Clinical significance and spectrum of action
Intranasal glucocorticoids are recognized as the most effective pharmacological group in the treatment of inflammatory diseases of the nasal cavity. Today, they often become first-line drugs, especially in moderate to severe allergic rhinitis (AR).
The main advantage of this group is their ability to relieve absolutely all symptoms of the disease. Of particular value is their pronounced effect on two of the most complex clinical manifestations:
- persistent nasal congestion;
- olfactory impairment (up to hyposmia and anosmia).
It is important to note that other drug classes cope significantly worse with these two symptoms, making topical steroids indispensable in clinical practice.
Indications for use
Drugs in this group have a clearly defined range of indications related to chronic allergic and non-allergic airway inflammation. The main pathologies include:
- Allergic rhinitis (both seasonal and perennial forms).
- Rhinosinusitis (as part of combination therapy).
- Nasal polyposis.
Age restrictions in pediatric practice
The prescription of intranasal glucocorticoids to children requires strict adherence to age restrictions regulated by the instructions for drugs registered in the Russian Federation. The choice of active substance depends directly on the child's age.
Permissible age to start therapy:
- From 2 years: mometasone (mometasone furoate) and fluticasone furoate are approved.
- From 4 years: fluticasone propionate can be included in the treatment regimen.
- From 6 years: the spectrum expands with budesonide and beclometasone.
Therapy guidelines and monitoring
The duration of a course of treatment with intranasal glucocorticoids is never standard—it is determined strictly on an individual basis. The physician makes a decision based on:
- The form of the disease (for example, seasonal rhinitis requires a different approach than perennial rhinitis).
- The patient's age.
- The presence of comorbid conditions.
Standard timeframe: the course of topical steroid prescription usually lasts from 4 weeks to 3 months.
Monitoring: therapy with local glucocorticoids requires mandatory and regular supervision by the attending physician. The examination of a patient receiving these drugs must be carried out at least once a month.
Two "FUROATES" — from TWO years: mometasone furoate and fluticasone furoate are approved for the youngest children.
Class and exam questions
Do local steroids help with loss of smell?
Yes, they are the most effective at restoring olfaction (in hyposmia and anosmia) and relieving nasal congestion compared to drugs from other classes.
From what age can fluticasone be prescribed?
Here it is important to pay attention to the salt: fluticasone furoate is approved from 2 years of age, while fluticasone propionate is approved only from 4 years of age.
How long can these drugs be used continuously?
The standard course ranges from 4 weeks to 3 months, although the exact duration is always determined individually depending on the form of rhinitis and concomitant diseases.
What else to study on this topic
- Mechanisms of relief of hyposmia and anosmia during topical steroid therapy
- Differences in the pharmacodynamics of furoates and propionates
- Criteria for choosing between intranasal steroids and other drug classes in mild rhinitis
- Algorithm for patient examination during monthly therapy monitoring
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Other topics in "Chapter 5. Allergic Diseases"
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