What are corticosteroids and what are they used for in the treatment of diseases of the nasopharynx and respiratory system. Treatment of allergic rhinitis: the role of topical antihistamines Nasal corticosteroids comparative characteristics

The Standards recommended in the ARIA document updated in 2010 mention seasonal (short-term, intermittent) and chronic (persistent, perennial) rhinitis and three degrees of its severity - mild, moderate-severe, severe (3). According to the latest official WHO recommendations, mentioned in the ARIA document, two forms of allergic rhinitis are also distinguished - intermittent and persistent, as well as two degrees of severity of severity - mild and moderate / severe (Table 1) (2,3). There is a clear correlation between seasonal occurrence. allergens and the clinical picture of the disease, fully justifies such a classification.

Table 1. Classification of allergic rhinitis (Zhernosek V.F., based on ARIA, 2011) (2,3)

Since seasonal rhinitis is always caused by a specific allergen, during an exacerbation of the disease and with the appearance of new symptoms, this allergen can be accurately identified. It is more difficult to define it in chronic rhinitis, which can manifest itself as an allergic reaction to ticks, mold spores, and animal hair. In turn, short-term rhinitis has its own pathogenetic features. Short-term exposure to allergens results in the typical symptoms of mast cell degranulation and histamine release, such as itching, coughing, and runny nose. In chronic rhinitis, symptoms depend on the late stage cellular allergic reaction associated with eosinophilic infiltration, eventually leading to swelling of the nasal mucosa and respiratory tract. Thus, a patient may suffer from short-term rhinitis a couple of times a year against the background of persistent allergic inflammation and vice versa - chronic rhinitis during seasonal allergies (4). The definition of periodic and chronic rhinitis makes it impossible to simultaneously recognize any of them in a patient, because they "do not overlap": periodic rhinitis lasts up to 4 days a week or up to 4 weeks a year, chronic - more than 4 days a week and for more than four weeks a year (4).

Treatment standards

According to various estimates, in the world AR affects from 10 to 25% of the population (1). In the largest Polish study, ECAP, which aimed to study the epidemiology of allergic diseases in Poland, it was found that about 12-13% of the Polish population (about 4 million of the population ) need constant medication for the treatment of allergic rhinitis. Correct AR treatment is the key to stopping the progress of the disease to bronchial asthma. Numerous studies have shown that the correct treatment of allergic rhinitis using GCS can reduce the number of hospitalized patients during an exacerbation of asthma (5).

The treatment recommended by ARIA primarily limits contact with the allergen, and when symptoms appear, systemic antihistamines, antileukotrienes, anticholinergic drugs, systemic corticosteroids, and specific immunotherapy (3). In addition, the development of an allergic reaction can be prevented by the administration of IgE preparations, although they are still inaccessible due to their high cost (5).

Each of the treatments plays a role in AR therapy. Some of the drugs remove the symptoms, without affecting the allergens themselves and the inflammation they induce: sympathomimetics narrow the nasal mucosa, and anticholinergic drugs contribute to the formation of exudate. The mechanisms of action of the various drug groups have important therapeutic implications (Table 2). The ARIA standards for rhinitis attacks associated with the release of histamine recommend, first of all, antihistamines (AH), topically and systemically, due to their rapid therapeutic effect and high efficacy in blocking histamine-associated symptoms. However, these drugs have very little effect on chronic rhinitis.

The eosinophilic nature of the disease indicates the need for the appointment of glucocorticoid drugs.

The need to prescribe glucocorticoids

A Cochrane meta-analysis that compares the two main groups of drugs used for allergic rhinitis - antihistamines and glucocorticoids - shows that long-term use of glucocorticoids has an advantage over antihistamines (7). Glucocorticoids have a particularly beneficial effect in the treatment of edema of the nasal concha mucosa.

The recommendations of the American Academy of Allergy, Asthma and Immunology, the American College of Allergy and Immunology and the corresponding recommendations of most European countries define intranasal glucocorticoids as the first line of therapy (4). Antileukotriene drugs are indicated as adjunctive therapy for rhinitis associated with asthma (Table 3)

One of the main problems is the concomitant allergic conjunctivitis (AK) AR. Especially often the presence of two diseases is observed in patients who are allergic to seasonal allergens (grass and tree pollen). In this group, the coexistence of both of the above allergic inflammations is more than 75%. Less commonly, conjunctivitis can also occur with sensitivity to household allergens. Typical symptoms of acute allergic conjunctivitis (redness of the eyes, watery eyes, itching) are found with prolonged and / or sudden contact with a large number of allergens in the air or when the allergen is transferred to the conjunctiva, for example, when wiping the eyes with hands. As a rule, the therapy of combined AK / AR is based on oral and / or antihistamine eye drops or cromones (in the form of eye drops). However, in recent years, intranasal glucocorticosteroids have become increasingly important in the anti-inflammatory treatment of both edema of the nasal epithelium and edema of the conjunctiva (6).

Clinical efficacy of intranasal glucocorticosteroids

Intranasal glucocorticosteroids (corticosteroids, glucocorticoids) (GCS) were introduced into clinical practice for the treatment of AR in the late 1960s. The first drugs (dexamethasone and beclomethasone) were initially released as drops and, after several years, as nasal sprays. It is the large number of side effects with the systemic use of glucocorticoids that led to the emergence of various new forms of GCS. In the 70s of the last century, drugs such as beclomethasone dipropionate (1972), flunisolide (1975), and then, in the early 80s, budesonide appeared. Almost 20 years ago, new drugs entered the market: triamcinolone, fluticasone propionate and mometasone furoate. In the last decade, new generation drugs, ciclesonide and fluticasone furoate, have become widely available (8).

GCSi affect many components of the inflammatory process in the nasal mucosa in patients with AR, preventing the accumulation and migration of key cells involved in allergic inflammation, inhibiting the secretion of many inflammatory mediators, especially in the late phase of the inflammatory response associated with eosinophils. The comprehensive action of GCS on the inflammation focus leads to early (weak) and late (very strong) inhibition of the allergic reaction in the nasal mucosa (8).

These properties of GCS determine their clinical significance as the strongest group of anti-inflammatory drugs in the treatment of AR. It has been proven that GCS significantly reduce AR symptoms, such as sneezing, nasal congestion, itching, rhinorrhea, both in periodic (seasonal) and chronic forms of the disease (2). It is very important that these drugs remove the feeling of nasal occlusion (blockage) and breathing problems, improving the quality of life of patients with AR (Table 2).

Intermittent AR - moderate / severe (as alternative drugs)
Chronic AR - mild stage (as alternative drugs)
Chronic AR - moderate / severe stage (as one of the possible groups of drugs)

However, despite the recommendations of GCSi as possible or alternative groups of drugs, many studies have shown that GCSi are the most effective in the treatment of AR in both children and adults. They reduce not only the subjective symptoms of AR, but also affect the objective indicators of the patency of the nasal passages. It was found that these drugs suppress the growth of nasal resistance in children with seasonal AR during the season of grass flowering and pollen appearance, and very quickly increase air flow to the nasal passages in patients with pollen allergy (8). In patients with chronic AR, the use of GCSi also significantly improved the morning and evening values of air flow and the cross-sectional area of the nose (measured using the method of acoustic rhinometry in patients with perennial AR (4). Meta-analyzes over the past 10 years have shown an advantage in clinical efficacy of GCS in comparison with antihistamines of the first and second generation in the treatment of AR (8).

Pharmacological properties of intranasal corticosteroids

Each type of GCS has certain properties that determine its pharmacokinetic profile and its pharmacodynamic activity. The combination of these properties determines the other clinical effects of each type of GCS. This also applies to the effectiveness of influencing the symptoms of AR, and the safety of their application locally and systemically. The key features of GCS that determine their clinical efficacy and safety are (8):

Affinity for the receptor for GCS (rGCS) (related to the strength of the drug)
Plasma protein binding
System clearance
Plasma distribution
Lipophilicity
Bioavailability.

Affinity for rGKS

Fluticasone furoate (FF) has the strongest affinity for rGCS among the GCSi available today in the arsenal of clinical agents, and mometasone furoate is slightly less. Other drugs in this group have a significantly lower affinity for rGCS. This means that it is possible to use lower doses of FF compared to budesonide or fluticasone propionate in order to obtain an equivalent clinical effect. Clinical studies have confirmed these assumptions - a lower dose of PF is more effective - for the relief of AR symptoms, a dose of 27.5 mg of PF was required, while the dose of budesonide or fluticasone propionate was 50 mg (8).

Selectivity towards rGCS

Another important feature of any GCS is its selectivity towards rGCS. And in this case, FF has the highest selectivity among the aforementioned GCSi. The selectivity index for FF (the activity of GCS in relation to rGCS to the activity of GCS in relation to the mineralocorticosteroid receptor) is about 850, while for fluticasone propionate - about 585, mometasone furoate - about 18, budesonide - about 9 (8). High selectivity is a key factor determining the low risk of FF side effects associated with the activation of receptors other than rGCS receptors.

Lipophilicity

This property is an important factor in determining the solubility of a drug, since only a soluble drug can penetrate the cell membrane. Compounds with high lipophilicity penetrate the mucous membrane faster and stay in the nasal tissues longer, which increases the chances of a greater clinical effect of the drug (4). However, the high lipophilicity of GCSi can also be the reason for the increased risk of local side effects. Therefore, the ideal solution for this group is a drug with high lipophilicity, low systemic absorption and high systemic clearance (8). These criteria are met: mometasone furoate, fluticasone propionate, ciclesonide and FF, and the rest of the GCSi group have much lower lipophilicity (4).

