The one airway hypothesis proposes that treatment of the upper airway improves the lower airway and visa versa. The extent to which this occurs clinically in patients with coexistent asthma and allergic rhinitis remains unanswered.

This 4-week study compared rhinitis control with fluticasone propionate nasal spray (FPNS) and montelukast (MON) and assessed any additional benefit in asthma control when added to fluticasone propionate/salmeterol 100/50μg BID (FSC) in 863 patients (≥15 years) with symptomatic seasonal allergic rhinitis and persistent asthma.

Both FPNS and MON produced significant (p<0.05) improvements in the primary rhinitis endpoint, mean change from baseline in subject-rated daytime total nasal symptom scores (TNSS) over weeks 1-2, compared with placebo. However, FPNS was superior to MON (p<0.05) in improving TNSS. Although MON is indicated for the treatment of asthma, improvements from baseline in the primary asthma endpoint, AMPEF over weeks 1-4, was similar for FSC + placebo (31.4 L/min), FSC + MON (30.6 L/min) and FSC + FPNS (32.0 L/min). No differences were seen among the three groups for asthma symptoms or rescue albuterol use. The incidence of adverse events was similar among the three groups.

In patients with asthma and allergic rhinitis, treatment with FPNS was superior to MON for nasal symptom control, while neither had a significant additive effect to FSC alone in improving asthma control. These data suggest that optimal treatment of the individual conditions should be the goal of treatment for patients with coexistent allergic rhinitis and asthma. (SAM40066.)