(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Nasal-Obstruction

To systematically review the efficacy and safety of beclomethasone nasal spray in the treatment of chronic adenoid hypertrophy in children.. We computerized searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (issue1, 009), MEDLINE (1950 to August 2008), EMbase (1984 to August 2008), CNKI (1994 to September 2008), and VIP (1989 to August 2008), WANFANG DATA, Annual Review-s and Elsevier Science. Also the reference lists of all papers were identified for further trials. All searches were initially performed in May 2007 and updated in April 2009.Randomized controlled trials (RCT) and quasi-RCTs were identified and analyzed according to the Cochrane Handbook for Systematic Reviews of Interventions.. Three RCT were included. Meta-analysis was not performed due to heterogeneity and the data were summarized in a narrative format. The trials showed that higher doses of beclomethasone (336 microg/d, 400 microg/d) might improve the nasal obstruction symptoms and reduce adenoid size in children with adenoid hypertrophy.. Higher and subsequently half doses of beclomethasone (336 microg/d, 400 microg/d) can improve the nasal obstruction symptoms in children with adenoid hypertrophy.The improvement appears to be associated with a reduction of adenoid size. Because of a lack of the RCT, further studies are required to support the use of beclomethasone as a first-line approach for these children.

Topics: Adenoids; Adolescent; Beclomethasone; Child; Child, Preschool; Female; Humans; Hypertrophy; Infant; Infant, Newborn; Male; Nasal Obstruction; Randomized Controlled Trials as Topic; Treatment Outcome

Nasal allergy is statistically related to inflammatory chronic sinusitis as a risk factor. But one question still remains unanswered: are the reactions and modifications observed in the sinuses after natural exposure to a nasal allergen or after nasal allergen challenge linked to an IgE mediated mechanism? Similarities in symptoms, eosinophils and mediators of inflammation in the mucosa have been found between allergic rhinitis and sinusitis. The same applies for the deposition of Major Basic Protein (MBP) and treatment results, especially when topical steroids are found. An original prospective study was held among 106 patients (24 patients allergic to perennial allergens, 82 non allergic patients) suffering from bilateral chronic inflammatory (no polyposis) ethmoidal sinusitis. The allergic group was submitted to a 3 months antiallergic treatment (Cetirizine 10 mg once a day, Beclomethasone dipropionate 50 micrograms three times a day) before being referred for bilateral endonasal ethmoidectomy under endoscopic control. Scores for rhinorrhea, nasal obstruction and global comfort (global assessment) were compared before and after ethmoidectomy. Both groups were significantly improved by surgery. Comparing both groups, no significant difference was found before and after surgery regarding the three above mentioned parameters. This suggests that 1) symptoms are common to both perennial nasal allergy and chronic ethmoidal sinusitis, 2) medical treatment failure in allergy must require a CT scan of the sinuses to assess a possible accompanying chronic sinusitis, 3) chronic ethmoidal sinusitis is probably the leading factor responsible for nasal symptoms such as rhinorrhea and nasal obstruction when associated with perennial allergy.

Topics: Allergens; Anti-Allergic Agents; Anti-Inflammatory Agents; Beclomethasone; Blood Proteins; Cetirizine; Chronic Disease; Endoscopy; Eosinophil Granule Proteins; Eosinophils; Ethmoid Sinus; Ethmoid Sinusitis; Humans; Immunoglobulin E; Inflammation Mediators; Mucous Membrane; Nasal Mucosa; Nasal Obstruction; Prospective Studies; Respiratory Hypersensitivity; Rhinitis, Allergic, Perennial; Ribonucleases; Risk Factors; Sinusitis; Tomography, X-Ray Computed

Sarcoidosis is a chronic multisystem granulomatous disease that has a predilection for pulmonary and upper respiratory tract involvement. Because the initial signs and symptoms of sarcoidosis may be identical to those of other forms of chronic sinonasal inflammatory disease, these patients will often first seek treatment from an otolaryngologist. We present a series of 28 patients whose primary symptoms was involvement of a sinonasal tract. A new staging system is proposed to categorize the severity and sites of involvement and to guide the aggressiveness of therapy. Sarcoidosis should be considered in the differential diagnosis of inflammatory sinonasal disease.