Bioavailability

Another important parameter from the point of view of the safety of GCS use is bioavailability, which includes both nasal bioavailability and bioavailability from the gastrointestinal tract. From this point of view of this characteristic, different GCSi differ significantly from each other. To understand the various aspects of the systemic bioavailability of an individual GCS, it is necessary to analyze its metabolism. Most of the drugs are administered intranasally (70-90% of the dose), swallowed, entering the liver. The remainder is distributed in the tissues of the nose (10-30%), where it exerts its clinical effect and enters the systemic circulation. There, depending on the degree of binding to plasma proteins, the fraction of free GCS remains, on which the possible conditions for the occurrence of any systemic side effects depend. It should be borne in mind that some GCSi in the process of metabolism in the liver form active metabolites that increase the pool of free drug in the blood. This effect is not inherent in ciclesonide, fluticasone propionate and FF, which makes the use of these drugs beneficial from the point of view of safety (8).

The higher the systemic bioavailability (total nasal and oral bioavailability) of a given GCS, the higher its systemic exposure and systemic side effects. However, it should be remembered that systemic bioavailability is not the determining and only factor in the occurrence of systemic side effects. However, this means that patients taking GCSs with very low systemic bioavailability may experience fewer systemic side effects compared to other GCSs, which is especially important in the treatment of AR in children.

Fluticasone furoate (FF) - new generation GCS

Works on the synthesis and launch on the market of the "ideal intranasal glucocorticoid", which would meet all the listed requirements for efficacy and safety, have been carried out since 2000. In 2008, a drug with unique pharmacological properties, close to the "ideal GCS" - fluticasone furoate (FF), appeared on the European market. very low bioavailability, almost complete elimination of the drug from the body after the first metabolic cycle in the liver, and a very high degree of binding to plasma proteins (4). Fluticasone furoate is rapidly excreted by extensive first pass metabolism involving cytochrome P450 and isoenzyme 3A4. Only 1-2 % of the drug is excreted in the urine. It can be assumed that the metabolism of glucocorticosteroids has the same metabolic pathway as some other drugs that undergo hepatic metabolism (for example, ketoconazole). However, the excellent results of the pharmacodynamics of FF indicate a relatively small increase in its level in blood with simultaneous administration and other drugs metabolized through the cytochrome P450 system. FF is rapidly excreted from the bloodstream (plasma clearance = 58.7 L / h). The half-life after intravenous administration is on average 15.1 hours (4).

One of the main features of FF is the unique nature of its connection with the receptor. PF was obtained by synthesizing fluticasone particles with furoate. As a result, a fundamentally new glucocorticoid with pronounced anti-inflammatory properties and high affinity for rGCS has appeared. Compared to other corticosteroids, this drug better affects the integrity of the nasal mucosa, reducing its permeability in response to mechanical irritation, inhibiting the transcription factor (NF-KB) better than other glucocorticoids. In animal studies, at a dose of 30 μg, FF showed complete inhibition of the influx of eosinophils into the lung tissue, which is higher than that of fluticasone propionate (11).

The high efficiency of FF in the treatment of various forms of AR has been confirmed in both adults and children (2,4). FF acts very quickly, as after the first day in patients with pollen allergy, a decrease in the intensity of clinical symptoms was observed. The maximum effect in this group of patients was achieved after 10-12 days of treatment (2). In numerous studies (a total of more than 3000 people with seasonal and perennial rhinitis), FF has shown a significant difference in the control of symptoms of rhinitis and conjunctivitis compared with placebo (8). At the same time, it was shown that the drug does not affect intraocular pressure and has minor side effects. With 12 months of treatment for perennial allergic rhinitis in a study of 605 patients, systemic side effects were no more common than in the placebo group. In this study, as in many others, side effects were local in nature, for example, bloody nasal cavity, less often epithelial ulcers. In general, side effects appeared in only 10% of respondents (10).

All studies available to date confirm the good tolerance and local high safety of FF in adults, children and adolescents. A summary of three studies on the tolerability and safety of topical FF in children was recently presented by Giavina-Bioanchi et al. (8) Symptoms and disorders reported by patients or detected by doctors appeared with the same frequency in the groups taking the lower dose of FF (55 mg / day), or the higher dose of FF (110 mg / day) and in the group taking placebo (p> 0.05).

The most important systemic side effects resulting from the long-term use of FF, noted in the course of the studies, were a slight slowdown in the growth rate of children and suppression of the activity of the hypothalamic-pituitary-adrenal axis. showed significant adverse effects of long-term administration of FF on the function of the hypothalamic-pituitary-adrenal axis in adults and in children aged 2-11 years (4,8).

Particularly interesting results have emerged when testing FF in the treatment of AR with concomitant ocular symptoms. Since the mid-80s of the last century, hypotheses have been expressed about the beneficial effect of GCS on eye symptoms in patients with seasonal allergic rhinitis and conjunctivitis (rhinoconjunctivitis) (9), but the mechanism of this effect has not yet been fully understood. Some GCSi, and especially FF, for a relatively short time of use, reduce the main symptoms of allergic conjunctivitis in patients with AR to pollen. In one of the studies, it was shown that lacrimation is significantly reduced already on the second day, and itching in the eyes and redness - on the fourth day of therapy (9). The effectiveness of the mechanism for controlling eye symptoms is not fully understood, but the results of clinical trials in this case are very promising. In the 2010 ARIA standards, there is no conclusive recommendation for the use of intranasal glucocorticosteroids in the treatment of allergic conjunctivitis, but a beneficial effect of this treatment is mentioned (3). Recent data on FF provide support for intranasal therapy with this drug in rhinoconjunctivitis in order to control nasal and ocular symptoms, and the effectiveness of the drug in relation to the latter may depend on the degree of affinity for receptors of the nasal mucosa (6).

Thus, FF is a glucocorticosteroid that, due to its high affinity for the rGCS receptor, exhibits unique properties: a high safety profile at low daily doses (110 mg in adults and 55 mg in children), required only once a day, which promotes patient adherence to treatment, a minimum of side effects with a long course of treatment and a persistent preservation of the anti-inflammatory effect.

Conclusion

AR is a common disease, the decisive importance in the effectiveness of therapy is timely diagnosis and correctly selected treatment. The 2010 ARIA standards primarily recommend limiting contact with the allergen, and when AR symptoms appear, the use of systemic antihistamines, antileukotrienes, anticholinergics, and systemic corticosteroids. However, recent studies convincingly indicate that intranasal GCS is the most effective way to treat AR. Intranasal glucocorticoids (GCS) effectively affect AR symptoms - sneezing, itching, nasal congestion, rhinorrhea - in children and adults with both seasonal and perennial rhinitis. The most effective and safe corticosteroids are drugs of a new generation with a high affinity for receptors for corticosteroids, low bioavailability and a minimum of side effects. These drugs include a new class of drugs - fluticasone furoate (FF), which has unique capabilities in the treatment of seasonal and perennial rhinitis, as well as an ideal efficacy and safety profile.

Bibliography

E. M. Dityatkovskaya. The role of cromones in the treatment of allergic rhinitis. Allergology and Pulmonology, No. 246,2008.
Zhernosek V.F. New possibilities for the treatment of allergic rhinitis. Medical News, No. 5,2011. Allergic Rhinitis and Its Impact on Asthma Guidelines 2010 - V. 9/8/2010
Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision
B. Samoliński, Flutykortyzonu furoinian - nowy glokokortykosteroid w terapii alergicznego nieżytu nosa, Alergia, # 3, 2008.
Adams RJ .; Fuhlbrigge AL; Finkelstein JA. i wsp. "Intranasal steroids and the risk of emergency departament visits for asthma"; Journal Allergy Clinical Immunology, 2002; 109 (4): 636-642.
Yáńez A .; Rodrigo GJ. "Intranasal corticosteroids versus topical H1 receptor ... with meta-analysis"; Ann Allergy Asthma Immunol. 2002; 89 (5): 479-84.
Nathan RA. The pathophysiology, clinical impact, and management of nasal congestion in allergic rhinitis. Clin Ther. 2008 Apr; 30 (4): 573-86.
A. Emeryk, M. Emeryk. Glikokortykosteroidy donosowe w terapii ANN - podobieństwa i różnice. Alergia, # 1,2009.
L. Bielory, C. H. Katelaris, S. Lightman, R. M. Naclerio, Treating the Ocular Component of Allergic Rhinoconjunctivitis and Related Eye Disorders. Medscape General Medicine. 2007; 9 (3): 35
Rosenblut A .; Bardin PG .; Muller B. et al "Long-term safety of fluticasone furoate nasal spray in adults and adolescents with perennial allergic rhinitis", Allergy, 2007; 62 (9): 1071-1077 33.
Salter M, Biggadike K, Matthews JL, West MR, Haase MV, Farrow SN, Uings IJ, Gray DW. Pharmacological properties of the enhanced-affinity glucocorticoid fluticasone furoate in vitro and in an in vivo model of respiratory inflammatory disease. Am J Physiol Lung Cell Mol Physiol. 2007 Sep; 293 (3): L660-7. Epub 2007 Jun 15.

Hormonal drops for nasal congestion help relieve swelling and inflammation, while not exerting a vasoconstrictor effect. The main active ingredients of such drugs are glucocorticosteroids, which normalize vascular tone, in contrast to conventional sprays for the common cold.

Hormonal sprays are indicated for the following diseases:

Long-term treatment of the common cold with vasoconstrictor drops often leads to the development of a drug-induced form of rhinitis. The body gets used to the action of the drugs and can no longer independently regulate the secretion of mucus from the nose.

The patient has a constant nasal congestion, the use of drops has a temporary effect. In this case, sprays and nasal drops with hormones are the only optimal option for normalizing breathing and treating a runny nose.

Glucocorticosteroids have a pronounced anti-inflammatory effect. With allergic forms of the common cold, the use of drugs of this group will quickly relieve swelling and inflammation.

Popular drugs

All hormonal drugs for the common cold contain a glucocorticosteroid.

The active substance of the drug may be:

Sprays from the common cold work locally and do not have a systemic effect on the entire body. The doctor should select the drug and the duration of the course of treatment.

To treat chronic or allergic rhinitis, the spray should be used for a long time, for two or three weeks, depending on the severity of the symptoms.

