of SFC-DPI with SFC-MDI exhaled through the nose improves eosinophilic chronic rhinosinusitis in patients with bronchial asthma.
abstract: OBJECTIVE
  Eosinophilic chronic rhinosinusitis (ECRS), a subgroup of chronic rhinosinusitis with nasal polyps, is a refractory disease closely associated with bronchial asthma. We recently reported on the efficacy of ultra-fine particle inhaled corticosteroids (ICS) (hydrofluoroalkane-134a-beclomethasone dipropionate: HFA-BDP) exhalation through the nose (ETN) treatment for mild-to-moderate asthmatics with ECRS. However, the effect of HFA-BDP ETN was found to be transient in some cases with severe ECRS and asthma, requiring treatment with higher-dose ICS and long-acting β2-agonists (LABA). Here, we present a case of refractory ECRS with severe asthma treated with a combination of high-dose ICS and LABA ETN, and we discuss the mechanisms for its effectiveness.
  
  
  METHODS
  A 57-year-old man was treated with the combined regimen of HFA-BDP ETN and salmeterol/fluticasone combination (SFC) dry powder inhaler (DPI) for his refractory ECRS with severe asthma. For better control, we replaced SFC-DPI with SFC metered-dose inhaler (MDI) ETN and evaluated the clinical effect and corticosteroid sensitivity. We also examined the flow and deposition of fine particles released by SFC-MDI ETN.
  
  
  RESULTS
  After switching to SFC-MDI ETN, the patient's conditions markedly resolved with the restoration of corticosteroid sensitivity and PP2A activity. The fine particles released by SFC-MDI ETN at least partially flowed out through the external nares and seemed to be deposited on the ethmoid sinus.
  
  
  CONCLUSIONS
  Fine particle ICS/LABA ETN might be an additional therapeutic option for refractory ECRS with severe asthma and corticosteroid insensitivity. .
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Mikiya
authors.initials: M
authors.lastname: Asako
authors.forename: Takahisa
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Yasuba
authors.forename: Koichi
authors.initials: K
authors.lastname: Tomoda
authors.forename: Akira
authors.initials: A
authors.lastname: Kanda
mesh_terms: D001249:Asthma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002908:Chronic Disease; D058995:Dry Powder Inhalers; D004802:Eosinophilia / Q000150:complications / Q000188:drug therapy*; D000068297:Fluticasone-Salmeterol Drug Combination / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D010316:Particle Size; D012220:Rhinitis / Q000150:complications / Q000188:drug therapy*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000068297:Fluticasone-Salmeterol Drug Combination