Topics: Adult; Beclomethasone; Chronic Disease; Constriction, Pathologic; Diagnosis, Differential; Edema; Epistaxis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasal Obstruction; Nose Deformities, Acquired; Nose Diseases; Paranasal Sinus Diseases; Prednisone; Sarcoidosis; Tissue Adhesions; Triamcinolone Acetonide

The aim of the present study was to objectively and subjectively evaluate the effects of adding rhinophototherapy to intranasal beclomethasone dipropionate to treat nasal congestion in patients with seasonal allergic rhinitis.. Seventy-five seasonal allergic rhinitis patients were randomly divided into two groups. Patients in Group 1 received intranasal beclomethasone dipropionate for two weeks and patients in Group 2 had rhinophototherapy added to the same medical therapy as Group 1. The effectiveness of treatments was evaluated with the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Nasal Obstruction Symptom Evaluation scale (NOSE) questionnaires and active anterior rhinomanometry.. After treatment, significant improvement was observed in Group 2. Our study shows that adding intranasal phototherapy with a combination of UVA, UVB and visible light therapy to nasal beclomethasone dipropionate treatment objectively improves nasal patency in patients with seasonal allergic rhinitis.. Effetto della rinofototerapia sulla congestione nasale nei pazienti con rinite allergica stagionale.. Valutare in maniera oggettiva e soggettiva gli effetti del dipropionato beclometasone con l’aggiunta della rhinofototerapia nel trattamento della rinite allergica stagionale.. Settantacinque pazienti affetti da rinire allergica stagionale sono stati randomizzati in due gruppi. Gruppo 1, trattamento con dipropionato beclometasone per due settimane. Gruppo 2, rinofototerapia in aggiunta al trattamento del gruppo 1. L’efficacia dei trattamenti è stata valutata con il Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), il Nasal Obstruction Symptom Evaluation scale (NOSE) e la rinomanometria attiva anteriore.. È risultata una differenza statisticamente significativa fra il gruppo 2 e 1 in termini di RQLQ (p = 0,011) e NOSE (p = 0,001). Nel gruppo 2 sono risultate delle differenze nelle resistenze nasali (p = 0,004) prima e dopo il trattamento e nessuna differenza statisticamente significativa nel gruppo 1.. L’aggiunta della fototerapia intranasale con UVA, UVB e luce bianca migliora i sintomi nei pazienti con rinite allergica stagionale.

Topics: Beclomethasone; Double-Blind Method; Humans; Nasal Obstruction; Quality of Life; Rhinitis, Allergic, Seasonal; Rhinomanometry

Perennial allergic rhinitis (PAR) affects children at a young age. Current guidelines recommend intranasal corticosteroids as the first-line treatment in patients with moderate-to-severe or persistent disease or in those who have congestion. In this study, the long-term safety and efficacy of mometasone furoate nasal spray (MFNS) were assessed in children with PAR.. In this multicenter, active-controlled, evaluator-blind, 12-month study, 255 children aged 6-11 years with a >or=1-year history of PAR were randomized to receive once-daily MFNS 100 microg (n=166) or the active comparator beclomethasone dipropionate (BDP) 168 microg (n=85). Changes from baseline in overall PAR symptoms and response to treatment were rated at each visit. Cosyntropin stimulation testing, as well as tonometry and slit lamp procedures, were performed. Safety variables were assessed.. A total of 137 subjects in the MFNS group and 68 in the BDP group completed treatment. The mean reductions in physician- and subject-rated overall condition of PAR at week 52 were -42.1% and -39.7%, respectively, for MFNS, compared with -44.0% and -39.0%, respectively, for BDP. A total of 94% and 100% of MFNS and BDP subjects, respectively, reported adverse events (AEs), which were mostly mild or moderate. The most frequently reported treatment-related AEs in both groups were epistaxis, headache, and pharyngitis. Response to cosyntropin was normal and no posterior subcapsular cataracts were observed in either group. Although no significant changes in intraocular pressure were observed with MFNS, one subject receiving BDP demonstrated this effect.. Treatment with MFNS 100 microg once daily for 1 year was well tolerated in children 6-11 years old, with negligible systemic exposure and no evidence of suppression of the hypothalamic-pituitary-adrenal axis or ocular changes.

