As well as corticosteroids and for whom it is vicious to treat in case of illnesses of the nasopharynx and dyshal systems. Intranasal corticosteroids in the therapy of allergic rhinitis and intranasal glucocorticosteroids

The human body is a foldable, uninterruptedly functional system, it is capable of producing active speech for the self-determination of symptoms of ailments and the removal of all the negative factors of the external and internal navkolishny middle. The active speech is called hormones and, in addition, the stench also helps to regulate the disease-free processes in the house.

Sho take glucocorticosteroids

Glucocorticosteroids (glucocorticosteroids) are the hormones of corticosteroids, which are violated by the bark of the nadnirniks. For the vision of steroid hormones, the organ of hypophysis appears, which produces a special speech in the roof - corticotropin. It itself stimulates the cortex of the supra-nirkovy zalosis and sees a great number of glucocorticoids.

Likar-fakhivtsi vvazayut, as well as in the middle of the clientele of the people, they know the special mediators, as they report on the reaction of the clitin to the cheeky speeches, as they go to her. The very stink of explaining the mechanism of some kind of hormones.

Glucocorticosteroids may be able to achieve great results on organism:

• nadayut anti-stress and protishokova diy;
• to accelerate the activity of the mechanism of adaptation of people;
• stimulate blood circulation of blood cells in the cystic marrow;
• increase the sensitivity of the myocardium and sudin, provoke an arterial clutch;
• Advise and may have a positive effect on gluconeogenesis, so that you can see in your brain. Organism can independently take off the attack of hypoglycemia, provoking steroid hormones into the shelter;
• to promote the anabolism of fats, to accelerate the exchange of brown electrolytes in the body;
• I will strain my immune regulation;
• to reduce the vivilnennya of mediators, nadayuchi antihistaminnyeffect;
• I will strain against the fire, change the activity of enzymes, wick destructive processes in cells and tissues. The smothering of mediators is fired up to change the exchange of people between healthy and healthy cells, as a result of which the fieryness does NOT grow and does not progress. In addition, the GCS does not allow the lipocortin blocks to vibrate with arachidonic acid, which are catalysts for the ignition process;

All the health benefits of steroid hormones in measles supra-nirkovy zalosis buli have appeared in the laboratory minds, who have seen success in the introduction of glucocorticosteroids in the pharmacological sphere. The increase is indicated by the anti-hypertension of hormones in the case of a permanent consumption.

A piece of glucocorticoid supplementation in the crowd of people internally or in a way that will help the body to better cope with a great number of problems.

Unimportant for high efficiency and coryza of hormones, modern pharmacological industries and synthetic analogs, some of the steroid hormones, which can become stagnant in the clear vigor side effects.

Shown before taking glucocorticosteroids

Glucocorticosteroids are recognized by drugs in quiet drops, if the body needs additional therapy. Tsі lіkarskі zoobi іnkіnаyut in the quality of monotherapy, in the main stench to be included in the complex of lіkuvannya singing ailment.

Most often it is shown before synthetic hormones glucocorticoids include the stepping stones:

• organism, including vasomotor rhinitis;
• i will pre-asthmatic;
• shkirnі zapalennya developmental ethology... Glucocorticosteroids can become stagnant in case of infectious diseases of the child, in combination with drugs, which are suitable for microorganism, which provoke ailments;
• be it a prodigal, including traumatic, viclikans of the second blood;
• , І Інші show pathologies with the resulting tissues;
• іstotne decrease in the number of internal pathologies;
• Trivial renewal of organ and tissue transplants, blood transfusions. Steroid hormones of this type will help the body to become more addicted to alien tilamі to clients, іstototuyuyuyu tolerance;
• glucocorticosteroids are included in the complex of renewal of food and exchange therapy of oncology;
• , Reduced the health of measles provoking the physiological number of hormones and іnshі endocrine discomfiture in hospitality and chronic stages;
• deyaki ailments of the shlunkovo-intestinal tract:,;
• autoimmune disease pechinki;
• stuffed up the brain;
• ailment of the eyes: keratitis, corneal iridescence.

