Intranasally administered budesonide, a glucocorticoid, does not exert its clinical effect through vasoconstriction

Dermally applied topical glucocorticoids induce a pallor of the skin, ‘vasoconstriction’, which has been used to grade the anti-inflammatory potency of such preparations. This study was performed in order to explore the possibility of a similar ‘vasoconstrictor’ phenomenon existing in the upper airway mucosa, which might thus offer one explanation for the clinically beneficial effect of topical glucocorticosteroid preparations in the treatment of allergic and non-allergic rhinitis. The possibility of a changed sensitivity to α and/or β-adrenergic stimulation was also evaluated. Ten normal subjects participated in the present double-blind, randomized, crossover, placebo-controlled study. After establishing a baseline in nasal peak flow and nasal mucociliary clearance, the patients were treated for 8 days with either budesonide 100 μg/nasal cavity morning and evening, or a matching placebo. After a wash-out period of 2 weeks the treatment was repeated using the other treatment alternative. Nasal peak flow measurements were taken immediately before and 1 h after each application of treatment. After 1 week of treatment the nasal mucociliary transport was determined and the subjects were subjected to an intranasal challenge with 0.05 mg of oxymetazoline and 5.2 mg terbutaline on 2 different days in order to test for α and β-adrenoceptor sensitivity. The response to these challenges was monitored by symptom scores and nasal peak flow measurements. Neither active treatment with budesonide aqueous suspension nor the placebo treatment induced any change in the mucociliary transport time nor in nasal airway as measured with the peak flow meters. No change in α or β-adrenergic receptor sensitivity was induced by the active treatment. We conclude that topical glucocorticoids have no vasoconstrictor effect on the capacitance vessels and do not induce any major changes in adrenoceptor sensitivity in normal subjects. The treatment has no effect on the mucociliary transport of the normal nasal mucosa.