-Original-

One-Year Evaluation of Combined Treatment with an Intranasal Corticosteroid and Montelukast for Chronic Rhinosinusitis Associated with Asthma

Manabu Nonaka^1,2, Atsuko Sakanushi¹, Kaoru Kusama^1,2, Nozomu Ogihara^1,2 and Toshiaki Yagi¹

¹Department of Head & Neck and Sensory Organ Science, Graduate School of Medicine, Nippon Medical School
²Department of Otolaryngology, Nippon Medical School Tama Nagayama Hospital

Objectives: Chronic rhinosinusitis associated with asthma is often difficult to treat effectively with intranasal corticosteroids alone. Thus, the aim of this study was to evaluate the effectiveness of combination treatment with an intranasal corticosteroid and a leukotriene-receptor antagonist (montelukast) in reducing the size of nasal polyps.
Methods: The subjects of this study were 20 patients with chronic rhinosinusitis associated with adult-onset asthma, which was being treated with inhaled corticosteroids. All patients were treated with intranasal fluticasone propionate, 200 μg/day, and montelukast, 10 mg/day, for 1 year. The size of nasal polyps and the score of sinus shadows were assessed with nasal endoscopy and computed tomography (CT), respectively, before and after treatment. The peripheral blood eosinophil counts were also evaluated before and after treatment.
Results: Nasal polyps were significantly smaller after both 6 months (p<0.01) and 12 months of treatment (p<0.01) than before treatment. The decrease in the shadow score was statistically significant after both 6 months (p<0.01) and 12 months of treatment (p<0.01). Significant reductions in peripheral blood eosinophil counts were also seen after both 6 months (p<0.05) and 12 months of treatment (p<0.01). A significant correlation was found between the rate of change in the peripheral blood eosinophil count and that in the CT score after both 6 months (r=0.578, p=0.012) and 12 months (r=0.625, p=0.007).
Conclusion: Combined treatment with intranasal fluticasone propionate and montelukast, for at least 1 year, is effective for chronic rhinosinusitis associated with adult-onset asthma.

J Nippon Med Sch 2010; 77: 21-28

Keywords
chronic rhinosinusitis, eosinophils, intranasal corticosteroid, anti-leukotriene, asthma

Correspondence to
Manabu Nonaka, Department of Otolaryngology, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo 206-8512, Japan
nonaka@nms.ac.jp

Received, August 3, 2009
Accepted, August 31, 2009