It is necessary to take glucocorticosteroids only if the drug is indicated, or in case of incorrect reception and inaccurately insured dose of a healthy dose of good quality to promptly provide unsafe side effects.

Synthetic steroid hormones can cause recovery syndrome- pogirshennya self-feeling of ailing pislya pryinennya admittance, right up to glucocorticoid deficiency. I didn’t get sick, the drug was not just a therapeutic dose of drugs with glucocorticoids. Youmu also need a vibuuvati scheme for doing things lykarskoy speech for the reduction of the state of the stage of pathology, and the reduction of the dose to the minimum for the transition to the point of becoming ill.

Classification of glucocorticoids

The triviality of the diy of glucocorticosteroids of the Bula was fixed by the fakhivtsy individually, for the capacity of a single dose of a specific lykarsky zasobu bring an adrenocorticotropic hormone, which is practically active in all pathological camps. Such a classification for steroid hormones of this type on the onset of the appearance:

1. short - adjust the activity of ACTH to the term of trocha more than dobi (Cortisol, Hydrocortisone, Cortisone, Prednizolone, Metipred);
2. average triviality - term dii approximately 2 dobi (Traimtsinolon, Polkortolon);
3. Preparations trivaloi diya - the effect of saving more than 48 years (Batmetazone, Dexamethasone).

In addition, the classification of drugs according to the method of introducing them into the body of a sick person is very classical:

1. Oral (in tablets and capsules);
2. nasal drops and sprays;
3. іngalyatsіynі form lіkarsky zasobu (most often zastosovuyusya asthmatics);
4. ointments and creams for zovnishny zasosuvannya.

It is a common organism and the type of pathology can be assigned to 1, as well as a number of forms of lykarsky diseases, which can avenge glucocorticosteroids.

List of popular drugs-glucocorticoids

In the midst of helpless drug users, to find in their warehouses glucocorticosteroids, doctors and pharmacologists see a number of drugs in other groups, so that they have high efficiency and low efficiency

Beast to respect

As a result, I will become the patient and the stage of developing ailments to take the form of lykarsky zasobu, dose and triviality of stasis. Victory of glucocorticosteroids is subject to permanent control of the doctor for the maintenance of any changes in the sick person's camp.

Side effects of glucocorticosteroids

Unimportant to those who are currently in the pharmacological center of the work over the advancement of the safety of the lykar's problems, to revenge the hormones, when high sensitivity The patient's body can manifest the following side effects:

• increased nervousness;
• sleeplessness;
• , Шо wiklikaє discomfort;
• , Thromboembolism;
• і intestines, zapalynnya zhovny mіkhura;
• p_advishennya vagi;
• with trivial vicoristannі;

Among the ready-made salt solutions, there are sea water preparations Aqua Maris, Humer, and preparations, which take away physiological solutions, - Nazol-Aqua.

For the cultivation of the state of the art bacteriological can be attributed to growth. It is especially important for ginny visions, which I am familiar with bacterial infections... Medium of antiseptics for empty nasal emptying becomes stagnant:

• .
  The drug is sold in ampoules, however, it doesn’t get licked - it’s not vicious. Open the ampoule, twist it into the hand;
• in tablets i water solution for zvnіshny і mustsovy zasosuvannya;

expektoranti

Up to the number of times, the efficiency of those with a state of fire is not brought to the point, it is not enough to be reported and examined - it is necessary to dispose of sputum. It is transmitted, which is the sign of a decrease in the viscosity of a secret and a maxillary sinus... For patients who have sinusitis, the sinusitis will accelerate to get sick dikhalnyh nobles, For example, bronchitis with thick viscous phlegm, examorant, madly, necessary. Until the number of most implanted ones, there should be preparations to take revenge on guaifenesin (Coldrex Broncho, Tussin). In such cases, there is a complex problem, including guaifenesin, paracetamol and phenylephrine. The remaining component in the case of a whole future will be the role of a vasoconstrictor agent, and the role of a vasoconstrictor is shown to the Expectorant guaifenesin.

