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Treatment of Nasal Inflammation Decreases the Ability of Subjects with Asthma to Condition Inspired Air

Section of Otolaryngology-Head and Neck Surgery, and The Section of Pulmonary and Critical Care Medicine, The Pritzker School of Medicine, The University of Chicago, Chicago, Illinois

Correspondence and requests for reprints should be addressed to Robert M. Naclerio, M.D., Section of Otolaryngology-Head and Neck Surgery, The Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637. E-mail: rnacleri{at}surgery.bsd.uchicago.edu

We previously showed that individuals with seasonal allergy have a reduced ability to condition air, which was improved by nasal inflammation. We also showed that subjects with asthma have a reduced ability to condition air. Because individuals with asthma usually have inflammation in the nose, we hypothesized that treatment with an intranasal steroid would reduce nasal inflammation and further decrease nasal conditioning capacity. We performed a randomized, double blind, placebo-controlled, 2-way crossover study on 20 subjects with asthma comparing the effect of treatment with intranasal budesonide for 2 weeks on nasal conditioning. Treatment with budesonide caused no significant effect on nasal conditioning as compared with placebo. When we evaluated the subgroup of nonsmoking subjects, budesonide caused a significant reduction in nasal conditioning. We speculate that nasal inflammation in nonsmoking individuals with asthma increases the conditioning capacity and reducing it with an intranasal steroid worsens the ability of the nose to condition air. In addition, smoking causes an increase in nasal conditioning capacity by non–steroid-dependent factors. These observations help us understand the pathophysiology of nasal conditioning, but do not negate the positive clinical benefits of budesonide on treating nasal inflammation.

Key Words: asthma • intranasal steroids • nasal conditioning • smoking

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