Topics: Aerosols; Anti-Allergic Agents; Anti-Inflammatory Agents; Beclomethasone; Cerebrospinal Fluid Rhinorrhea; Child; Cosyntropin; Demography; Double-Blind Method; Female; Humans; Hydrocortisone; Male; Mometasone Furoate; Nasal Obstruction; Pregnadienediols; Rhinitis, Allergic, Perennial

To describe the long-term outcome of a cohort of children with symptomatic adenotonsillar hypertrophy treated with aqueous nasal beclomethasone.. The children enrolled completed a 4-week single-blind, saline solution controlled crossover study of aqueous beclomethasone (total: 400 micro g/d). In a 24-week open-label follow-on study, beclomethasone 200 micro g/d was offered to all patients. During a 100-week follow-up, the degree of nasal obstruction and the frequency of adenotonsillectomy were assessed.. Fifty-three children of the 60 enrolled completed the study. After the 4-week crossover trial, the severity of nasal obstruction of 24 children (45%) significantly decreased during the use of nasal steroids, but no child improved when saline solution was used. At 24, 52, and 100 weeks, the 24 children who had initially improved showed a significant decrease of the severity of nasal obstruction and of the frequency of adenotonsillectomy (54% vs 83%) compared with the 29 children who had not responded after the initial steroidal therapy.. Evidence from this study suggests that 45% of children with adenoidal hypertrophy improved after 2 weeks of steroidal therapy. Among these children, an additional 24-week treatment at a lower steroid dosage was associated with a significant 52- and 100-week clinical improvement and with reduction of adenotonsillectomy compared with children (55%) who had not responded after the initial 2-week steroidal therapy.

Topics: Adenoidectomy; Adenoids; Administration, Intranasal; Anti-Inflammatory Agents; Beclomethasone; Child; Child, Preschool; Cross-Over Studies; Female; Glucocorticoids; Humans; Hypertrophy; Male; Nasal Obstruction; Palatine Tonsil; Pilot Projects; Tonsillectomy; Treatment Outcome

Pediatric adenoidal obstruction of the nasal airway is associated with significant morbidity and is a frequent indication for surgery. Because efficacious medical alternatives to adenoidectomy are lacking, we assessed the potency of standard-dose topical nasal beclomethasone in reduction of adenoidal obstruction of the nasal airway.. Seventeen children, 5 to 11 years of age, exhibiting chronic obstructive nasal symptoms and a group mean (+/- SE) adenoid/choana ratio of 91 +/- 1% on rhinoscopic examination, completed an 8-week, double-blind, placebo-controlled crossover study of standard-dose aqueous nasal beclomethasone (total 336 micrograms/day) in the treatment of adenoidal hypertrophy. In a 16-week, open-label, follow-on study, subjects received beclomethasone 1 spray in each nostril twice daily (168 micrograms/day).. Over the initial 4 weeks, improvements in the mean adenoidal obstruction of the choanae were significantly greater in the group receiving beclomethasone than in the group receiving placebo (right, -14.0% vs. +0.4%, P = .0002) (left, -15.0% vs. -2.0%, P = .0006). In the subsequent crossover 4 weeks, a significant beclomethasone carryover effect resulted in further adenoid size reduction in both treatment groups. All patients demonstrated a decrease in adenoid size with beclomethasone treatment, compared with a mixed response to placebo. Over the full 8-week crossover study, the mean (+/- SE) obstructive symptom score after beclomethasone treatment (20.5 +/- 3.0) was significantly improved compared to patients' initial (43.1 +/- 2.9) and placebo scores (31.1 +/- 4.2, P < or = .05), despite the active drug carryover effect into the placebo treatment period. Significant improvements in adenoidal obstruction and symptom scores over the 8-week crossover study were enhanced in the subsequent 16-week open-label period (P = .0001). By 24 weeks, an 82% reduction in group mean nasal obstruction symptom score accompanied a 29% mean reduction in adenoid/choana ratio. No clinical or demographic characteristic predicted a patient's degree of response to treatment.. Properly administered aqueous nasal beclomethasone in standard doses can significantly reduce adenoidal hypertrophy and nasal airway obstructive symptoms in children.

Topics: Adenoids; Administration, Intranasal; Beclomethasone; Child; Child, Preschool; Cross-Over Studies; Double-Blind Method; Female; Humans; Hypertrophy; Male; Nasal Obstruction; Treatment Outcome

Intranasal budesonide and beclomethasone dipropionate (BDP), each administered as aqueous, aerosol formulations at dosages of 200 micrograms twice a day, morning and evening, were compared over a 3-week period in a randomized, parallel group study of 88 adults with seasonal allergic rhinitis. Budesonide treatment produced significantly lower mean symptom scores for the whole study compared with BDP for runny nose, itchy nose and sneezing (P < 0.05). The difference in nasal symptom scores produced by budesonide in comparison with BDP was particularly great towards the end of the treatment period. The budesonide-treated group also had lower scores for nasal blockage and two eye symptoms (runny and sore eyes), but the differences noted were not significant. Adverse events recorded by both groups were mild and transient. In conclusion, aqueously administered budesonide is likely to be of more clinical value than BDP for the control of seasonal allergic rhinitis.