Lykuvannya course

Dose and course of treatment antibacterial drugs are selected individually. The average triviality of antibiotic therapy in case of severe sinusitis becomes 14 days.

preparations

Until the number of the most common antibiotics for sinusitis, preparations of the group are given:

• peniciliniv.
  Amoxicilin is orally ingested with clavulanic acid (Amoxiclav, Flemoxin solutab, Augmentin). In addition, in important cases, they recognize the form of abducted penitentiaries;
• cephalosporin.
  Preparations of another generation Cefuroxime, Cefpodoxime and the third - Ceftriaxone, Cefaclor;
• macrolidi.
  Erythromicin, clarithromicin (Fromilid, Klacid), Azithromicin;
• fluorochinoloni.
  Levofloxacin (Leflox), Ciprofloxacin (Ciprolet, Ciprinol, Cifran), moxifloxacin (Avelox). Nagadaєmo, scho fluorohіnoloni zaboronenі until zasosuvannya in children younger than 18 years - preparations can porushuvati form cartilage tissue;
• carbapenemi.
  With important infections, they recognize imipenem, meropenem;
• aminoglycoside.
  Ін'єкційні aminoglykozidi Gentamycin і Tobramіcin stagnate only in case of detection of gram-negative flora;
• anti-microbial drugs.
  In case of resistance to antibiotics, antibiotic drugs are prescribed. Among them are trimeptoprim and sulfamethoxazole (Biseptol), metronidazole and іnshі.

On the other hand, it’s great, but it’s the size of the general disease. As long as you do not have a problem, as you will increase the risk of chronic sinusitis, if you follow all the recommendations of the doctor and see the scheme of the addiction, you can not turbuvate in success, the cause of all the inevitable.

The Standards, recommended in the ARIA document updated in 2010, have a guess about seasonal (short-hour, intermittent) and chronic (persistent, cyclonic) rhinitis and three stages of its severity - light, medium (3) important. One can see two forms of allergic rhinitis - intermittent and persistent, as well as two grades of gravity of severity - light and important season 1 allergen wins i a clever picture becoming ill, I will grow into such a classification.

Table 1. Classification of allergic rhinitis (Zhernosuk V.F., for materials ARIA, 2011) (2,3)

Oscillations of seasonal rhinitis are susceptible to a singular allergen; It is more visceral in chronic rhinitis, which can manifest itself as an allergic reaction to clues, disputes, colors, wool. Have your own chergu, short-term rhinitis has its own pathogenetic particularity. Short-term contacts with allergens can lead to typical fallow degranulation of fat cells and the development of symptoms of gastrointestinal symptoms: coughing, coughing, undead. With chronic rhinitis, the symptoms are late in the clinical new stage allergic reactions, tied to eosinophilic infiltration, as a result, lead to the mucous membrane of the nose and dyshleys. In such a rank, a patient may have a short-term rhinitis a couple of times on the risk of persistent allergic inflammation and navpaki - chronic rhinitis before the hour of seasonal allergy (4). When a periodic and chronic rhinitis occurs, I can’t immediately recognize any of them at the patient’s time, so that the stench “does not change”: periodic rhinitis is trivial up to 4 days per week, up to 4 days per day, until tyzhniv u rotsi (4).

standards of lykuvannya

According to recent estimates, in the light of the Autonomous Republic of the guardians from 10 to 25% of the population (1). ) require continuous use of drugs for the treatment of allergic rhinitis. Correctly lіkuvannya AR є zupinka zupinka progress to get sick to bronchial asthma... In numerical doslіdzhennyah bulo is brought, scho correct lіkuvannya Allergic rhinitis with corticosteroids is allowed to change the number of hospitalized ailments every hour they have asthma (5).