Pregnancy is not an absolute contraindication to the use of intranasal hormonal sprays. Women carrying a child can use drugs in this group, but only as directed by a doctor. This is due to the lack of data on the effects of glucocorticoids on the fetus.

Beclomethasone sprays

Beclomethasone is used to treat rhinitis due to the rapid absorption of the drug by the mucous membrane. The effect appears a few minutes after the application of the drug.

Beclomethasone-based hormonal nasal sprays are named Beconase, Nasobek, and Aldecin.

Beconase

Spray Beconase is used to treat rhinitis of any nature, including those provoked by infections. The medicine is recommended for the treatment of allergic rhinitis, since with regular use it helps to reduce the intensity of symptoms that occur when an allergic reaction reappears.

Absolute contraindications for the use of Beconase are tuberculosis, candidal skin lesions and childhood. Individual intolerance to the drug is manifested by urticaria and dermatitis.

Nasobek

Spray Nasobek is used for chronic and allergic rhinitis, as well as as an adjuvant in the treatment of sinusitis.

It comes in a small plastic bottle with a dispenser. One press on the dispenser delivers one therapeutic dose of medication. The absolute contraindications for the drug include:

first trimester of pregnancy;
systemic fungal infections;
viral diseases;
tuberculosis;
bleeding from the nose.

If the patient regularly encounters nosebleeds, it is necessary to consult with an otolaryngologist. In this case, the use of hormonal sprays may be prohibited, since glucocorticosteroids affect the vascular tone.

Aldecin

Spray Aldecin is indicated for the treatment of rhinitis and is used as an adjunct in the treatment of polyposis of the nasal mucosa. The use of the drug can reduce mucosal edema.

Beclomethasone has an anti-inflammatory effect, so the medicine can be used for sinusitis in conjunction with other drugs recommended by the doctor.

In contraindications to the use of Aldecin, pregnancy and lactation are not indicated. However, women are advised to consult a doctor about the safety of treatment with this drug.

Like other drugs with beclomethasone, Aldecin spray is contraindicated in the following cases:

systemic fungal and bacterial infections;
tuberculosis;
nosebleeds and mucosal damage;
individual intolerance to the components of the drug.

Important! Sprays with glucocorticosteroids can impair tissue regeneration and are therefore not used after surgery or nasal injuries.

Medicines containing beclomethasone can be used in children over 6 years of age.

Fluticasone based drugs

The corticosteroid fluticasone has a pronounced anti-edema effect and reduces mucosal inflammation. Sprays with this active ingredient form the basis of the treatment of allergic rhinitis.

Popular intranasal drugs based on fluticasone are Avamis, Fliksonase and Nazarel.

Avamis

A feature of the Avamis spray is the possibility of using it for children over the age of two and for pregnant women, but only as directed by a doctor.

An absolute contraindication to the use of Avamis spray is a violation of the liver.

Fliksonase

Spray Fliksonase allows you to quickly relieve allergic swelling of the nasal mucosa. The medicine can be used in the treatment of hay fever. This spray is not indicated for pregnant women or children under four years of age.

Nazarel

Nazarel is used to treat allergic rhinitis.

The drug is not prescribed for women during lactation, since there is a high probability of release of the active substance into breast milk.

Children under four years of age should not use the medicine.

The instructions do not contain contraindications for the use of the spray by pregnant women, but doctors recommend refraining from using the medicine in the first trimester.

Hormonal intranasal medications can cause a number of side effects. With individual intolerance, urticaria or allergic dermatitis on the face may appear. Local side effects are common - dryness of the mucous membrane, short-term nosebleeds, itching and irritation of the nasopharynx.

Sprays with mometasone

The most popular drug with mometasone is Nasonex spray. The medicine is available in various dosages and is intended for the treatment of allergic sinusitis and chronic rhinitis. Due to its prolonged action, the drug is used only once a day. One application of the spray is enough to allow you to breathe freely all day.

With rhinitis of an allergic nature, the medicine can be prescribed to children over two years old.

Also, the spray is prescribed as a therapeutic agent against the common cold against the background of adenoid vegetations in children.

During pregnancy, the spray can be used, but in a small course. Long-term use of the medication can harm the fetus.

The Dezrinit spray also contains mometasone. In general, the action, side effects and contraindications of different hormonal intranasal sprays do not differ.

Conclusion

When using a drug based on synthetic glucocorticoids, it should be remembered that the therapeutic effect is achieved only with regular use of the drug. Unlike vasoconstrictor drops, these sprays do not provide immediate relief. The result becomes noticeable 5-7 days after the start of treatment.

In the treatment of sinusitis, hormonal agents are used as an auxiliary therapeutic agent to reduce swelling of the mucous membrane.

Due to the peculiarities of pharmacodynamics, intranasal hormonal drugs are available only in the form of a spray with a dispenser. This form of release allows you to avoid overdose, which often happens when using drops.

The course of treatment with hormonal drugs is selected individually for each patient. In order to prevent seasonal exacerbation, the spray can be used according to the instructions one and a half to two weeks before the beginning of the flowering of allergenic plants.

Directory of major ENT diseases and their treatment

All information on the site is for informational purposes only and does not claim to be absolutely accurate from a medical point of view. Treatment must be carried out by a qualified doctor. Self-medication can hurt yourself!

Sinusitis nasal spray - a list of the best sprays for treatment

Sprays are considered to be a fairly popular, functional and convenient pharmacological form of drugs. Especially often, such systems are used in drugs intended for the treatment of the nasopharynx. A small hand pump allows you to efficiently and quickly deliver a properly dosed dose of medication through the nasal passage right into the sinuses. Nasal sprays for sinusitis are topical drugs and do not cause problems with the liver, pancreas, intestines and other organs as when taking the tablet form of drugs. Thanks to the convenient dispenser and the even distribution of the active ingredient over the mucous membrane, the patient using the sprays gets a better result compared to conventional nasal drops.

What are they?

Sprays are different. Most modern drugs of this type that are present on pharmacy shelves alleviate the course of the disease and relieve its symptoms, and only a few of them really eliminate the cause of the problem.

Vasoconstrictor sprays

This type of medication relieves the symptoms of nasal congestion and dries the mucous membranes slightly. In addition, the edema of the membrane decreases and breathing through the nose is normalized. You can use this kind of drugs for no more than a week, since the body quickly gets used to the systemic action and the positive effect disappears, being replaced by even greater nasal congestion and even medication rhinitis. All vasoconstrictor sprays are contraindicated in pregnant and lactating mothers.

Vibrocil is a complex vasoconstrictor spray based on phenylephrine and dimethindene maleate. Provides not only air permeability of the nasal passages, but also has an anti-allergic effect, simultaneously reducing abundant exudation. The spray can be used by children from the age of six. To obtain a lasting effect, one full injection into each nostril is enough. There are practically no side effects if you do not use it for more than a week in a row.
Sanorin is a drug based on naphazoline. An inexpensive spray has a systemic effect on the vessels of the mucous membranes, reducing swelling. The effect of the application lasts for three to four hours. Contraindicated in children under twelve years of age and in patients with arterial hypertension. Side effects include burning in the mucous membranes, headache and tachycardia. You can use this type of spray for no more than five days in a row, one spray three times a day.
Tizine is a xylometazoline-based vasoconstrictor. The therapeutic effect of the spray appears a few minutes after use and lasts for six to eight hours. The product can be used by children from the age of six. Possible side effects are reactive hyperemia, headache, burning of the mucous membrane. Spray Tizin should not be used together with monoaminoxylase inhibitors.

Moisturizing Sprays

This type of nasal spray moisturizes the nasal mucosa, eliminates allergens and gently cleanses the sinuses. Almost all such drugs have no contraindications and can be used from the first days of life, since they contain only prepared saline solution.

Salin is a preparation based on ionized salt water. It can be used from the first day of life, effectively and quickly moisturizes the mucous membranes of the nose and paranasal sinuses, and provides a gentle dilution of mucus. Has no side effects.
Aqua-Maris is a combined spray system with a convenient dispenser based on purified ocean water. Helps to liquefy mucus, removes pathogenic microbes from cavities, moisturizes mucous membranes. The drug has no contraindications and age restrictions.
Morenazole is a moisturizing spray based on ionized sea water. Has a cleansing and thinning effect, has no side effects and contraindications.

It is worth noting that it is a good idea to use rinsing of the nose for sinusitis, in which saline solutions are usually used.

Sprays-Mucolytics from sinusitis

This type of spray not only helps to thin the viscous mucus, but also effectively flushes it out of the sinuses.

Sinuforte is a drug for the effective treatment of sinusitis. The components of the spray are plant-based (cyclamen) and when they get on the mucous membranes, they quickly liquefy stagnant snot, irritating the membranes, which in turn stimulate the removal of secretions from the nasal passages. In addition, the general condition of the nasopharynx normalizes, and swelling decreases. Spray Sinuforte can be used by children from the age of twelve, two injections once a day. The average course of treatment is six to fourteen days. Possible side reactions - profuse tearing, burning in the nose, redness of local areas on the face. The spray should not be used by pregnant women, people under twelve years old, patients with hypertension, polyposis and cystic sinusitis, as well as allergy sufferers.
Rinofluimucil is a combined mucolytic nasal spray based on tuaminoheptane and acetylcysteine. It has anti-inflammatory, mucolytic and pronounced antioxidant effects, reduces edema and hyperemia. Can be used by children over six years old. Dosage: 1-2 sprays three times a day for no more than a week. Possible side effects include dryness of the mucous membranes, palpitations, allergic reactions, and CNS excitation. Contraindicated in pregnant women, patients with glaucoma, thyrotoxicosis and those taking MAO inhibitors, as well as allergy sufferers.

Corticosteroid sprays

The above type of sprays significantly slows down inflammatory processes, however, it can be used only for a short period of time and strictly according to the doctor's prescription. Effective against a very strong blockage of the nasal air passages, some types of sinusitis and polyps. Compared to broad-spectrum systemic corticosteroids in tablet form, this type of hormonal fluid does not have such strong side effects, since it is used topically.

