Effect of endosinusal treatment on cellular markers in mild and moderate asthmatics

OBJECTIVE: To determine the efficacy of topical endosinusal treatment in terms of reduction in activation of inflammatory cells and asthma/rhinosinusitis symptoms in patients with asthma and chronic rhinosinusitis (CRS). MATERIAL AND METHODS: Eighteen mild-to-moderate asthmatics with CRS were subjected to antral sinoscopy and endosinusal treatment with 2 mg of dexamethasone and 40 mg of gentamicin per maxillary sinus for 7 days. Sinus lavage and serum samples were taken before and after the treatment and bacteriological swabs from the sinuses were taken at the time of inclusion in the study. Subjective scores for CRS symptoms and forced expiratory volume in 1 s (FEV1) were tested at inclusion and after 30 days. Levels of eosinophil cationic protein (ECP), tryptase and myeloperoxidase (MPO) were analyzed in serum and sinus fluid before and after the treatment. RESULTS: ECP and tryptase levels were significantly reduced in both serum and sinus fluid, but serum MPO did not show significant changes after the treatment. MPO in sinus lavage was reduced only in moderate asthmatics. Subjective scores for CRS and FEV1 were significantly improved for the whole group. ECP, usually used as a parameter for asthma staging, was mostly affected at the systemic level, whilst tryptase was more markedly reduced at the local level. CONCLUSION: The topical endosinusal treatment used in this clinical study significantly reduced activation of eosinophils and mastocytes, improved FEV1 and reduced symptoms of CRS in mild-to-moderate asthmatics.