Recommended ARIA lіkuvannya, in the first place, intertwines contact with an allergen, and when symptoms appear - systemic antihistamines, antileukotrenia, anticholinergic drugs, systemic corticosteroids, as well as specific immunotherapy. In addition, the development of an allergic reaction can be caused by the introduction of IgE preparations, if the stench is inaccessible through the high frequency (5).

Skin s vidіv lіkuvannya graє its role in AR therapy. Some of the drugs clean up the symptoms, without pouring on the very allergies and induce them to ignite: sympathomimetics sound the mucus membrane of the nose, and anticholinergic drugs take the formulated exudate. Mechanisms of different groups of drugs may be important therapeutic herds (Table 2). The ARIA standards for attacks of rhinitis, associated with wicid gistamina, recommend, in the first place, antihistamines (AG), muscular and systemic, in connection with the rapid therapeutic effect of hypoxamic effective Protest, the chronic rhinitis of the cycle is even weak.

The eosinophilic nature of the disease is caused by the need for the appointment of glucocorticoid drugs.

Necessity of the sign of glucocorticoids

Cochrane meta-analysis, which is a combination of two main groups of drugs, which can develop in case of allergic rhinitis - antihistamines and glucocorticoids, Especially friendly effect of glucocorticoid can be seen in the lining of the mucous membrane of the turbinates.

Recommendations of the American Academy of Allergy, Asthma and Immunology, the American College of Allergy and Immunology and advised recommendations of the greater European powers on the basis of intravenous glucocorticoid therapy. Antileukotrenic drugs are indicated in pre-treatment therapy for rhinitis, which can cause asthma (Table 3)

One of the main problems is the suppression of allergic conjunctivitis (AK) AR. Especially often, the manifestation of two illnesses is encouraged by the patients, who suffer from allergies for seasonal allergies (saws of herbs and trees). In the whole group, the list of both allergic and allergic flares becomes 75%. On the other hand, conjunctivitis can occur with sensitivity to odd allergens. Typical symptoms of a severe allergic conjunctivitis (occlusion of the eyes, lacrimation, itching) appear with repeated or rapid contact with a great number of allergens, which are known to be in the hands, or when the condition is transferred. As a rule, the therapy of a single AK / AR is based on oral and / or antihistamines in full bloom abo cromoney (in viglyadі full-time specks). However, for the next hour, an increasingly important role in the anti-inflammatory treatment of nasal epithelium, as well as conjunctival enlargement, intranasal glucocorticosteroids (6).

Clinical efficacy of intranasal corticosteroids

Intranasal glucocorticoids (corticosteroids, glucocorticoids) (DKZI) boules were introduced into clinical practice for the treatment of AR in the late 1960s. The first drugs (dexamethasone and beclomethasone) were boiled in a sprinkle of droplets, and by the end of the decal, in nasal sprays. The greatest number of side effects in case of systemic glucocorticoid intake caused new forms of GCS to appear. In the 70s of the last century, such drugs appeared, such as beclomethasone propionate (1972), flunizolid (1975), and later, on the cob of the 80s, budesonid. As early as 20 years ago, there were new drugs on the market: triamcinolone, fluticasone propionate and mometasone furoate. In the last ten years, new generation drugs - cyclesonide and fluticasone furoate - have become widely available (8).

DKZI is infused into a rich component in the inflammatory process in the mucous membrane of the nose in patients from the AR, which are overpriced and purchased and migrated from key cells, and to take part in the allergic inflammation, the hypersensitive phase of the medication All general use of GCS on the burner should be produced to early (weak) and early (even strong) galvanizing of allergic reactions in the mucous membranes of the nose (8).