Beconase is a spray based on an intranasal corticosteroid from the adrenal cortex. It has a powerful anti-allergic, anti-edematous and anti-inflammatory effect, partially enters the circulatory system. You can use the spray strictly according to the instructions prescribed by your doctor, and a clear therapeutic effect is observed five days after the start of the course. Beconase can be used for a long period of time. From side effects, there are bleeding from the nose, burning of the mucous membranes, rarely - allergic reactions and perforation of the nasal septum. It can be used by children from six years of age and pregnant women, it is contraindicated in patients with hypersensitivity to the drug component.
Nazonex is a local anti-allergic and anti-inflammatory spray based on adrenal cortex hormones. It inhibits the development of infections, does not penetrate the bloodstream, and is more effective against allergies of various etymologies. Can be used by children from two years of age and pregnant women, the drug effect is visible a day after application. The dose of the drug is determined exclusively by the attending physician, usually it is 2 injections into each nostril throughout the day, the course of treatment is from six to twelve days. Possible side effects are burning, exacerbation of pharyngitis, headache, and very rarely - perforation of the nasal septum. Contraindicated in children under two years of age, patients with tuberculosis of any form, people with nasal injuries, as well as those who have fungal or viral forms of diseases of the respiratory system.

Antibiotic sprays

Topical antibiotic sprays are a good alternative to broad-spectrum antimicrobials in tablet form.

Bioparox is an inhalation antibiotic spray based on fusangin, which has a powerful bacteriostatic effect on most pathogenic microorganisms. It can be used both through the nasal passages and through the mouth. Approved for use in children from 2.5 years of age, the course of treatment does not exceed a week. The dosage is one to two doses of the medicine three times a day. Possible side effects: allergic reactions, dryness and burning of the mucous membranes, nausea, redness of the eyes, in rare cases - anaphylactic shock. Pregnant women are prescribed with caution, it is contraindicated for allergy sufferers and persons under 2.5 years of age.
Isofra is an antibiotic spray based on framycetin. It has a pronounced antimicrobial activity, does not enter the bloodstream. Intranasal course: one injection three times a day for no more than ten days. Contraindicated in children under one year of age and people with allergies. Possible side reactions: systemic symptomatic allergy.

Useful video

Treat correctly, choose the sprays that are suitable for your situation and, if necessary, be sure to contact a specialized ENT clinic!

What are corticosteroids and what are they used for in the treatment of diseases of the nasopharynx and respiratory system

Synthetic and natural corticosteroids come to the rescue when other anti-inflammatory drugs are powerless.

Corticosteroids

This is the collective name for a group of steroid hormones. They are produced only by the adrenal glands. These hormones have no androgenic, estrogenic, or gestaminic activity.

The type of hormone is determined by its main activity.

Glucocortisoids

They are glucocorticoids. The main hormones of this type that are synthesized in the human body are cortisone and hydrocortisone (aka cortisol).

They affect carbohydrate metabolism in the human body, as well as the metabolism of proteins and fats.

Mineralocortisoids

They are mineralocorticoids. The main hormone of this type, which is produced by the adrenal glands, is aldosterone. Hormones of this type affect the body's water-salt balance.

Indications

Among the diseases for which corticosteroids are used:

For the drugs of the corticosteroid group, see our video:

Drugs

In the European classification, four groups of synthetic corticosteroids are distinguished: weak, moderate, strong, very strong. The main properties of such drugs are anti-inflammatory and depressing immunity. Additional properties include:

Antiallergic
Adjusting the water-salt balance
Regulation of calcium metabolism
Regulation of carbohydrate metabolism
Regulation of protein metabolism
Regulation of fat metabolism
Effects on the cardiovascular system
Effect on blood
Influence on the hormonal system

There are the following treatment options with these drugs:

Injections

Medications for Breathing Problems

Intranasal

Most often used for allergic rhinitis and purulent inflammation in the maxillary sinuses.

They quickly facilitate breathing through the nose, stop the development of pathogenic microflora on the mucous membranes.

Drops

Drops are used to treat diseases of the nose and eyes, often with allergies or with viral, bacterial, fungal, infectious inflammatory processes. Short courses are used.

Creams, ointments

These drugs are used mainly for dermatological diseases. Most often these are combined drugs - in addition to topical corticosteroids, they contain components with antiseptic, anti-inflammatory and antibiotic effects:

Inhalation

Inhalation is done for bronchial asthma and prolonged spastic conditions of the bronchi.

Budesonide
Fluticasone propionate
Triamsinalon
Flunisolide
Beklazon Eco
Beclamethasone dipropionate
Klenil
Benacourt
Beklospir
Budenite Steri-Neb
Pulmicort Turbuhaler
Depo-medrol
Diprospan
Tafen Novolizer
Bekodisk

Inhaled corticosteroid preparations

Medicines come in the form of ready-made solutions, emulsions and powders. In accordance with the instructions of the doctor, the filler for the inhaler is prepared and used according to the prescribed scheme.

This corticosteroid use is also very safe relative to others.

Instructions for use

The instruction depends on the selected drug and its dosage form. Consult your doctor and do not neglect the information from the attached instructions when purchasing.

The drugs are tried to be used during the natural activity of the adrenal glands.

Side effects

When using weak and moderate drugs, side effects are less common and less pronounced. Possible side effects include:

Edema
High blood pressure
High blood sugar (up to and including corticosteroid diabetes)
Osteoporosis
Aseptic necrosis of bone tissue
Stomach ulcer (exacerbation or occurrence)
Gastric and intestinal bleeding
Increased thrombus formation
Weight gain
Secondary immunodeficiency (the appearance of infections, often fungal and bacterial)
Menstrual irregularities in women
Neurological disorders
Development or exacerbation of glaucoma
Development or worsening of cataracts
Skin atrophy
Increased perspiration
The appearance or aggravation of acne
Slowing down the processes of tissue regeneration (for example, long wound healing)
Enhanced facial hair growth
Suppression of the functions of the adrenal glands
Unstable emotional state
The appearance or aggravation of depression
Itsenko-Cushing's cider

Side effects of corticosteroid use:

Overdose

Overdose rarely causes life-threatening conditions. Most often, these or those side effects appear.

special instructions

How to take hormonal drugs, says Dr. Komarovsky:

Drug interactions

Antacids reduce the absorption of drugs from the gastrointestinal tract
Barbiturates, Hexamedin, Diphenin, Rifampicin, Carbamazepine and Diphenhydramine accelerate the metabolism of corticosteroids in the liver
Erythromycin, Isoniazid slow down the metabolism of corticosteroids in the liver
Corticosteroids accelerate the excretion of salicylates, Butadion, barbiturates, Digitoxin, Penicillin, Diphenin, Chloramphenicol and Isoniazid from the body
Co-administration with Isoniazid causes mental disorders
Co-administration with reserpine causes depressive conditions
Tricyclic antidepressants with corticosteroids increase intraocular pressure
With prolonged use, corticosteroids increase the effectiveness of adrenergic agonists
Theophylline enhances the anti-inflammatory effect and contributes to the cardiotoxic effect
Amotericin, diuretics can increase the diuretic effect, lead to sodium retention or a decrease in potassium in the blood
Simultaneous intake of mineralocorticoids and glucocorticoids aggravates hypokalemia and hypernatremia, and hypokalemia enhances the side effects and effects of cardiac glycosides
Laxatives Increase Potassium Decrease
Butadione, indirect anticoagulants, ibuprofen, and ethacrynic acid may contribute to hemorrhagic manifestations, especially bleeding
Sallicylates, Indomethacin contribute to ulcerative lesions of the gastrointestinal tract
The combination with paracetamol increases the toxic effect on the liver
Retinol preparations weaken the anti-inflammatory effect, but improve wound healing
Azathioprine, Methandrostenol, Hingamin, together with hormones, increase the risk of cataracts and other side effects
Decrease in the effectiveness of antihyperglycemic drugs
Reducing the effectiveness of Cyclophosphamide
Reducing the antiviral effect of idoxuridine
Estrogens enhance the action of corticosteroids
Androgens and iron supplements increase the formation of red blood cells, reduce the excretion of hormones, increase side effects, especially increased blood clotting, menstrual irregularities, sodium retention
Reduction to Fentanyl required
The initial stage of anesthesia is longer, the total duration is shorter.

Feedback on application

The drugs are undoubtedly effective; with proper use and control by medical professionals, they deserve positive reviews from doctors and patients. With illiterate use, the treatment of the consequences will also take a long time.

Intranasal corticosteroids: drug characteristics

Corticoids are hormonal substances produced by the human adrenal cortex. There are several types of them - mineral and glucocorticoids. Preparations that contain only one type of the hormonal substances listed are called corticosteroids. Intranasal corticosteroids are the most commonly used form of these medications in otolaryngology.

Properties of corticosteroids

Synthetic glucocorticoids have the same properties as natural ones. Nasal corticosteroids, like other forms of hormonal drugs, have pronounced anti-inflammatory and anti-allergic effects. The anti-inflammatory effect is based on the inhibition of the production of active substances (leukotrienes, prostaglandins), which take part in the protective function of the body. There is also a delay in the multiplication of new protective cells, which significantly affects local immunity. The antiallergic action of hormonal drugs is performed by inhibiting the release of allergy mediators, in particular, histamine. As a result, a long-term (throughout the day) anti-edema effect is achieved.

Due to all of the above properties, nasal hormonal preparations are indispensable for many inflammatory and allergic diseases of the nose.

Use of nasal corticosteroids

Currently, in the practice of an ENT doctor, the use of hormonal groups of drugs is widespread, based on their high efficiency. Most often they are prescribed for diseases that arise against the background of contact with an allergen:

Nasal corticosteroids effectively eliminate local allergic manifestations, namely sneezing, nasal congestion, rhinorrhea.

Drugs are also prescribed for vasomotor rhinitis in pregnant women. In this situation, they significantly improve nasal breathing, but do not contribute to a complete cure.

