Replacement of SFC-DPI with SFC-MDI exhaled through the nose improves eosinophilic chronic rhinosinusitis in patients with bronchial asthma

• Published in: International journal of clinical pharmacology and therapeutics Vol. 55; no. 1; pp. 89 - 94
• Main Authors: Kobayashi, Yoshiki, Asako, Mikiya, Yamamoto, Takahisa, Yasuba, Hirotaka, Tomoda, Koichi, Kanda, Akira
• Format: Journal Article
• Language: English
• Published: Germany 01-01-2017
• Subjects: Asthma - complications; Asthma - diagnosis; Asthma - drug therapy; Chronic Disease; Dry Powder Inhalers; Eosinophilia - complications; Eosinophilia - drug therapy; Fluticasone-Salmeterol Drug Combination - administration & dosage; Fluticasone-Salmeterol Drug Combination - therapeutic use; Humans; Male; Metered Dose Inhalers; Middle Aged; Particle Size; Rhinitis - complications; Rhinitis - drug therapy; Severity of Illness Index; Sinusitis - complications; Sinusitis - drug therapy; Treatment Outcome
• ISSN: 0946-1965
• DOI: 10.5414/CP202633

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.
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.
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.
Fine particle ICS/LABA ETN might be an additional therapeutic option for refractory ECRS with severe asthma and corticosteroid insensitivity.
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