The impact of different strategies for allergic rhinitis control on the course of concomitant bronchial asthma in children

Allergic rhinitis (AR) is the main risk factor for the development of bronchial asthma (BA), increasing the likelihood of its development by 2—7 times and influencing the course of the disease throughout life. The presence of concomitant AR is associated with a more severe and uncontrolled course of asthma. Intranasal glucocorticosteroids (InGCSs) are the most effective drugs for the treatment of AR and are used as first-line therapy for patients with persistent AR. According to ARIA guidelines, preference is given to intranasal agents, which provide a more pronounced clinical effect and rapid onset of action compared to systemic drugs. Fixed combinations of InGCSs and intranasal antihistamines (InAHs) are considered as a promising treatment option in patients with moderate to severe symptoms. Despite the presence of data on the impact of InGCSs on the course of BA in patients with a combination of AR and BA, studies assessing the effect of fixed combinations of InGCSs and InAHs on the control of BA in children could not be found in the available literature. Objective. To evaluate the effect of olopatadine hydrochloride/mometasone furoate (OLO/MF) combination spray and mometasone furoate (MF) nasal spray as monotherapy on the control of AR and concomitant BA symptoms in children of different ages. Patients and methods. An open prospective comparative clinical study included 81 children aged 7—17 years (median age 12 [10; 14] years) with uncontrolled moderate to severe persistent AR and concomitant partially controlled or uncontrolled mild or moderate BA. Patients were divided into two groups using a simple randomization method. For 57 [56; 60] days, all subjects underwent AR therapy: the 1st group included 60 patients who received a fixed combination of OLO/MF; the 2nd group included 21 patients who received MF in age-related dosages. Background BA therapy remained unchanged throughout the study, three visits were carried out at interval of 28 [28; 30] days. At the first and final visits, laboratory and instrumental studies (spirometry with bronchodilator test, determination of nitric oxide in exhaled air, FeNO) were performed, and at each visit, AR and BA control was assessed using validated questionnaires (VAS, ACQ-5, cACT/ACT, PAQLQ(s)). Results. The use of both the fixed-dose combination of OLO/MF and MF as monotherapy resulted in improved control of AR and BA, but the intensity of the clinical effect varied. In the OLO/MF group, a more significant decrease in the severity of AR symptoms according to the VAS (from 60 to 20 mm) was noted compared to the MF group (from 60 to 35 mm). BA control according to the cACT/ACT and ACQ-5 data improved statistically significantly in both groups, thus in primary school-age children, a significant improvement in the ACQ-5 and cACT scores was noted only in the OLO/MF group. Quality of life indicators according to the PAQLQ(s) questionnaire increased significantly in both groups. However, no significant changes were found in the physical activity domain in the MF group. Improvement in respiratory function and reduction in bronchial obstruction were more pronounced in patients who received OLO/MF. Levels of FeNO did not change statistically significantly, reflecting its auxiliary nature as an inflammatory marker. Dynamics of laboratory parameters of eosinophilic inflammation was more pronounced in the OLO/MF group, especially in adolescents. Conclusion. AR plays a key role in the development and maintenance of uncontrolled BA course in children, which necessitates a comprehensive assessment and treatment of the symptoms of both diseases. The obtained data indicate that rapid and effective achievement of AR control using the fixed combination of OLO/MF contributes to improvement of the control of concomitant BA and quality of life in children of different age groups without the need for escalation of background anti-asthmatic therapy.