When polyps are detected in the nasal cavity, the use of nasal hormonal drugs, at the moment, has no alternative among other methods of drug treatment.

Before using the nasal hormonal agent directly, it is important to establish the cause of the disease.

It must be remembered that these drugs do not affect the pathogen itself (viruses, bacteria), but only eliminate the main local manifestations of the disease.

Contraindications

In most cases, taking glucocorticoid drugs is well tolerated by patients. Despite this, there are a number of restrictions on their purpose:

Hypersensitivity to drug components.
Tendency to nosebleeds.
Younger childhood.

Taking hormonal drugs for pregnant women is prescribed with caution, and during breastfeeding they are not at all recommended for use.

Side effects

The most often undesirable clinical manifestations on the part of the body occur during their prolonged and uncontrolled use.

Soreness in the nasopharynx.
Dryness of the nasal mucosa.
Bleeding from the nasal passages.
Headaches, dizziness, drowsiness.

If corticosteroid drugs are used for a long time in high doses, the risk of developing candidiasis in the nasopharynx area increases.

The possibility of such clinical manifestations remains rather low, since intranasal hormonal drugs, unlike tablets, act only locally and are not absorbed into the bloodstream.

Forms of issue

Intranasal hormonal drugs are available in the form of drops and sprays. It is necessary to instill the medicine in the nose in a supine position, with the head thrown back and laid aside for better penetration of the drug into the nasal cavity.

If the technique of instilling the medicine is not followed, a person may experience painful sensations in the forehead, a sensation of a taste of the drug in the mouth. Unlike drops, nasal sprays are much more convenient to use because they do not require any preparation before applying them.

Their main advantage is that due to the presence of a dispenser, it is difficult to overdose the drug.

Types of intranasal hormonal drugs

Currently, on the pharmaceutical market there are a large number of hormonal preparations similar in their action, but with varying degrees of pronounced effectiveness.

The table below shows the most common nasal corticosteroid medications and their analogues.

It is worth dwelling in detail on the features of the main drugs in order to understand what the advantage of each of them is.

Fliksonase

In addition to the main substance - fluticasone propionate, the drug contains a number of auxiliary components: dextrose, cellulose, phenylethyl alcohol and purified water.

Fliksonase is produced in bottles with a dispenser for 60 and 120 doses (in one dose - 50 μg of active substance). The anti-inflammatory effect of the drug is moderately pronounced, but it has a fairly strong antiallergic property.

The clinical effect of the drug develops 4 hours after administration, but a significant improvement in the condition occurs only 3 days from the start of therapy. If the symptoms of the disease decrease, the dosage can be reduced.

The average course duration is 5-7 days. Allowed to take the drug for prophylactic purposes during seasonal allergies. Unlike other hormonal drugs, Fliksonase does not have a negative effect on the hypothalamic-pituitary system.

The medication is strictly forbidden to be taken in case of herpes infection, and also, in addition to the side reactions common with other hormones, can provoke the development of glaucoma and cataracts. For children, the drug is approved for use only from the age of 4.

Alcedeen

The drug is available in 8.5 g cans with a dispenser and a mouthpiece in the form of a white, opaque suspension. Contains an active substance - beclomethasone (in one dose - 50 mcg). In addition to anti-inflammatory, antiallergic, it also exhibits immunosuppressive effects. When using standard doses, the drug does not have a systemic effect.

When injecting Alsedin into the nasal cavity, avoid direct contact of the applicator with the mucous membrane. After each dose, you need to rinse your mouth. In addition to indications for use common with other hormonal agents, it can be used as part of the complex therapy of bronchial asthma (not used during an attack).

Alcedine can increase blood glucose levels, so it must be taken with caution by people with diabetes. Also, special attention during its reception is paid to people with hypertension, with impaired function of the liver and thyroid gland.

For women in the first trimester of pregnancy and during breastfeeding, as well as for children under 6 years of age, the drug is contraindicated.

Nazonex

The main component of the drug is mometasone furoate, a synthetic glucocorticosteroid with pronounced anti-inflammatory and antihistamine effects. It is produced in the form of a white suspension in plastic bottles with a volume of 60 and 120 doses.

In its action and method of application, Nasonex is similar to Fliksonase, but, unlike it, has an effect on the hypothalamic-pituitary system. The first clinical effect after the administration of the drug is observed after 12 hours, which is much later than when taking Fliksonase.

Very rarely, prolonged and uncontrolled administration of a drug can lead to an increase in intraocular pressure and a violation of the integrity of the nasal septum (its perforation).

Nasonex is not prescribed for people with pulmonary tuberculosis, for acute infectious diseases, as well as for people who have recently undergone trauma or surgery in the nasopharynx area. There are no absolute contraindications to taking this drug in pregnant women.

However, after the birth of a child, it must be examined for the safety of adrenal function. It is assigned to children from the age of two.

Avamis

A hormonal drug in which, unlike others, a powerful anti-inflammatory effect prevails. It contains fluticasone furoate and excipients. It is produced, like the previous drugs, in vials with a volume of 30, 60 and 120 doses.

The clinical effect after the first dose becomes noticeable after 8 hours. If accidentally swallowed during instillation, Avamis is not absorbed into the bloodstream and does not have a systemic effect.

The drug has a number of advantages in comparison with other nasal hormones and, first of all, this is due to the good tolerance of the drug and the absence of serious contraindications to its appointment.

Only the appointment of Avamis to people with severe violations of the functional ability of the liver requires caution. The use of the drug for pregnant and lactating women is not recommended due to the insufficient number of studies on its effect.

Children are prescribed Avaris from the age of two. Cases of overdose with this drug were also not recorded.

Polydexa

The drug is significantly different from all previous ones. This is a combined drug that includes three groups of drugs, namely antibiotics (neomycin and polymyxin sulfate), vasoconstrictors (phenylephrine hydrochloride) and hormones (dexamethasone 0.25 mg).

Due to the presence of an antibiotic, Polydex is active against bacterial infections (the only exceptions are representatives of the cocci group). Therefore, its appointment is justified for persons with diseases of the nasopharynx of an allergic nature, in the presence of an infectious pathogen.

Polydexa is made in the form of drops and spray. Drops, as a rule, are used only in the treatment of diseases of the ear of an inflammatory nature, however, their use for the treatment of inflammatory processes in the nose is also permissible. Drops are produced in yellow-brown bottles with a capacity of 10.5 ml. The spray, unlike ear drops, includes phenylephrine in its composition and is available in a blue bottle (15 ml), protected from daylight.

The duration of drug therapy is on average 5-10 days, with prolonged use of the drug, the risk of developing candidiasis and nasopharyngeal dysbiosis is high.

The use of Polydex is absolutely contraindicated in viral diseases of the nasopharynx, angle-closure glaucoma, severe renal dysfunction, as well as during pregnancy and breastfeeding.

The drug is not prescribed for children under two years of age. It is forbidden to simultaneously use Polydex with antibacterial aminoglycoside drugs.

Comparative characteristics of nasal corticosteroids

Given the variety of nasal hormonal drugs, it is often difficult for a person to distinguish between them by action and give preference to any of them. Below is a table, the main purpose of which is to simplify the understanding of the main differences between nasal corticosteroids.

Despite the fact that hormonal drugs in the form of nasal sprays do not enter the general circulation, the risk of adverse reactions remains high. With this in mind, the choice of corticosteroids should be taken seriously.

Only the attending physician can prescribe these medicines. The patient should only take the prescribed dosage and observe the duration of the drug intake.

For the stability of the dosage form, purified water, cellulose and other auxiliary compounds are added to them.

The quick positive effect of hormonal drugs is due to their powerful anti-inflammatory effect. The synthetic corticosteroid fluticasone, contained in the preparations Flixonase or Nazarel, affects the formation of mediators in the body that cause the inflammatory process. It inhibits the formation of biologically active substances (leukotrienes, histamine, prostaglandins), which are involved in the body's defense reaction.

In addition, fluticasone delays cell proliferation, that is, the formation of new macrophages, neutrophils, lymphocytes, eosinophils. This property affects the local immunity of the nasal mucosa.

The positive effect of the use of hormones occurs within 2-4 hours and is expressed in a decrease in the swelling of the mucous membrane, the cessation of sneezing and itching in the nose, restoration of nasal breathing, and a decrease in the formation of secretions.

Fluticasone, like other corticosteroids, does not have any effect on the formation of its own hormones in the body. It does not inhibit the adrenal glands, pituitary gland, hypothalamus. When administered intranasally (nasal drops), it is 90% bound by blood plasma and rapidly excreted from the body through the kidneys and liver.

Decongestant, anti-inflammatory, antiallergic effect after topical application of hormonal drugs lasts about a day. Therefore, they are prescribed no more than 1 time per day. But there is also a negative property of drugs with synthetic corticosteroids. They suppress local immunity - with prolonged and uncontrolled use of them, a significant weakening of it can occur.

It is not recommended to use hormonal drugs on your own. It is necessary to consult a doctor who will determine the indications for their appointment, prescribe the dose, frequency of use, duration of the course and monitor the effectiveness of therapy.

Use of hormonal agents for allergic rhinitis and sinusitis

A runny nose caused by exposure to various allergens is in second place in terms of frequency after infectious rhinitis. Allergic sinusitis is also diagnosed, more often sinusitis. The time of their occurrence, the brightness of the clinical picture and the duration of the pathological process largely depend on the properties of the allergen. Seasonal allergic rhinitis, or hay fever, can be autumn or spring and is caused by pollen from flowering plants.

An episodic runny nose occurs under the short-term influence of a certain allergen (for example, contact with animal hair). With constant exposure to allergens (house or book dust), the phenomena of allergic rhinitis are also constant.

Regardless of the characteristics of the allergen, a runny nose or sinusitis proceeds with a similar clinical picture. Due to the release of a huge amount of inflammatory mediators (histamine, prostaglandins), the inflammatory process begins. The capillaries of the mucous membrane of the nose and sinuses expand, and the permeability of their walls increases. Through them, blood plasma seeps into the intercellular space of the membrane, mixes with the secretion that is produced by epithelial cells.

