***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: During the ragweed season of 1984 we studied 120 patients with hay fever ; 58 had a history of asthma during the ragweed season the year before . They were divided into four treatment groups to receive nasal sprays of placebo , cromolyn sodium , flunisolide , or beclomethasone . In controlling hay fever symptoms all medications were superior to placebo ; the glucocorticoids were more effective than was cromolyn sodium .  Chest symptoms in the 58 patients with a history of asthma were also relieved by the topical nasal treatment . Various explanations for the beneficial effect of topical nasal treatment in asthma symptoms are conceivable . We consider the most likely to be improvement of nasal airway function . With restoration of the filtering action of the nose , less allergen would penetrate to the intrathoracic airways because of reduction in mouth breathing Background Asthma and allergic rhinitis are the two most common chronic disorders in childhood and adolescence . To date , no study has examined the impact of comorbid allergic rhinitis on asthma control in children . Objective To examine the prevalence of allergic rhinitis in children with asthma , and the impact of the disease and its treatment on asthma control . Methods A cross-sectional survey in 203 children with asthma ( 5–18 years ) using vali date d question naires on rhinitis symptoms ( stuffy or runny nose outside a cold ) and its treatment , and the  paediatric Asthma Control Question naire  ( ACQ  ) . Fraction of nitric oxide in exhaled air ( FeNO ) was measured with a Niox Mino analyser ;  total and specific IgE levels were assessed by the Immunocap system . Results 157 children ( 76.2 % ) had symptoms of allergic rhinitis but only 88 of these ( 56.1 % ) had been diagnosed with the condition by a physician  . ACQ scores were worse in children with allergic rhinitis than in those without the condition ( p=0.012 ) . An ACQ score ≥1.0 ( incomplete asthma control ) was significantly more likely in children with allergic rhinitis than in those without ( OR 2.74 , 95 % CI 1.28 to 5.91 , p=0.0081 ) , also after adjustment for FeNO levels and total serum IgE. After adjustment for nasal corticosteroid therapy , allergic rhinitis was no longer associated with incomplete asthma control ( OR 0.72 , 95 % CI 0.47 to 1.12 , p=0.150 ) . Conclusion Allergic rhinitis is common in children with asthma , and has a major impact on asthma control . The authors hypothesise that recognition and treatment of this condition with nasal corticosteroids may improve asthma control in children , but r and omised clinical trials are needed to test this hypothesis Introduction . Rhinitis and asthma are currently recognized as manifestations of a single syndrome , the chronic allergic respiratory syndrome . Nearly all individuals with asthma have rhinitis , and severe rhinitis has been associated with worse outcomes in asthma patients . Intranasal treatment has been reported to be beneficial for the lower airways . Methods . This was a r and omized , double-blind , placebo-controlled study . The objective was to evaluate the effects that treatment with intranasal beclomethasone dipropionate ( BDP ; 400 μ g/d ) has on nasal and bronchial symptoms , as well as on lung function test results and bronchial responsiveness to histamine in patients with allergic rhinitis and asthma . We evaluated 33 patients , divided into two groups : treatment ( n = 17 ) ; and  placebo ( n = 16 ) . Over the course of the 125-day study period , each patient reported daily rhinitis and asthma symptoms , as well as the need for additional medication . All patients were su bmi tted to spirometry and histamine challenge at baseline and at each subsequent evaluation ( on days 50 and 75 ) . Results . In comparison with the patients in the placebo group , those in the BDP treatment group presented significantly fewer nasal symptoms on day 50 and fewer asthma symptoms on day 75 ( p < 0.01 for both ) ; required rescue medications less often ; and presented a significantly lower degree of bronchial responsiveness to histamine on day 75 ( p < 0.01 ) . Conclusion . In this study , intranasal BDP was effective in treating rhinitis as well as asthma . The benefits for the lower airways were observed only after prolonged treatment and might be better evaluated through nonspecific bronchial challenge BACKGROUND It has been reported that intranasal corticosteroids can influence