Efficacy of intranasal fluticasone propionate and budesonide in management of allergic rhinitis—a prospective comparative study

Background Allergic rhinitis (AR) or Hay fever is a chronic inflammation of the nasal mucosa induced by IgE-mediated hypersensitivity due to exposure of various allergens. AR occurs as a response against these inhaled allergens that cause inflammation of nasal mucosal membranes. In this study, a reliable treatment for allergic rhinitis with maximum effectiveness and minimal side effects was assessed. This study compared the effectiveness of intranasal Fluticasone propionate (FUP) and intranasal Budesonide (BUD) in reducing the eosinophil count and in improving the nasal and ocular symptoms. This prospective study was conducted on 62 cases of allergic rhinitis and patients with mild-to-moderate allergic rhinitis were selected for the study. They were randomly divided into two groups; group I consists of 30 patients who received intranasal Fluticasone propionate aqueous spray, total daily dose of 200 μg (50 μg/spray) as 2 sprays in each nostril administered once daily, whereas the group II consists of 32 patients who received intranasal Budesonide aqueous spray, total daily dose of 400 μg/day (100 μg/spray) as 1 spray in each nostril administered twice daily. Results Analysis on patient-based symptom scores revealed that both the groups showed statistically significant reduction in symptoms. Fluticasone propionate was found to be significantly more effective (P < 0.05) than Budesonide in reducing sneezing, nasal itching and majority of symptoms of individual symptom scores. Budesonide showed somewhat similar effect in reducing nasal blockage at 4 weeks of treatment. Conclusion Clinically, both the drugs showed statistically significant improvement when compared to baseline, but Fluticasone propionate was superior at reducing nasal symptoms, ocular symptom and eosinophil count.

Trends in Nasal Spray Prescribing Patterns by Otolaryngologists in the US Medicare Population

Objectives: To quantify national and state-level prescribing and cost trends for the 3 most prescribed nasal sprays by otolaryngologists in the Medicare population. Methods: Through the Centers for Medicare and Medicaid Services (CMS) database and the Kaiser Family Foundation, we retrieved data on Medicare enrollment and on claims and costs of fluticasone propionate, azelastine HCl, and ipratropium bromide prescribed by otolaryngologists from January 1, 2013 to December 31, 2017. Results: From 2013 to 2017, CMS reimbursed $128.8 million for 5.2 million claims of fluticasone propionate, azelastine HCl, and ipratropium bromide prescribed by otolaryngologists. The national claim rate for fluticasone propionate increased 6.5% per year from 2013 to 2015 and then decreased 4.3% per year from 2015 to 2017 while azelastine HCl and ipratropium bromide consistently increased annually (19.0% and 12.2% respectively) from 2013 to 2017. The cost for fluticasone propionate decreased 33.0% a year from 2013 to 2015 and then increased 5.4% annually to $13.60 per claim in 2017. Azelastine HCl decreased 14.8% annually from $91.30 to $50.23 per claim and ipratropium bromide increased 5.2% annually to $34.78 in 2017. Variations in the claim rate and cost for all 3 nasal sprays were observed in some states. Conclusions: Otolaryngologists are prescribing azelastine HCl and ipratropium at an increasingly higher rate in the Medicare population, while the rate for fluticasone propionate has been decreasing nationally. Utilization and costs of nasal sprays also vary geographically across the United States.

Pretreatment With Fluticasone Propionate Increases Antibiotic Efficacy During Treatment of Late-Stage Primary Pneumonic Plague

Severe and late-stage pneumonias are often difficult to treat with antibiotics alone due to overwhelming host inflammatory responses mounted to clear infection. These host responses contribute to pulmonary damage leading to acute lung injury, acute respiratory distress syndrome, and death. In order to effectively treat severe and late-stage pneumonias, use of adjunctive therapies must be considered to reduce pulmonary damage when antimicrobial agents can be administered. Pneumonic plague, a severe pneumonia caused by inhalation of Yersinia pestis , is a fatal disease that causes death within six days without antibiotic intervention. Late-stage pneumonic plague is difficult to treat, as antibiotics must be delivered within 24 hours after onset of symptoms to be effective. Here, we use a murine model of primary pneumonic plague to examine how host inflammatory responses impact antibiotic treatment of late-stage pneumonic plague. We developed a murine infection model demonstrating the poor outcomes associated with delayed delivery of antibiotics. We show that pretreatment of mice with intranasal fluticasone propionate increased efficacy of delayed antibiotic delivery and enhanced murine survival. Mice receiving fluticasone propionate also showed decreased bacterial burden and reduced inflammatory pathology in the lungs. Further, we show that treatment and survival correlated with decreased levels of IL-6 and reduced neutrophil infiltration to the lungs. This work demonstrates how host inflammatory responses complicate treatment of late-stage pneumonic plague, and suggests that targeting of host inflammatory responses may improve treatment of severe, late-stage pneumonia.