As a result, the mucous membrane thickens, partially or completely blocking the nasal passages and making it difficult to breathe through the nose. The congestion is accompanied by abundant transparent discharge, frequent sneezing and constant itching or burning in the nose.

With allergic sinusitis, the formation of secretions increases in the sinuses, which can accumulate due to edema of the drainage ducts. Symptoms of intoxication (fever, headache, weakness) are absent, since the inflammation is not of infectious origin.

Nasal drops containing corticosteroids are used with success for allergic rhinitis or sinusitis. They are necessarily included in the complex treatment regimen along with antihistamines, vasoconstrictor, immunomodulatory and barrier agents. With the correct selection of drugs from all these groups, their positive qualities are enhanced, and the negative effects are smoothed out.

For example, suppression of local immunity when using hormonal drugs is successfully compensated by the appointment of immunomodulatory drugs. Corticosteroid drugs can be used not only for the treatment of allergic rhinitis, but also for its prevention, before the expected onset of the action of the allergen (before the flowering of a particular plant).

Fliksonase nasal drops in the form of a spray are prescribed by a doctor strictly individually. With a vivid clinical picture of allergy, with a combination of a runny nose and conjunctivitis, in the first two days it is possible to take 2 injections into each nostril once a day. When symptoms subside, the dose is reduced to 1 injection 1 time per day. The course should be no more than 5-7 days, at the discretion of the attending physician.

As a prophylactic agent, Fliksonase is used 1 dose once a day in the first 5-6 days of flowering of the allergen plant. The agent is approved for use in pediatrics in children from 4 years of age, 1 injection into each nostril 1 time per day for strict indications.

Avamis or Nazarel nasal drops containing the synthetic corticosteroid fluticasone are used for the same indications and in the same doses as Fliksonase. Depending on the effect obtained and the severity of the clinical picture, the dosage of hormonal drugs in adults and children can be changed under the strict supervision of a physician.

Polydex nasal drops are a combined remedy that includes drugs from three groups. These are antibiotics (polymyxin, neomycin), a vasoconstrictor (phenylephrine), and a hormonal agent (dexmethasone).

The appointment of Polydexa is justified in cases when a person with an allergic rhinitis or sinusitis has a layer of infectious inflammation caused by bacterial microflora. The appearance of symptoms of intoxication against the background of allergic rhinitis, a change in the mucous nature of nasal discharge to purulent clearly indicates this.

Polydex nasal drops are prescribed for children from 2 to 15 years old, 1-2 drops 3 times a day, for adults - 2 drops up to 5 times a day. The course of treatment is determined by the doctor and is 5-7 days.

Use of hormonal nasal drops for vasomotor rhinitis

A runny nose caused by a violation of the neuro-reflex regulation of capillary tone is called vasomotor. It can be caused by a sudden change in temperature when going from heat to cold, when lighting changes from dark to bright light, when inhaling strong odors.

One of the forms of vasomotor rhinitis is the so-called rhinitis of pregnant women, which occurs with a sharp increase in the number of female sex hormones and with an increase in the volume of circulating blood. Very often, a vasomotor rhinitis is combined with an allergic one.

The effectiveness of the use of hormonal agents in vasomotor rhinitis has been proven by many studies. They are an important part of complex therapy, without systemic effects on the body and without causing addiction. For treatment, Nazarel, Nazocort, Aldecin can be used. In each case, especially during pregnancy, the dosage and duration of the course is determined by the attending physician strictly individually.

Side effects and contraindications for hormonal treatment

The effectiveness of using hormonal nasal drops leaves no doubt, but it must be remembered that various side effects are possible. They occur most often with unreasonable or uncontrolled intake of hormonal drugs.

The appearance of dryness and irritation of the mucous membrane, nosebleeds, a feeling of an unpleasant taste and smell, a rash on the skin and mucous membranes is possible. With long courses, osteoporosis, adrenal suppression, bronchospasm can develop.

The use of hormonal nasal drops is contraindicated in case of intolerance to the components of the drug, in children under 4 years of age, in nursing mothers. During pregnancy, their appointment should be very careful, only when absolutely necessary and under constant medical supervision.

The use of drugs with synthetic corticosteroids, including hormonal nasal drops, is justified and very effective in certain forms of rhinitis and sinusitis. But they should only be used as directed by a doctor, with strict adherence to all recommendations.

Sinusitis (32)
Nasal congestion (18)
Medicines (32)
Treatment (9)
Folk remedies (13)
Runny nose (41)
Others (18)
Rhinosinusitis (2)
Sinusitis (11)
Snot (26)
Frontite (4)

What hormonal sprays and nasal drops are there?

A runny nose is an unpleasant symptom that accompanies any colds and inflammation of the ENT organs. Treatment for rhinitis depends on the type of disease. With severe edema caused by an allergic reaction and inflammation of the mucous membrane, special nasal drops and hormonal sprays are shown.

Indications for use

Hormonal sprays are indicated for the following diseases:

Glucocorticosteroids have a pronounced anti-inflammatory effect. With allergic forms of the common cold, the use of drugs of this group will quickly relieve swelling and inflammation.

Popular drugs

All hormonal drugs for the common cold contain a glucocorticosteroid.

The active substance of the drug may be:

Sprays from the common cold work locally and do not have a systemic effect on the entire body. The doctor should select the drug and the duration of the course of treatment.

To treat chronic or allergic rhinitis, the spray should be used for a long time, for two or three weeks, depending on the severity of the symptoms.

Beclomethasone sprays

Beclomethasone is used to treat rhinitis due to the rapid absorption of the drug by the mucous membrane. The effect appears a few minutes after the application of the drug.

Beclomethasone-based hormonal nasal sprays are named Beconase, Nasobek, and Aldecin.

Beconase

Absolute contraindications for the use of Beconase are tuberculosis, candidal skin lesions and childhood. Individual intolerance to the drug is manifested by urticaria and dermatitis.

Nasobek

Spray Nasobek is used for chronic and allergic rhinitis, as well as as an adjuvant in the treatment of sinusitis.

It comes in a small plastic bottle with a dispenser. One press on the dispenser delivers one therapeutic dose of medication. The absolute contraindications for the drug include:

first trimester of pregnancy;
systemic fungal infections;
viral diseases;
tuberculosis;
bleeding from the nose.

Aldecin

Spray Aldecin is indicated for the treatment of rhinitis and is used as an adjunct in the treatment of polyposis of the nasal mucosa. The use of the drug can reduce mucosal edema.

Beclomethasone has an anti-inflammatory effect, so the medicine can be used for sinusitis in conjunction with other drugs recommended by the doctor.

In contraindications to the use of Aldecin, pregnancy and lactation are not indicated. However, women are advised to consult a doctor about the safety of treatment with this drug.

Like other drugs with beclomethasone, Aldecin spray is contraindicated in the following cases:

systemic fungal and bacterial infections;
tuberculosis;
nosebleeds and mucosal damage;
individual intolerance to the components of the drug.

Important! Sprays with glucocorticosteroids can impair tissue regeneration and are therefore not used after surgery or nasal injuries.

Medicines containing beclomethasone can be used in children over 6 years of age.

Fluticasone based drugs

The corticosteroid fluticasone has a pronounced anti-edema effect and reduces mucosal inflammation. Sprays with this active ingredient form the basis of the treatment of allergic rhinitis.

Popular intranasal drugs based on fluticasone are Avamis, Fliksonase and Nazarel.

Avamis

A feature of the Avamis spray is the possibility of using it for children over the age of two and for pregnant women, but only as directed by a doctor.

An absolute contraindication to the use of Avamis spray is a violation of the liver.

Fliksonase

Nazarel

Nazarel is used to treat allergic rhinitis.

The drug is not prescribed for women during lactation, since there is a high probability of release of the active substance into breast milk.

Children under four years of age should not use the medicine.

The instructions do not contain contraindications for the use of the spray by pregnant women, but doctors recommend refraining from using the medicine in the first trimester.

Sprays with mometasone

With rhinitis of an allergic nature, the medicine can be prescribed to children over two years old.

Also, the spray is prescribed as a therapeutic agent against the common cold against the background of adenoid vegetations in children.

During pregnancy, the spray can be used, but in a small course. Long-term use of the medication can harm the fetus.

The Dezrinit spray also contains mometasone. In general, the action, side effects and contraindications of different hormonal intranasal sprays do not differ.

Conclusion

In the treatment of sinusitis, hormonal agents are used as an auxiliary therapeutic agent to reduce swelling of the mucous membrane.

Directory of major ENT diseases and their treatment

Corticosteroids - names of drugs, indications and contraindications, features of use in children and adults, side effects

Introduction (characteristics of drugs)

Natural corticosteroids

Synthetic corticosteroids

Forms of release of corticosteroids

Internal preparations (tablets and capsules)

Prednisolone;
Celeston;
Triamcinolone;
Kenacort;
Kortineff;
Polcortolone;
Kenalog;
Metipred;
Barleycourt;
Florinef;
Medrol;
Lemod;
Decadron;
Urbazon and others.

Preparations for injection

Prednisolone;
Hydrocortisone;
Diprospan (betamethasone);
Kenalog;
Flosterone;
Medrol et al.

Topical preparations (topical)

Prednisolone (ointment);
Hydrocortisone (ointment);
Locoid (ointment);
Corteid (ointment);
Afloderm (cream);
Latikort (cream);
Dermovate (cream);
Fluorocort (ointment);
Lorinden (ointment, lotion);
Sinaflan (ointment);
Flucinar (ointment, gel);
Clobetasol (ointment), etc.

Topical corticosteroids are classified as more or less active.

Weakly active agents: Prednisolone, Hydrocortisone, Corteid, Locoid;

Moderately active: Afloderm, Latikort, Dermovate, Ftorokort, Lorinden;

Highly active: Akriderm, Advantan, Kuterid, Apulein, Kutiveit, Sinaflan, Sinalar, Sinoderm, Flucinar.

