Illustration of medication particles flowing through the nose into the sinuses and lungs.

Breathe Easier: New Hope for Asthma and Chronic Sinusitis Sufferers

Elliot Brynn in Health & Wellness December 2025 • 4 min read.

"Could a simple nasal exhalation technique unlock better relief?"

If you're among the millions battling both asthma and chronic rhinosinusitis, you know the struggle is real. Eosinophilic chronic rhinosinusitis (ECRS), a particularly stubborn type of sinus inflammation, often goes hand-in-hand with asthma, creating a frustrating cycle of airway woes. Traditional treatments sometimes fall short, leaving many searching for better solutions.

Now, a new study offers a glimmer of hope. Researchers have been exploring a unique method of delivering inhaled corticosteroids (ICS)—a common asthma medication—by exhaling it through the nose. This technique, known as ETN (exhalation through the nose), aims to target inflammation in both the upper and lower airways, addressing the 'united airway' concept that links these conditions.

This article delves into the findings of a recent clinical trial investigating the effectiveness of HFA-BDP (beclomethasone dipropionate) metered-dose inhaler ETN. We'll explore how this approach could potentially improve symptoms, reduce inflammation, and enhance the quality of life for those struggling with ECRS and asthma.

How Does Nasal Exhalation Work?

Illustration of medication particles flowing through the nose into the sinuses and lungs.

The study, published in Frontiers in Immunology, involved 23 patients with severe ECRS and asthma whose conditions were not adequately controlled by standard nasal corticosteroids. The participants were divided into two groups: one receiving HFA-BDP via ETN, and the other receiving a placebo inhaler using the same ETN technique. Both groups continued their existing treatments.

The ETN method involved a specific breathing technique:

Inhaling fine particles released from a metered-dose inhaler (MDI) orally for 3 seconds using a valved holding chamber.
Holding breath for 3 seconds.
Exhaling through the nose for 3 seconds.

Researchers then assessed changes in nasal polyp scores, CT scans, smell tests, and quality of life questionnaires. They also measured fractionated exhaled nitric oxide (FENO), a marker of airway inflammation.

The Future of Airway Treatment

The study revealed that HFA-BDP MDI ETN led to significant improvements in nasal polyp scores, sinus CT scans, and overall quality of life compared to the placebo group. The ETN group also experienced a reduction in FENO levels and improved sensitivity to corticosteroids, suggesting a decrease in airway inflammation.

This research indicates that exhaling inhaled medication through the nose could be a valuable addition to the treatment arsenal for ECRS and asthma, particularly for those who don't respond well to traditional therapies. The ETN technique helps deliver medication to the sinuses, addressing both upper and lower airway inflammation simultaneously.

While the study's findings are promising, further research is needed to confirm these results in larger, multi-center trials. Nevertheless, this novel approach offers a potential new avenue for managing these chronic conditions and improving the lives of those affected.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3389/fimmu.2018.02192, Alternate LINK

Title: Hfa-Bdp Metered-Dose Inhaler Exhaled Through The Nose Improves Eosinophilic Chronic Rhinosinusitis With Bronchial Asthma: A Blinded, Placebo-Controlled Study

Subject: Immunology

Journal: Frontiers in Immunology

Publisher: Frontiers Media SA

Authors: Yoshiki Kobayashi, Hirotaka Yasuba, Mikiya Asako, Takahisa Yamamoto, Hiroshi Takano, Koichi Tomoda, Akira Kanda, Hiroshi Iwai

Published: 2018-09-25

Everything You Need To Know

What does the exhalation through the nose (ETN) method involve?

The ETN (exhalation through the nose) method involves inhaling fine particles from a metered-dose inhaler like HFA-BDP orally using a valved holding chamber for 3 seconds, holding your breath for 3 seconds, and then exhaling through your nose for 3 seconds. This technique aims to deliver the inhaled corticosteroids (ICS) to both the upper and lower airways, addressing the combined nature of asthma and ECRS.

What improvements were observed in the study participants who used the HFA-BDP MDI ETN (exhalation through the nose) method?

The study showed that using HFA-BDP MDI ETN (exhalation through the nose) significantly improved nasal polyp scores, sinus CT scans, and overall quality of life when compared to the placebo group. Furthermore, the ETN group experienced a reduction in FENO levels, which is a marker of airway inflammation, and showed improved sensitivity to corticosteroids. This indicates that the ETN method can reduce inflammation and improve outcomes for individuals with both ECRS and asthma.

What is eosinophilic chronic rhinosinusitis (ECRS), and how is it related to asthma?

Eosinophilic chronic rhinosinusitis (ECRS) is a specific type of sinus inflammation that often occurs alongside asthma. The connection arises from what's known as the 'united airway' concept, which recognizes that the upper and lower airways are linked. Inflammation in one area can influence the other. Because traditional treatments sometimes don't fully address both the nasal and lung inflammation, new approaches like ETN are being explored.

What are the implications of the study's findings regarding sensitivity to corticosteroids when using the HFA-BDP MDI ETN method?

The study's findings on HFA-BDP MDI ETN indicate that this method improves sensitivity to corticosteroids, potentially reducing airway inflammation. This is significant because it suggests that even when standard nasal corticosteroids are not adequately controlling symptoms, ETN can enhance their effectiveness. This improvement in sensitivity could lead to better symptom management and a higher quality of life for those with ECRS and asthma. However, the study focused on a specific medication. Further research is needed to see if this applies to other inhaled medications and delivery systems.

What is fractionated exhaled nitric oxide (FENO), and what does a reduction in FENO levels indicate in the context of this study?

Fractionated exhaled nitric oxide (FENO) is a measurement of nitric oxide in your breath, and it serves as a marker of airway inflammation. High FENO levels typically suggest that there is inflammation in the airways, such as in asthma or ECRS. In the study, the ETN (exhalation through the nose) group experienced a reduction in FENO levels, indicating that the ETN method was effective in reducing airway inflammation. Monitoring FENO levels can help doctors assess the severity of airway inflammation and track treatment effectiveness.