Chronic nasal sinus disease is common in asthma and it is associated with poor asthma control. A recent study showed that intranasal steroids does not help poorly controlled asthma over 24 weeks. It was hypothesized that the intranasal corticosteroids might decrease airway markers of allergic inflammation with chronic treatment, and also improve asthma control specifically during the allergy season.
Intranasal steroids are the gold standard treatment for allergic rhinitis. Common branded name steroids that you may see in the pharmacy that are OTC are Flonase, Nasocort, Rhinocort, Veramyst and Beconase. Other nasal steroids that you can obtain only via prescription from a doctor are Nasonex (it is generic now, the name is Mometasone), Omnaris, Qnasl, Flunisolide and Zetonna. Dymista has nasal steroid in it plus a nasal antihistamine. Other nasal antihistamines are Astelin, Astepro and Patanase.
Before we get into the study, we will review to to use a nasal spray.
- Blow your nose gently before beginning
- Shake medication (if instructed).
- Stand or sit, and tip your chin down.
- Keeping the sprayer upright, insert the tip 1/4 to 1/2 inch into one nostril while holding the other closed with your fingers.
- Point tip AWAY from center of nose.
- Inhale gently through your nose while you release the spray. Qnasl: hold your breath while spraying. Zetonna: lean head back slightly, release spray and breathe in through nose, hold breath for a few seconds before exhaling.
- Exhale though your mouth.
- Wipe any drip, but avoid blowing your nose for 15 minutes.
In the study, the patients used Nasonex for 24 weeks. They found that it did not affect markers of allergic airway inflammation in study participants with chronic sinonasal disease and poorly controlled asthma. Nor is there a reduction in the risk of having episodes of poorly controlled asthma during allergy seasons. Patients with both sinonasal disease and asthma will most likely need nasal steroids for their upper airways (nose) and a separate asthma steroid inhaler medication.
If you have chronic sinus disease and asthma that is not well controlled, speak to your primary care doctor about a referral to a local asthma and allergy specialist who can help identify your triggers and help manage your symptoms better.