Very highly active: Clobetasol.

Inhaled corticosteroids

Beclamethasone in the form of metered-dose aerosols (Bekotid, Aldecim, Beclomet, Beklokort); in the form of bekodisks (powder in a single dose, inhaled with a dischaler); in the form of a metered-dose aerosol for inhalation through the nose (Beclomethasone-nasal, Beconase, Aldecim);
Flunisolide in the form of metered-dose aerosols with a spacer (Ingacort), for nasal administration (Sintaris);
Budesonide - dosed aerosol (Pulmicort), for nasal use - Rinocort;
Fluticasone in the form of aerosols Flixotide and Fliksonase;
Triamcinolone - metered dose aerosol with a spacer (Azmakort), for nasal use - Nazacort.

Indications for use

Indications for the use of glucocorticoids

Rheumatism;
rheumatoid and other types of arthritis;
collagenoses, autoimmune diseases (scleroderma, systemic lupus erythematosus, periarteritis nodosa, dermatomyositis);
blood diseases (myeloblastic and lymphoblastic leukemia);
some types of malignant neoplasms;
skin diseases (neurodermatitis, psoriasis, eczema, seborrheic dermatitis, discoid lupus erythematosus, atopic dermatitis, erythroderma, lichen planus);
bronchial asthma;
allergic diseases;
pneumonia and bronchitis, fibrosing alveolitis;
glomerulonephritis;
ulcerative colitis and Crohn's disease;
acute pancreatitis;
hemolytic anemia;
viral diseases (infectious mononucleosis, viral hepatitis and others);
otitis externa (acute and chronic);
shock treatment and prevention;
in ophthalmology (for non-infectious diseases: iritis, keratitis, iridocyclitis, scleritis, uveitis);
neurological diseases (multiple sclerosis, acute spinal cord injury, optic neuritis;
with organ transplantation (to suppress rejection).

Indications for the use of mineralocorticoids

Addison's disease (chronic insufficiency of hormones of the adrenal cortex);
myasthenia gravis (an autoimmune disease manifested by muscle weakness);
disorders of mineral metabolism;
weakness and muscle weakness.

Contraindications

hypersensitivity to the drug;
severe infections (other than tuberculous meningitis and septic shock);
chicken pox;
immunization with live vaccine.

Glucocorticosteroids should be used with caution in diabetes mellitus, hypothyroidism, gastric ulcer and duodenal ulcer, ulcerative colitis, high blood pressure, liver cirrhosis, cardiovascular failure in the stage of decompensation, increased thrombus formation, tuberculosis, cataract and glaucoma, mental illness.

high blood pressure;
diabetes;
low blood potassium levels;
glaucoma;
renal and hepatic failure.

Adverse Reactions and Precautions

the appearance of edema due to sodium and water retention in the body;
increased blood pressure;
an increase in blood sugar (possibly even the development of steroid diabetes mellitus);
osteoporosis due to increased calcium excretion;
aseptic necrosis of bone tissue;
exacerbation or occurrence of gastric ulcer; gastrointestinal bleeding;
increased thrombus formation;
increase in body weight;
the occurrence of bacterial and fungal infections due to a decrease in immunity (secondary immunodeficiency);
violation of the menstrual cycle;
neurological disorders;
the development of glaucoma and cataracts;
skin atrophy;
increased sweating;
the appearance of acne;
suppression of the process of tissue regeneration (slow wound healing);
excess facial hair growth;
suppression of adrenal function;
instability of mood, depression.

Long-term courses of corticosteroids can lead to a change in the patient's appearance (Itsenko-Cushing syndrome):

excessive deposition of fat in certain areas of the body: on the face (the so-called "moon face"), on the neck ("bull's neck"), chest, on the abdomen;
the muscles of the limbs are atrophied;
bruising on the skin and stretch marks (stretch marks) on the abdomen.

With this syndrome, growth retardation, disturbances in the formation of sex hormones (menstrual irregularities and male type of hair growth in women, and signs of feminization in men) are also noted.

How do I use corticosteroids?

Corticosteroid treatment

In intensive therapy (in the case of acute, life-threatening pathology), drugs are administered intravenously and, once the effect is achieved, are canceled at once.

alternating therapy- use glucocorticoids with short and medium duration of action (Prednisolone, Methylprednisolone) once from 6 to 8 am every 48 hours;
intermittent therapy- short, 3-4-day courses of taking the drug with 4-day breaks between them;
pulse therapy- rapid intravenous administration of a large dose (at least 1 g) of the drug for emergency care. The drug of choice for this treatment is Methylprednisolone (it is more readily available for administration to the affected area and has fewer side effects).

Daily doses of drugs (in terms of Prednisolone):

Low - less than 7.5 mg;
Medium - 7.5-30 mg;
High - mg;
Very high - above 100 mg;
Pulse therapy - above 250 mg.

Treatment with corticosteroids should be accompanied by the appointment of calcium and vitamin D preparations for the prevention of osteoporosis. The patient's diet should be rich in proteins, calcium and include a limited amount of carbohydrates and table salt (up to 5 g per day), liquid (up to 1.5 liters per day).

Corticosteroids for children

Corticosteroids during pregnancy and lactation

1. The threat of premature birth (a short course of hormones improves the readiness of the premature fetus for birth); the use of a surfactant for a baby after birth has made it possible to minimize the use of hormones in this indication.

2. Rheumatism and autoimmune diseases in the active phase.

3. Hereditary (intrauterine) hyperplasia in the fetus of the adrenal cortex is a difficult to diagnose disease.

Corticosteroids for bronchial asthma

Corticosteroids for allergies

Corticosteroids for psoriasis

Drug interactions

Antacids (drugs that reduce the acidity of gastric juice) reduce the absorption of glucocorticoids taken by mouth.
Barbiturates, Diphenin, Hexamidine, Carbamazepine, Rifampicin, Diphenhydramine accelerate the metabolism (conversion) of glucocorticoids in the liver, and Erythromycin and Isoniazid slow it down.
Glucocorticoids accelerate the excretion of Butadion, salicylates, barbiturates, Digitoxin, Diphenin, Penicillin, Isoniazid, Chloramphenicol from the body.
Glucocorticoids, when taken together with Isoniazid, can cause mental disturbances; with reserpine - depressive conditions.
Tricyclic antidepressants (Amitriptyline, Coaxil, Imipramine and others) in combination with glucocorticoids can cause an increase in intraocular pressure.
Glucocorticoids (with prolonged use) enhance the effectiveness of adrenergic agonists (Adrenaline, Dopamine, Norepinephrine).
Theophylline in combination with glucocorticoids promotes the appearance of a cardiotoxic effect; enhances the anti-inflammatory effect of glucocorticoids.
Amphotericin and diuretics in combination with corticosteroids increase the risk of hypokalemia (a decrease in the level of potassium in the blood) and an increase in the diuretic effect (and sometimes sodium retention).
The combined use of mineralocorticoids and glucocorticoids increases hypokalemia and hypernatremia. With hypokalemia, side effects of cardiac glycosides are possible. Laxatives can worsen hypokalemia.
Indirect anticoagulants, Butadion, Ethacrynic acid, Ibuprofen in combination with glucocorticoids can cause hemorrhagic manifestations (bleeding), and salicylates and Indomethacin - the formation of ulcers in the digestive organs.
Glucocorticoids increase the toxic effect of paracetamol on the liver.
Retinol preparations reduce the anti-inflammatory effect of glucocorticoids and improve wound healing.
The use of hormones together with Azathioprine, Methandrostenolone and Hingamin increases the risk of developing cataracts and other adverse reactions.
Glucocorticoids reduce the effect of Cyclophosphamide, the antiviral effect of Idoxuridine, and the effectiveness of antihyperglycemic drugs.
Estrogens potentiate the action of glucocorticoids, which may reduce their dosage.
Androgens (male sex hormones) and iron preparations increase erythropoiesis (the formation of red blood cells) when combined with glucocorticoids; reduce the process of excretion of hormones, contribute to the appearance of side effects (increased blood clotting, sodium retention, menstrual irregularities).
The initial stage of anesthesia with the use of glucocorticoids is lengthened and the duration of anesthesia is shortened; doses of fentanyl are reduced.

Corticosteroid withdrawal rules

Corticosteroid prices

Hydrocortisone - suspension - 1 bottle 88 rubles; eye ointment 3 g - 108 rubles;
Prednisolone - 100 tablets of 5 mg - 96 rubles;
Metipred - 30 tablets of 4 mg - 194 rubles;
Metipred - 250 mg 1 bottle - 397 rubles;
Triderm - ointment 15 g - 613 rubles;
Triderm - cream 15 g - 520 rubles;
Dexamed - 100 ampoules of 2 ml (8 mg) - 1377 rubles;
Dexamethasone - 50 tablets 0.5 mg each - 29 rubles;
Dexamethasone - 10 ampoules of 1 ml (4 mg) - 63 rubles;
Oftan Dexamethasone - eye drops 5 ml - 107 rubles;
Medrol - 50 tablets of 16 mg - 1083 rubles;
Flixotide - aerosol 60 doses - 603 rubles;
Pulmicort - aerosol 100 doses - 942 rubles;
Benacort - aerosol 200 doses - 393 rubles;
Symbicort - aerosol with a dispenser 60 doses - 1313 rubles;
Beklazon - aerosol 200 doses - 475 rubles.

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The adrenal cortex performs a secreting function, producing corticosteroids... These are biologically active hormones, including a mineral (aldosterone) and glucocorticoids (cortisone).

Natural corticosteroids control the following processes in the body:

metabolism of minerals (retain sodium ions and remove potassium);
puberty process;
metabolism of lipids, proteins and carbohydrates;
stress reactions;
during pregnancy;
block the production of inflammatory mediators.

Synthetic corticosteroids have properties similar to natural hormones.