The power of the DKZI summarizes the most important group of anti-inflammatory drugs for treatment of AR. Bulo has been brought to the point that DKZI will rapidly change the symptoms of AR, such as chhannya, nasal congestion, itching, rhinorrhea, as during periodic (seasonal), and if chronic form getting sick (2). It is even more important that the preparations tidy up the appearance of occlusions (blockages) of the nose and problems with the behavior, causing the quality of life of patients in the AR (Table 2).

• Periodic AR - middle / important stage (in terms of alternative drugs)
• Chronic AR - easy stage (as alternative drugs)
• Chronic AR - middle / important stage (like one of the possible groups of drugs)

However, unimpressed on the recommendation of the DKZI in the capacity of any alternative or alternative groups of drugs, it has been shown quite recently that DKZI is the most effective in the type of AR and in children and in adults. The stench does not lower the sub-active symptoms of AR, but infuse them into the active indicators of the passage of the nasal passages. It has been shown that the preparation will adapt the growth of the nasal support in children with seasonal AR in the season of herbal blooming; In patients with chronic AR, as a result of the loss of AR, as a result of the loss of AR, there was also a decrease in the rate of flux and the area of ​​the transverse nasal recession (as a result of an additional method of acoustic diagnostics). clinical efficacy of DCZI in the context of antihistamines of the first and other generations in the AR (8).

Pharmacological power of intranasal corticosteroids

Skin type of DKZI is powerful, as it starts its pharmacokinetic profile and its pharmacodynamic activity. The supremacy of the cich power is due to the primary clinical effect of the skin type DKZI. There is a focus on efficiency in addition to the symptoms of AR, and on the safety of the systemic and microorganism. The key features of the DKZI, which are the initial and critical efficiency and security, є (8):

• The compatibility with the receptor to GCS (rGCS)
• The stage of ringing with plasma beads
• systemic clearence
• Rospodil in plasma
• Lipophilicity
• Bioavailability.

Competition with rGKS

The most obvious season in the arsenals of key DKZI values ​​is the highest rate to rGCS for fluticasone furoate (FF), trochi less - mometasone furoate. The Іnshі preparations of this group significantly reduce the steps of spore rate to rGKS. This means that the possibility of vicoristovuvati more low doses of FF in proportion to budesonide or fluticasone propionate is possible, so it is possible to eliminate an excellent clinical effect. Clinical preferences were confirmed - the lower dose of FF is more effective - for the relief of AR symptoms, a dose of FF of 27.5 mg is required, at that hour the dose of budesonide or fluticasone propionate (8) became 50 mg.

Selectivity in relation to RGKS

Another important feature of any DKZI is the selectivity in relation to the RGKS. In general, in the form of FF, the selectivity of the mean DKZI values ​​is found. The selectivity index for FF (the activity of GCS in terms of delivery to rGCS to the activity of GCS in terms of delivery to the minerlocorticosteroid receptor) becomes close to 850, in that hour the rate for fluticasone propionate is about 585, mometasone is close to 8- furoate. High selectivity is a key factor, which is a low risk of side effects of FF, associated with activation of other receptors, except for receptors to rGCS

Lipophilicity

Powerfulness - An important factor in determining the drug's relevance is that only a single drug can penetrate the cell membrane. Due to the great lipophilicity, it penetrates through the mucus membrane and gets more lost in the tissues of the nose, which gives the drug more chances for a greater clinical effect (4). However, the lipophilicity of DKZI can be a reason for the increase in the risk of muscular side effects. To that ideal solution for this group is a drug with high lipophilicity, low systemic absorption and high systemic purification (8). These criteria include: mometasone furoate, fluticasone propionate, cyclesonide and FF, while preparations from the DKZI group may have a lower lipophilicity (4).

