Early Intervention with Fluticasone Furoate for Nasal Symptoms and Sleep Disturbance in Patients with Japanese Cedar Pollinosis

抄録

Background: Japanese cedar pollinosis (JCP) could lead to impaired quality of life through causing rhinitis-related sleep problems. In this study, we investigated, using both subjective and objective methods, the efficacy of treatment initiation with fluticasone nasal spray (NS), as compared to oral loratadine in ameliorating the nasal symptoms and sleep disturbance in patients presenting with symptoms of JCP.

Methods: A total of 48 patients with JCP were randomly assigned to treatment initiation with fluticasone NS, using oral loratadine tablets as the add-on drug, or the converse treatment, namely, treatment initiation with oral loratadine, using fluticasone NS as the add-on drug. The study outcomes were the average apnea-hypopnea index (AHI), Japanese version of the Pittsburgh sleep quality index (PSQI-J) Global score, total nasal symptom score (TNSS), score on the Epworth sleepiness scale (ESS), score on the Japanese rhinoconjunctivitis quality of life questionnaire (JRQJQ), and score in the Japanese version of the rhinoconjunctivitis quality of life questionnaire (RQLQJ). The clinical trial registration number is UMIN000003374.

Results: There were no significant differences in the AHI and PSQI-J scores between the groups. However, significantly greater improvements in the TNSS (p = 0.007) and nasal blockage (p = 0.009) scores during the peak pollen season, and in the JRQLQ (p = 0.00144), RQLQJ (p = 0.0107), and ESS (p = 0.026) scores after the peak pollen season were observed in the group initiated on treatment with fluticasone NS as compared to the group initiated on treatment with oral loratadine.

Conclusion: In patients with JCP, initiation of treatment with fluticasone NS was associated with improvement of all of the nasal symptoms, excessive daytime sleepiness, and impaired activities of daily living.