Ask your question to a neurologist for free

Irina Martynova. Graduated from Voronezh State Medical University. N.N. Burdenko. Clinical resident and neurologist BUZ VO \ "Moscow polyclinic \".

They able to eliminate the symptoms of the inflammatory process(anesthetize, relieve swelling and redness, locally reduce the temperature). Synthetic molecules of corticosteroids are incorporated into the cycle of metabolic reactions natural for the body, removing natural hormones from them, which disrupts the work of the adrenal cortex and hormonal balance in general. In this regard, drugs based on synthetic corticosteroids are prescribed by a doctor when non-hormonal drugs are not effective.

Forms of production of synthetic corticosteroids

Synthetic corticosteroids are available in the following forms:

tablets (capsules);
solutions in ampoules for injection;
topical corticosteroids that are used externally (ointments, creams);
forms for inhalation.

Let us dwell in detail on the most demanded and prescribed drugs.

Prednisolone tablets

They have a powerful anti-allergic and anti-inflammatory effect. The medication is contraindicated in case of gastric and intestinal ulcers, during the vaccination period, with hypertension and a tendency to form blood clots in the vessels.

The price for a pack of 100 pieces is about 120 rubles. Prednisolone can be in liquid form for injection of corticosteroids.

Celeston

It has betamethasone as an active ingredient. Tablets are not prescribed for the following pathologies: after myocardial infarction, with hypertension, endocrine disorders, with glaucoma, with severe infections (syphilis, tuberculosis), osteoporosis, poliomyelitis. Suppresses natural immune responses.

The anti-inflammatory effect is 30 times more effective than hydrocortisone.

Kenacort tablets

The drug stabilizes the cell membranes, eliminates the symptoms of inflammation and allergies. Not used for psychosis, chronic nephritis, complex infections and fungal infections.

50 10 mg tablets cost about 200 rubles.

Betamethasone dipropionate is present as an active component in the composition. Injections with the drug are effective for the following pathologies: shock state of various nature, with cerebral edema, with acute adrenal insufficiency. "Diprosan" is contraindicated in case of hypersensitivity to the components of the composition, with infectious lesions, with diseases of the digestive organs, hypothyroidism, hypertension, with complex pathology of the kidneys and liver.

1 ampoule of the medication costs about 200 rubles.

Kenalog

The active ingredient of the drug is. The medicine compares favorably with a gentle effect on the body, no effect on the work of the pituitary gland and mineral metabolism in the body.

A box with 5 ampoules of the drug costs about 400 rubles.

The active component of the drug is methylprednisolone. Contraindicated in fungal infections and individual intolerance.

Topical corticosteroids for external use

Topical corticosteroids are classified as follows:

weak activity ("", "Locoid", "Korteid");
moderately active (Afloderm, Esperson, Latikort);
highly active (Kuterid, Kutiveit, Elokom);
very highly active (Dermovate, Clobetasol).

Most used corticosteroid ointments

Locoid

The active ingredient hydrocortisone has an antipruritic, anti-inflammatory effect, eliminates edema.

30 grams of the drug cost about 300 rubles.

Lorinden S

The composition has an antimycotic effect. It is used for allergic and inflammatory processes complicated by a fungal component.

The price per tube starts at 330 rubles.

Fluorocort - triamcinolone-based ointment

It perfectly relieves itching, swelling and redness.

The cost of the tube is about 250 rudders.

Fucidin G

In addition to hydrocortisone, the product contains fusidic acid, which has an antibiotic effect. Compound applies to children after 2 years.

The cream will cost 450 rubles, the ointment - 400.

The nuances of using topical agents

The choice of a remedy depends on the severity, localization and depth of the process. It must be carried out by a physician;
depending on the dynamics of the process on the skin, correction is carried out with a change in the drug of choice;
after removing the symptoms, they switch to a remedy without hormones.

Inhaled corticosteroids

Corticosteroids in the form of inhalation solutions are effective reduce membrane permeability, limit the release of proteolytic enzymes outside the lysosomes. A high concentration of the substance is created locally in the walls of the bronchial action, which minimizes the systemic effect.

Nasal corticosteroids effectively eliminate inflammatory and allergic manifestations, are used in the form of inhalation through the nose.

Beklamitozone (Aldecim, Bekotid, Beklokort)

The active substance reduces the secretion of prostaglandins and the production of pathological exudate. Contraindication is children under 6 years of age, individual intolerance.

A 200 mcg bottle of Beklamitazone costs 300 - 400 rubles.

Beklamitazon-nasal, Beconase

They are used as nasal corticosteroids, eliminating edema and hyperemia in the nasal mucosa.

A bottle of "Beconase" costs about 300 rubles.

Flunisalide (Ingacort)

Effective for bronchial asthma, obstructive bronchitis and chronic rhinitis.

Contraindicated in the 1st trimester of pregnancy, for children under 5 years of age, with fungal infections, active form of tuberculosis.

Major side effects of corticosteroids

If you are using corticosteroids for a long time, side effects develop In most cases.

Preparations:

violate the ionic composition of biological fluids of the body, contributing to the alkalization of blood;
provoke the development of steroid diabetes mellitus;
retain fluid, disrupting the work of the heart muscle;
loss of potassium ions leads to muscle weakness, and calcium - to osteoporosis, a tendency to fracture;
reduce immune responses, increasing susceptibility to infections;
provoke insufficiency of the adrenal cortex;
increase the risk of developing ulcerative lesions of the stomach, intestines.

Special cases of corticosteroid use

Childhood

Topical corticosteroids appoint children with caution... The smaller the child, the greater the ratio of surface area to body weight and the risk of developing systemic pathologies (developmental delay, hormonal imbalance, adrenal suppression). Children under one year old are prescribed ointments that contain no more than 1% of active hydrocortisone; Dermatol can be used.

After 2 years "Mometasone" is allowed.

During pregnancy

During pregnancy, corticosteroids are prescribed in exceptional cases when the result of the use outweighs the possible risks to the fetus.

These are the following situations:

the threat of premature birth of a baby;
active form of rheumatism;
intrauterine hyperplasia of the adrenal cortex in the fetus.

Short-term topical corticosteroids practically do not pass into breast milk

If the doses of drugs are high, then this can cause impaired development of the child and suppression of the hormonal system.

With bronchial asthma

Corticosteroids are effective for bronchial asthma. They relieve the symptoms of inflammation, but do not dilate the bronchi. These medicines are used during attacks when other drugs are not effective. After stopping the attack, the dose of the active component is gradually reduced (2 times every 4 days). In bronchial asthma, inhaled corticosteroids are indicated. These are: Beklozon Eco, Budesonide Forte, Pulmicort, Pulmicort Turvuhaler, Fluticonazole Propionate.

For allergies

For complex forms of allergy, corticosteroids are effective, they are prescribed systemically and locally. List of drugs: "Betamethasone", "Prednisolone", "", as well as their analogues.

Intranasal aerosols ("Flucatizone", "Beconase", "Propionate") help with pollinosis and allergic rhinitis.

Currently, beclomethasone dipropionate, flunisolide, budesonide, fluticasone propionate, mometasone furoate, triamcinolone acetonide are used in clinical practice for intranasal use. Flunisolide and triamsinolone in the form of nasal aerosols are not currently used in Russia. Hydrocortisone, prednisolone and dexamethasone should not be used intranasally, since they are characterized by a very high bioavailability and can cause side effects characteristic of systemic glucocorticoid therapy. Based on safety data, mometasone furoate and fluticasone propionate are recommended for long-term use.

After intranasal administration, part of the dose that settles in the pharynx is swallowed and absorbed in the intestine (> 50% of the administered dose), part is absorbed into the blood from the nasal mucosa. With a functioning mucociliary transport, already 20-30 minutes after spraying a powder or aerosol, only a small part of the drug remains in the nasal cavity. Up to 96% of the drug is transported by the cilia of the nasal mucosa into the pharynx, swallowed, enters the stomach, and is absorbed into the bloodstream. Therefore, the important pharmacokinetic characteristics of topical steroids are oral and intranasal bioavailability. These indicators largely determine the therapeutic index of glucocorticoids, i.e. the ratio of their local anti-inflammatory activity and possible systemic action.
The low bioavailability of modern topical GCS is explained by their minimal (1-8%) absorption from the gastrointestinal tract and almost complete (about 100%) biotransformation to inactive metabolites during the first passage through the liver. A small part of the drug, which is absorbed from the mucous membrane of the respiratory tract, is hydrolyzed by esterases to inactive substances. The bioavailability of many intranasal corticosteroids is relatively high. For example, in beclamethasone, it is approximately 10%. Modern drugs of this group (fluticasone and mometasone) have a bioavailability of 1% and 0.1%, respectively. That is, among intranasal corticosteroids, mometasone has the lowest bioavailability.
Bioavailability of nasal glucocorticoids

Glucocorticoids	Intranasal bioavailability (%)	Oral Bioavailability
Beclomethasone dipropionate	44	20-25
Triamcinolone acetonide	There is no data	10,6-23
Flunisolide	40-50	21
Budesonide	34	11
Fluticasone propionate	0,5-2
Mometasone furoate

Nasal glucocorticoid delivery systems
The efficacy and safety of topical steroids is largely determined by their delivery systems to the nasal cavity. The characteristics of existing systems for inhalation administration are given in the table.

Efficiency of drug delivery into the nasal cavity using various dosing devices

Dosing device	The amount of the drug delivered to the patient (% of a single dose)	The amount of the drug remaining in the nasal cavity (% of the delivered dose)
Dosing aerosol	64	20
Nasal spray	100	50
Turbuhaler	70	90

In our country, dosage forms are currently registered in the form of a metered aerosol and a nasal spray. The latter has a greater efficiency of drug delivery and fewer local side effects that occur in patients with the use of glucocorticoids (nosebleeds, dryness and burning sensation in the nose, itching and sneezing). It is believed that they are caused by the irritating effect of freon and the high rate of drug entry into the nasal cavity, observed when using metered aerosols.