Intranasal budesonide for rhinitis during a high airborne pollution period: a randomized controlled trial

• Research
• Open Access
• 
  

• Yuan Zhang, 
• Chunguang Shan, 
• Weiwei Liu, 
• Yaozhong Han, 
• Guanggang Shi, 
• Yongjian Ma, 
• Kerstin Wagner, 
• Xiaoyan Tian, 
• Lili Zhang, 
• Allan Joseph Larona, 
• Steven Sacavage, 
• Kathleen Franklin, 
• Chengshuo Wang & 
• Luo Zhang 

Allergy, Asthma & Clinical Immunology volume 18, Article number: 56 (2022) 

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Abstract

Background

Air pollution may induce or reinforce nasal inflammation regardless of allergy status. There is limited direct clinical evidence informing the treatment of airborne pollution-related rhinitis.

Objective

To assess the effectiveness of intranasal budesonide in adults with self-reported rhinitis symptoms triggered/worsened by airborne pollution.

Methods

Adults in northern China with self-reported rhinitis symptoms triggered or worsened by airborne pollution were randomized to budesonide 256 µg/day or placebo for 10 days in pollution season (October 2019 to February 2020). The primary endpoint was the mean change from baseline in 24-h reflective total nasal symptom score (rTNSS) averaged over 10 days. The secondary endpoints were subject-assessed Global Impression of Change (SGIC), mean change from baseline in individual nasal symptom severity, and mean change from baseline in individual non-nasal symptoms of cough and postnasal drip severity. One-sided P < 0.0125 was considered statistically significant.

Results

After an interruption by COVID-19, an interim analysis showed that the study could be ended for efficacy with n = 206 participants (103/group) since the primary efficacy endpoint demonstrated significant results. The final efficacy results showed that the 10-day-averaged rTNSS change in the budesonide group was greater than with placebo (− 2.20 vs − 1.72, P = 0.0107). Budesonide also significantly improved 10-day-averaged itching/sneezing change (− 0.75 vs − 0.51, P = 0.0009). Results for SGIC and all other individual symptoms did not show significant differences between the two groups.

Conclusions

Intranasal budesonide 256 µg once daily improved the total nasal symptoms and itching/sneezing over 10 days in adults with rhinitis triggered/worsened by airborne pollution.

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