bioavailability

The most important parameter from the point of view of the safety of DKZI is the accessibility, which includes both nasal accessibility and biological accessibility from the intestinal tract. From the point of view of the general characteristics of the DKZI, one form of one is meaningfully displayed. Investigation of the aspect of systemic bioavailability of the surrounding DCZI, it is necessary to analyze its metabolism. A great part of the drug is administered intra-nasally (70-90% of the dose), prokovtuє, enters the liver. The surplus develops in the tissues of the nose (10-30%), and it develops its own clinical effect and is consumed in the systemic circulation. There, in the debris from the step of the ringing with the plasmas, there is a fraction of the vital GCS, as if you can lay down for the detection of any systemic side effects. Slid vrahovuvati, which deyaki DKZI in the process of metabolism in the liver establish an active metabolism, which increases the pool of drugs in the blood. It does not have the effect of preventing cyclesonide, fluticasone propionate and FF, to prevent the intake of these drugs from the point of view of safety (8).

Systemic bioavailability (total nasal and oral bioavailability) for this GCS, this type of systemic infusion and systemic side effects. However, it is a memory that systemic accessibility is not an initial and only factor in the diagnosis of systemic side effects. Tim doesn’t mean, it doesn’t mean that the patients who took the DCZI because of the even low systemic bioavailability, it can be promoted fewer systemic side effects in the more important children, when the AR is especially important.

Fluticasone furoate (FF) - DKZІ new generation

Robots for the synthesis and launch of the "ideal intranasal glucocorticoid" on the market, which suggested that all of them were re-insured to be effective and safe, were carried out since 2000. In 2008r, a drug appeared on the European market, which Volodya is unique pharmacological authorities, Approaches to the "ideal DKZI" - fluticasone furoate (FF). metabolism in the liver, and even higher steps of the metabolism with plasma proteins (4). Fluticasone furoate can be rapidly metabolized by the way of intensive metabolism of the first passage with the participation of cytochrome P450 and the metabolism of 3A4%. glucocorticoids in the same metabolic pathway, which are metabolized by the same drugs, are taken to the liver metabolism (for example, ketoconazole). P450. FF shvidko vivod from the bloodstream (plasma clearance = 58.7 l / year). apart from the internal introduction in the middle become 15.1 years (4).

One of the main features of FF is the unique nature of the link with the receptor. FF buv otrimaniyah by way of synthesis of particles of fluticasone with furoat. As a result, a fundamentally new glucocorticoid appeared with a very pronounced anti-firing power and a high spore rate up to rGKS. In porous corticosteroids, the drug is more beautifully injected into the thickness of the mucous membrane of the nasal passages, lowering the penetration in the case of mechanically subdividing, attracting the transcription factor In pre-adolescents for tvarin in a dose of 30 mcg PF, it showed an increase in eosinophilic influx in the tissue of legends, but also in fluticasone propionate (11).

Visoka efficiency of FF in treatment new forms AR Bula pidtverzhena in older adults, and in children (2.4). FF din duzhe shvidko, so as on the first day of the first day, the patients with an allergy to the files made a change in the intensity key symptoms... The maximum effect in the whole group of ailments is reached after 10-12 days of life (2). In the number of pre-adolescents (in the whole more than 3000 people with seasonal and cyclonic rhinitis), FF has demonstrated a significant difference in the control of symptoms of rhinitis and conjunctivitis in patients with placebo (8). In this case, it is shown that the drug is not injected onto the internal vice and only slightly side effects. at 12- the thousandth love cyclonic allergic rhinitis in pre-lactation, which was carried out for the participation of 605 patients, systemic failure occurred not often, not in the placebo group. In general, as in the bagatokh, the local character, for example, the bloody vision of the nasal emptying, is more advanced - the epithelial curves. In general, side effects were manifested in all 10% of respondents (10).

All in all, on the current day, until the end of the day, I have good tolerance and good tolerance to the visceral safety of FF and for older adults, for children, and for old people. A summary of three advances in the tolerance and tolerance of non-alcoholic FF in children has recently been presented by Giavina - Bioanchi et al. (8) Symptoms and discomforts, if the patients were sick, or if they had drugs, they appeared at the same frequency in groups, if they take a lower dose of FF (55 mg / day), or a larger dose of FF, or a higher dose of FF) (110 mg / day). placebo (p> 0.05).

