Q: Nasal plus inhaled steroids - opinions?

[Leo Spaceman v2]

Is it okay to use nasal steroids for allergic URT symptoms as well as inhaled for asthma/COPD? I guess they're supposed act within the confines of their own precincts but they share the pharynx and this seems to come up quite a bit as a situation and makes me a tad uncomfortable.

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[CPRBandit]

Is it okay to use nasal steroids for allergic URT symptoms as well as inhaled for asthma/COPD? I guess they're supposed act within the confines of their own precincts but they share the pharynx and this seems to come up quite a bit as a situation and makes me a tad uncomfortable.

Personally do it and do it all the time for patients. I don't feel like the Flonase really gets back much into the pharynx (at least not if turbinates are very large), and certainly doesn't get adequate dosing into the lungs. And Flovent/QVar/etc don't really get into the nose. If you need anti-inflammatory action in both sites I think it's pretty benign (of course rinsing out the mouth and using normal precautions).

 

[Hernandez]

Better re-adjust your comfort level, you will be seeing many difficult to control pts with multiple co-current allergic/respiratory issues. I find many times, especially in asthma pts if you don't control the rhinitis you'll have much harder time controlling the asthma. Usually when I get to this point I'll go ahead and overly screen with ANCA & IgE levels as well.

 

[Hernandez]

I don't feel like the Flonase really gets back much into the pharynx

I take it you've not watched many pts use this med, men are the worst about improper technique.....I'll instruct on proper use and tell them sniff it like a flower don't snort it like cocaine, you don't want it in the back of your throat.

 

[jdh71]

Is it okay to use nasal steroids for allergic URT symptoms as well as inhaled for asthma/COPD? I guess they're supposed act within the confines of their own precincts but they share the pharynx and this seems to come up quite a bit as a situation and makes me a tad uncomfortable.

I don't care about using them together.

 

[Leo Spaceman v2]

I take it you've not watched many pts use this med, men are the worst about improper technique.....I'll instruct on proper use and tell them sniff it like a flower don't snort it like cocaine, you don't want it in the back of your throat.

Thanks everyone and LOL! I sniff it like cocaine

 

[Mad Jack]

The doses of steroid present in inhaled steroids are typically miniscule (50-500 mcg). Your patient will swallow some, but the majority will go to where it needs to go. If they're on the high end and swallowing half their meds due to poor technique, they're only getting 0.9 mg into their digestive system (assuming BID Advair 500 and QID Flonase 200), of which almost none will become bioavailable due to their not being designed to pass through the harsh environment of the stomach and first-pass metabolism. And that's a worst case- if your patient is washing their mouth out like they should, they'll be ingesting substantially less.