Balancing control and safety: hypothalamic-pituitary-adrenal axis effects of dual-route fluticasone in unified airway disease

The concurrent presence of allergic rhinitis and bronchial asthma, known as unified airway disease, often requires combined therapeutic approaches. This prospective study investigates the clinical efficacy and safety of combined inhaled and intranasal fluticasone propionate in such patients. A total of 25 adult patients with moderate to severe allergic rhinitis and bronchial asthma were enrolled. After excluding 2 lost-to-follow-up patients, 23 patients completed the study. Participants received combined inhaled and intranasal fluticasone propionate for four weeks. Clinical outcomes were assessed using Total Nasal Symptom Score (TNSS), Asthma Control Test (ACT), spirometry, and 24-hour urinary free cortisol levels pre- and post-treatment. Significant improvements were observed in TNSS (9.09±2.89 to 2.13±1.62; p<0.0001) and ACT scores (20.48±3.07 to 24.09±1.12; p<0.0001). Pulmonary function tests showed significant increases in forced vital capacity from 3.16±0.73 L to 3.75±0.63 L (p=0.0053) and forced expiratory volume in 1 second from 2.18±0.75 L to 2.71±0.80 L (p=0.0252). Mean urinary free cortisol levels decreased from 31.35±9.35 mcg/24 h to 28.02±9.14 mcg/24 h, though the change was not statistically significant (p=0.2295). Combined inhaled and intranasal fluticasone propionate therapy significantly improves symptom control and pulmonary function in patients with allergic rhinitis and bronchial asthma. No significant suppression of the hypothalamic-pituitary-adrenal axis was observed, indicating a favorable safety profile for short-term use.