Some important systemic side effects, which are the result of a trivial FF reception, which are significant in the course of the last few days, will help increase the growth of children and the smothering of the activity of hypothalamus-hypophysis-overheads. did not show significant unfriendly inheritances of the trivial FF reception on the function of the hypothalamic-hypophyseal-supra-nirkovo axis in older adults and in children from 2-11 years of age (4,8).

Particularly, the results were found to be clinically evident in the case of FF testing in the AR with congenital symptoms. Already in the mid-1980s, in the last century, hypotheses about the beneficial infusion of DKZI on the internal symptoms of patients due to seasonal allergic rhinitis and conjunctivitis (rinokonyunktivit) (9), before Deyak DKZI, and especially FF, stretching out for a short hour every time the main symptoms of allergic conjunctivitis in patients with AR were changed on files. In one of the dosages it is shown that there is a drop in the mean value of the other dob, and the sverb in the eyes and in the heart - for the fourth dob of therapy (9). The effectiveness of the mechanism of control of face-to-face symptoms is unclear until the end, but the results of clinical tests are even more promising. In the ARIA 2010 standards, there are no few overkill recommendations before intranasal corticosteroids in cases of allergic conjunctivitis, rather than a positive effect in the form of a drug (3). The rest of the FF data should be indicated on the start of intranasal therapy with a drug in case of nasal congestion, with the control of nasal and internal symptoms, and the effectiveness of the drug can still be found in the stage of spores of nasal congestion.

Thus, FF is a glucocorticosteroid, which has a high spore rate with the rHCS receptor, exhibits unique power: a high profile of safety at low additional doses (110 mg in older adults and 55 mg in children), before treatment, the minimum of side effects with a trivial course of treatment and style of saving the anti-firing effect.

visnovok

AR є we will broaden ailments, which are of the greatest importance in the effectiveness of therapy, quick diagnostics and correct treatment. ARIA Standards 2010r in Persha Cherga recommend intercourse with contact with allergen, and if symptoms of AR appear, the intake of systemic antihistamines, antileukotrenes, anticholinergic drugs and systemic corticosteroids. However, until the end of the rocky outbreak, it is overkill to conclude that the intranasal congestion of the GCS naybilsh in an efficient way lykuvannya AR. Intranasal glucocorticoid (DKZI) effectively infuses on the symptoms of AR - chhannya, sverbіzh, nasal congestion, rhinorrhea - in children and older adults with seasonal, and with cyclonic rhinitis. The most effective and safe DKZI є drugs of a new generation with a high spore rate to receptors to GCS, low bioavailability and a minimum of side effects. Prior to such drugs, a new class of drugs is introduced - fluticasone furoate (FF), which has great flexibility in the context of seasonal and cyclonic rhinitis, as well as an ideal profile of efficiency and safety.