bronchial hyperresponsiveness ( BHR ) in asthmatic subjects with seasonal rhinitis . The purpose of the present study was to evaluate the effect of intranasal fluticasone propionate and beclomethasone dipropionate on BHR and bronchial calibre ( forced expiratory volume in one second , FEV1 ) in children and young adults with seasonal rhinitis and mild asthma during two consecutive grass pollen seasons . METHODS In the first pollen season 25 patients aged 8–28 years were included in a double blind , placebo controlled study . The active treatment group used fluticasone aqueous spray 200 μg once daily . In the second pollen season 72 patients aged 8–28 years participated in a double blind , placebo controlled study of a similar design to that of the previous year except that an additional treatment group of patients using beclomethasone 200 μg twice daily was included . FEV1 was measured before and after three and six weeks of treatment ; BHR to methacholine ( PD20 ) was measured before and after six weeks of treatment . RESULTS In the first season the mean ( SD ) logPD20 of the patients decreased significantly both in the fluticasone group ( from 2.43 ( 0.8 ) μg to 1.86 ( 0.85 ) μg ) and in the placebo group ( from 2.41 ( 0.42 ) μg to 1.87 ( 0.78 ) μg ) without any intergroup difference in the change in logPD20 . In the second pollen season the mean logPD20 in the fluticasone , beclomethasone , and placebo groups did not change significantly . CONCLUSIONS Intranasal steroids did not influence BHR during two grass pollen seasons in children and young adults with seasonal rhinitis and mild asthma The effect of treatment of allergic rhinitis with intranasal corticosteroids on lower airway responsiveness was assessed in a r and omized , double-blind , placebo-controlled , crossover study . Twenty-one young patients with perennial allergic rhinitis and asthma , with documented lower airway hyperresponsiveness ( PC20 methacholine < 8 mg/ml ) , were treated with intranasal aqueous beclomethasone dipropionate and placebo , each given for 4 weeks . Patients recorded rhinitis and asthma symptom scores and monitored peak expiratory flow rates every morning and evening . Patients recorded global assessment of rhinitis and global asthma symptom scores at the beginning and end of each treatment . PC20 methacholine was performed at baseline and at the end of each treatment period . Intranasal beclomethasone dipropionate significantly reduced global rhinitis symptom scores ( p = 0.05 ) after 4 weeks of treatment . Global asthma scores did not change significantly ( p = 0.2 ) . Geometric mean PC20 methacholine improved significantly after 4 weeks of intranasal beclomethasone , but not after placebo ( p = 0.04 ) . Daily morning and evening rhinitis symptom scores were lower in patients treated with intranasal corticosteroids over the first 4 weeks of treatment , but carryover effect of steroids precluded comparative analysis of the second 4-week block ( morning p = 0.06 , evening p = 0.03 ) . Morning asthma scores tended to decrease ( p = 0.07 ) . Evening asthma scores were significantly decreased at weeks 2 and 3 ( p = 0.001 , p = 0.02 , respectively ) . No change in peak expiratory flow rate was seen . This study confirms that treatment of inflammation in the upper airways indirectly improves asthma symptoms and decreases bronchial hyperreactivity . Ignoring inflammation in the upper airway may lead to suboptimal results in asthma treatment Background Allergic rhinitis and asthma commonly coexist and are both mediated by similar inflammatory mechanisms . Leukotriene antagonists may therefore be an alternative to corticosteroid therapy To test the hypothesis that nasal antiinflammatory treatment can modify both upper and lower airway responses to allergen exposure , 12 cat-allergic subjects underwent 1 h cat  exposure challenges at baseline , with nasal occlusion , and after 1 wk of treatment with either intranasal triamcinolone acetonide or placebo in a double-blind crossover trial . Challenges were performed in a room containing two cats with airborne Fel d I levels ranging from 35 to 37,525 ng/m3 . Overall , nasal symptoms were moderately reduced by treatment ( p = 0.06 ) , with the greatest reduction occurring in the first 15 and 30 min of the challenge ( p < 0.01 and p < 0.05 , respectively ) . Mean lower respiratory symptoms were also diminished by treatment ( p = 0.02 ) , although those effects were most evident during the last 15 min of the challenge . Maximum changes in FEV1 were slightly reduced by the nasal therapy ( p = 0.07 ) , reaching statistical significance only at the 30-min intervals ( p < 0.05 ) . There were no significant differences in nasal histamine or TAME esterase levels . When challenges were repeated with nasal occlusion , no significant differences were detected in chest symptoms or FEV1 changes . We conclude that treatment with an intranasal corticosteroid led to significant reductions in both upper and lower airway responses to intense cat exposure BACKGROUND Allergic rhinitis ( AR ) and asthma are commonly associated , and similar underlying inflammatory processes link both diseases . AR , even in the absence of asthma , is associated with increased levels of exhaled nitric oxide ( ENO ) and hydrogen peroxide ( H(2)O(2 ) ) in exhaled breath condensate , 2 noninvasive markers of lower airway inflammation . OBJECTIVE We sought to evaluate the effect of treatment with the nasal steroid triamcinolone acetonide on ENO and exhaled H(2)O(2 ) in subjects with AR . METHODS We allocated 23 subjects in a r and omized , double-blind , parallel-controlled fashion to 4-week treatment with triamcinolone acetonide ( 220 microg/d ) or matching placebo . RESULTS ENO levels were greater in the subgroup with concomitant asthma ( 16/23 subjects ) and decreased significantly with triamcinolone acetonide treatment in this subgroup of patients in comparison with patients receiving placebo .  Breath condensate levels of H(2)O(2 ) were higher in patients with AR without asthma than in those with asthma but decreased significantly with triamcinolone acetonide treatment in both subgroups . No changes were observed in bronchial hyperresponsiveness , nasal and asthma symptoms , or peak expiratory flow with active treatment or placebo . CONCLUSION We conclude that treatment of AR with triamcinolone acetonide results in decrease of 2 noninvasive markers of lower airway inflammation , ENO and H(2)O(2 ) , supporting that upper and lower airway inflammation should be seen as a continuum in subjects with AR with and without asthma . ENO might be a more specific marker of the lower airway inflammation present in asthma RATIONALE Allergic rhinitis and exercise induced bronchoconstriction ( EIB ) are common in asthmatic children . The aim of this study was to investigate whether treatment of allergic rhinitis with an intranasal corticosteroid protects against EIB in asthmatic children . METHODS This was a double-blind , r and omized , placebo-controlled , parallel group study . Subjects aged 12 - 17 years , with mild-to-moderate asthma , intermittent allergic rhinitis and ≥ 10 % fall in FEV(1 ) at a screening exercise challenge were r and omized to 22 ± 3 days treatment with intranasal fluticasone furoate or placebo . The primary outcome was change in exercise induced fall in FEV(1 ) . Secondary outcomes were changes in the area under the curve ( AUC ) , asthma control question naire ( ACQ ) , pediatric asthma quality of life question naire ( PAQLQ ) , and exhaled nitric oxide ( FeNO ) . RESULTS Twenty-five children completed the study . Mean exercise induced fall in FEV(1 ) ( ± SD ) decreased significantly ( 95 % CI : 0.7 - 18.2 % , P = 0.04 ) in the fluticasone furoate group from 28.4 ± 15.8 % to 19.0 ± 13.8 % , compared to the placebo group ( 27.4 ± 16.0 % to 27.4 ± 19.2 % ) . The change in AUC was not significantly different between treatment groups . However , within the fluticasone furoate group the AUC decreased significantly ( P = 0.01 ) . Although total PAQLQ score did not improve , the activity limitation domain score improved significantly within the fluticasone furoate group ( P = 0.03 ) . No significant changes were observed in FeNO 
    Output:
    
Nasal inhalation of corticosteroids significantly improved morning and evening peak expiratory flow .
There were no significant changes in asthma outcomes with the addition of INCS spray to orally inhaled corticosteroids .
Thus , the results of this meta- analysis demonstrated that intranasal corticosteroid medications significantly improve some asthma-specific outcome measures in patients suffering from both AR and asthma .
This effect was most pronounced with INCS sprays when patients were not on orally inhaled corticosteroids , or when corticosteroid medications were inhaled through the nose into the lungs .
Overall , intranasal corticosteroid medications improve some asthma-specific outcome measures in patients with both AR and asthma .