Topics: Administration, Intranasal; Adolescent; Adult; Aerosols; Anti-Inflammatory Agents; Beclomethasone; Budesonide; Endophthalmitis; Female; Glucocorticoids; Humans; Male; Medical Records; Middle Aged; Nasal Obstruction; Pregnenediones; Pruritus; Rhinitis; Rhinitis, Allergic, Seasonal; Single-Blind Method; Sneezing

Study of the association between immunoglobulin-G (IgG) subclass deficiency and nasal polyposis.. Longitudinal study (5 years) in a prospective cohort of 161 nasal polyposis patients. Analysis of the association between humoral immunodeficiency, rhinologic symptoms, endoscopy score and prescribed doses of local and systemic corticosteroids.. The prevalence of IgG subclass deficiency was 13.7% (22/161). One patient was diagnosed with common variable immunodeficiency (CVID). No significant differences were observed between the groups with and without pre-treatment deficiency for symptom severity, endoscopic score or local or systemic corticosteroid regimens at baseline or during the 5 years, following initiation of medical and surgical treatment. Only the Lund-Mackay CT score was significantly higher in the pre-treatment deficiency group.. There was no correlation between the presence of humoral deficiency and either symptom evolution after medical and surgical treatment or the dose of corticosteroids needed to control disease. Thus, a link between IgG subclass deficiency and nasal polyposis seems unlikely.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Beclomethasone; Common Variable Immunodeficiency; Female; Glucocorticoids; Humans; IgG Deficiency; Longitudinal Studies; Male; Middle Aged; Nasal Obstruction; Nasal Polyps; Olfaction Disorders; Prospective Studies; Young Adult

Allergy does not modify the symptoms and steroid consumption (oral and local) of nasal polyposis (NP) patients after functional endoscopic sinus surgery (FESS).. To assess the role of allergy in the evolution after FESS of patients presenting with the diagnosis of NP.. This was a prospective study of 63 consecutive patients with NP (57% males, mean age 45.8 years), who were analyzed to detect whether the results of a surgical treatment of NP were influenced by the presence of positive allergic tests (Phadiatop). Three nasal criteria were scored: nasal obstruction, posterior rhinorrhea, and the loss of smell. The frequency of asthma was evaluated. Medical treatment of NP after FESS consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of consumption of steroids (prednisolone and beclomethasone) was studied.. Decrease of all nasal symptoms was not statistically different in the two groups of patients with and without allergy. Cumulative consumption of prednisolone and beclomethasone after surgery was similar in the two groups.

Topics: Adult; Asthma; Beclomethasone; Bronchial Hyperreactivity; Bronchial Provocation Tests; Combined Modality Therapy; Cross-Sectional Studies; Endoscopy; Ethmoid Sinusitis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasal Obstruction; Nasal Polyps; Olfaction Disorders; Postoperative Complications; Prednisolone; Recurrence; Respiratory Hypersensitivity

This prospective study is the first in the literature to present long-term results of a combined medical and surgical treatment in patients with nasal polyposis (NP) including strict inclusion criteria, analysis of the results in terms of clinical amelioration, polyp size reduction, and steroid consumption. The results of the present study show that combined surgery and corticosteroid therapy is effective in the treatment of NP.. Most publications on outcome after functional endoscopic sinus surgery (FESS) include patients with various pathologies. The aim of this study was to provide reference information for FESS in patients with NP with strict inclusion and exclusion criteria.. This was a prospective study involving 194 consecutive patients. Clinical symptoms, polyp size, and steroid consumption were evaluated before and after FESS (mean follow-up, 74 months). An actuarial analysis using the Kaplan Meier life table method was performed with regard to the 3- and 5-year symptoms control rates.. All symptoms were improved after FESS. The 5-year actuarial nasal obstruction control rate was 65.8%. The 5-year actuarial severe posterior rhinorrhea control rate was 82.9%. The 5-year actuarial smell loss and anosmia control rates were 17.7% and 65.8%, respectively. Polyp volume and steroid consumption decreased significantly after FESS.