List of Literature

1. E.M. Dityatkovskaya. The role of cromones in the treatment of allergic rhinitis. Allergology and pulmonology, No. 246,2008.
2. Zhernosuk V.F. The novelty of allergic rhinitis and Its Impact on Asthma Guidelines 2010 - V. 9/8/2010
3. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision
4. B. Samoliński, Flutykortyzonu furoinian - nowy glokokortykosteroid w terapii alergicznego nieżytu nosa, Alergia, # 3, 2008.
5. Adams RJ .; Fuhlbrigge AL; Finkelstein JA. i wsp. "Intranasal steroids and the risk of emergency departament visits for asthma"; Journal Allergy Clinical Immunology, 2002; 109 (4): 636-642.
6. Yáńez A .; Rodrigo GJ. "Intranasal corticosteroids versus topical H1 receptor ... with meta-analysis"; Ann Allergy Asthma Immunol. 2002; 89 (5): 479-84.
7. Nathan RA. The pathophysiology, clinical impact, and management of nasal congestion in allergic rhinitis. Clin Ther. 2008 Apr; 30 (4): 573-86.
8. A. Emeryk, M. Emeryk. Glikokortykosteroidy donosowe w terapii ANN - podobieństwa i różnice. Alergia, # 1,2009.
9. L. Bielory, C. H. Katelaris, S. Lightman, R. M. Naclerio, Treating the Ocular Component of Allergic Rhinoconjunctivitis and Related Eye Disorders. Medscape General Medicine. 2007; 9 (3): 35
10. Rosenblut A .; Bardin PG .; Muller B. et al "Long-term safety of fluticasone furoate nasal spray in adults and adolescents with perennial allergic rhinitis", Allergy, 2007; 62 (9): 1071-1077 33.
11. Salter M, Biggadike K, Matthews JL, West MR, Haase MV, Farrow SN, Uings IJ, Gray DW. Pharmacological properties of the enhanced-affinity glucocorticoid fluticasone furoate in vitro and in an in vivo model of respiratory inflammatory disease. Am J Physiol Lung Cell Mol Physiol. 2007 Sep; 293 (3): L660-7. Epub 2007 Jun 15.

nasal glucocorticoids

In Danish hour in CLINIC PRACTICE for intranasal administration of vicorisation, beclomethasone dipropionate, flunizolide, budesonide, chluticasone propionate, mometasone furoate, triamcinolone acetoneide are used. Flunizolide and triamsinalon in cob aerosols in Russia in this day is not vicious. Hydrocortisone, prednisolone and dexamethasone are not guilty of being consumed intranasally, as the stench is characterized by an even higher bioavailability and may be characteristic of systemic glucocorticoid therapy bitter appearances... At the end of the day, we recommend mometasone furoate and fluticasone propionate for a trivial victorian.

pharmacodynamic efficiency
The nasal corticosteroids produce desensitizing and antiapalary action - to reduce the secretion of the mucous membrane, the extravasation of plasma and tissue gland, to reduce the sensitivity of the receptors in the mucous membrane of the nose to the gastrointestinal Regular testing of topical GCS can be applied to all symptoms of AR: nasal congestion, rhinorrhea, channya, sverbіzh і flaky in the nose, in the lesser world - to lower scent. In case of AR, topical GCS is more effective, less decongestants, systemic and topical antihistamines, stabilizers of membranes of fatty clitins (ketotifen and cromoglate sodium).

Pharmacokinetics
Part of the dose is administered intra-nasally, which settles in the throat, is projected and soaked in the intestine (> 50% of the injected dose), and the part is soaked in the blood of the mucous membrane of the nose. With a functional mucociliary transport already after 20-30 minutes when the powder is cut, or the aerosol, the part of the lykarsky will be lost in the empty nose. Up to 96% of the drug is transported through the mucous membrane of the nose into the pharynx; In addition, the important pharmacokinetic characteristics of topical steroids are bioavailability for oral and intranasal administration (Table 6.6). These indicators are rich in why there is a therapeutic index of glucocorticoid activity, to put it in place of muscle anti-apnea activity and youthful systemic activity.
The low bioavailability of the current topical GCS is explained by the minimal (1-8%) absorption from the slunk-intestinal tract and the lower (close to 100%) biotransformation to inactive metabolites during the first pass. A small part of the drug, as it gets wet from the mucous membrane of the dichal tract, is hydrolyzed by esterases to inactive substances. Bioavailability of bagatokh intranasal corticosteroids through the temporal area. For example, beclomethasone won approximately 10%. modern drugs The whole group (fluticasone and mometasone) may have a bioavailability of 1% and 0.1%. Tobto the middle of the intranasal corticosteroids mometasone volodya is at the lowest bioavailability.

Table 6... Bioavailability of nasal glucocorticoids