Topics: Administration, Inhalation; Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Beclomethasone; Combined Modality Therapy; Dose-Response Relationship, Drug; Drug Administration Schedule; Endoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasal Obstruction; Nasal Polyps; Postoperative Care; Prednisolone; Prospective Studies; Tomography, X-Ray Computed

In general, steroid is mainly used as anti-inflammatory action in case of allergic diseases. As one of the side effects of inhalation steroid, a report is given below regarding buccal capsule/esophageal candidiasis. The patient came to the hospital with the chief complaint regarding passage dysphagia in the time of deglutition; pharyngitis and esophageal candidiasis were found by endoscopy of upper gastrointestinal tract.The interview after the endoscopy revealed that the patient, a 69-year-old female was diagnosed as chronic perennial allergic rhinitis a few years ago, and had been inhaling rhinenchysis Beclometasone dipropionate (BDP) before sleep every day for the past two years because using this collunarium seemed to mitigate the nasal obstruction and mucus during sleep. The patient did not report this fact before the endocsopy because she did not associate it with her subjective symptom. In this case, it was assumed that nebulized rhinenchysis BDP was accidentally swallowed to the pharynx and esophagus during sleep. As a treatment, rhinenchysis BDP was canceled and instead Azunol mouth washing (gargling/nasal douche) was used. No antifungal agent was used. In two weeks, the patient reported some improvement, and this was confirmed by reexamination of the upper gastrointestinal tract using endoscope in one month and a half. Pharyngitis was improved, and in the digital endoscopic assessment of esophageal candidiasis complicating inhaled steroid therapy the esophageal candidiasis became Grade I (mild grade). As for the later progress, the patient did not report any subjective symptoms such as nasal obstruction and dysphagia. In addition, the inflammation caused by candidiasis and found in the early examination was improved. The patient in this case was under treatment for thrombosis in the vein of lower extremity, but no complications such as diabetes mellitus or immune deficiency syndrome were observed.. Esophageal candidiasis by chronic administration of inhalation of steroid before sleep for asthmatic patients has been reported. However, there has not been a report of esophageal candidiasis by chronic administration of rhinenchysis steroid before sleep for patients with allergic rhinitis. Similarly, in the case of the use of steroid in the form of collunarium before sleep, steroid stayed in the esophagus via the transendothelial nasal cavity, and that seemed to cause, in the long run, to develop esophageal candidiasis.. One of the implications of the above case is that collunarium can go down, even when it is nebulized in the nasal cavity, to the esophagus via the nasal cavity to buccal capsule. This suggests the necessity for preventative measures in the case of chronic administration of steroid as follows. A. Blowing of the nose just after the use of collunarium B. Daily rinsing (gargling and nasal douche).

Topics: Administration, Inhalation; Aged; Beclomethasone; Candidiasis; Esophageal Diseases; Female; Glucocorticoids; Humans; Nasal Obstruction; Rhinitis, Allergic, Perennial; Sleep; Time

Allergy does not modify the symptoms of nasal polyposis, either initially or after a 1-year medical treatment.. To assess the role of allergy in the symptoms and treatment of patients presenting with the diagnosis of nasal polyposis.. Two simultaneous studies were carried out. In the first study, 180 consecutive patients with nasal polyposis (60% males, mean age = 48.4 years) were analyzed to detect whether the severity of their symptoms correlated with the presence of positive allergic tests. In the second study, 74 consecutive patients (57.5% males, mean age = 48.3 years) were analyzed to detect whether the results of a 1-year medical treatment of nasal polyposis were influenced by the presence of positive allergic tests (Phadiatop). Five nasal criteria were scored: nasal obstruction, anterior and posterior rhinorrhea, facial pain, and the loss of sense of smell. The frequency of asthma was evaluated. Treatment of nasal polyposis consisted of washing of the nasal cavities, steroid spray, and oral steroid administration. The amount of steroid consumption (prednisolone and beclomethasone) was studied.. In the first study, mean scores of nasal symptoms did not differ between the two groups of patients with and without allergy. The prevalence of asthma (p = 0.03) was higher in the group with than without allergy. In the second study, decrease of all nasal symptoms was not statistically different in the two groups. Cumulative consumption of prednisolone and beclomethasone between baseline and year 1 were similar in the two groups.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Asthma; Beclomethasone; Bronchial Provocation Tests; Comorbidity; Cross-Sectional Studies; Drug Hypersensitivity; Follow-Up Studies; Forced Expiratory Volume; Humans; Immunoglobulin E; Methacholine Chloride; Nasal Obstruction; Nasal Polyps; Olfaction Disorders; Prednisolone; Prospective Studies; Rhinitis, Allergic, Perennial