Topical therapy with high-volume budesonide nasal irrigations in difficult-to-treat chronic rhinosinusitis

Eduardo Macoto Kosugi,Guilherme Figner Moussalem,Juliana Caminha Simões,Rafael De Paula E Silva Felici De Souza De Souza,Vitor Guo Chen,Paulo Saraceni Neto,José Arruda Mendes Neto

doi:10.1016/j.bjorl.2015.03.014

Eduardo Macoto Kosugi, Guilherme Figner Moussalem + Show 5 more

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https://doi.org/10.1016/j.bjorl.2015.03.014

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Abstract

IntroductionChronic rhinosinusitis (CRS) is termed difficult-to-treat when patients do not reach acceptable level of control despite adequate surgery, intranasal corticosteroid treatment and up to 2 short courses of systemic antibiotics or corticosteroids in the preceding year. Recently, high-volume corticosteroid nasal irrigations have been recommended for CRS treatment. ObjectiveTo assess high-volume budesonide nasal irrigations for difficult-to-treat CRS. MethodsProspective uncontrolled intervention trial. Participants were assessed before- and 3 months after nasal irrigation with 1mg of budesonide in 500mL of saline solution daily for 2 days. Subjective (satisfactory clinical improvement) and objective (SNOT-22 questionnaire and Lund–Kennedy endoscopic scores) assessments were performed. ResultsSixteen patients were included, and 13 (81.3%) described satisfactory clinical improvement. SNOT-22 mean scores (50.2–29.6; p=0.006) and Lund–Kennedy mean scores (8.8–5.1; p=0.01) improved significantly. Individually, 75% of patients improved SNOT-22 scores, and 75% improved Lund–Kennedy scores after high volume budesonide nasal irrigations. ConclusionHigh-volume corticosteroid nasal irrigations are a good option in difficult-to-treat CRS control of disease, reaching 81.3% success control and significant improvement of SNOT-22 and Lund–Kennedy scores.

Highlights

Chronic rhinosinusitis (CRS) is defined as a chronic inflammatory process of nasal mucosa and paranasal sinuses, lasting more than 12 weeks, without complete resolution of symptoms.[1]
The doses of the drugs mentioned did not change during the SinoNasal Outcomes Test (SNOT)-22, SinoNasal Outcome Test-22; F, female; M, male; CRSwNP, chronic rhinosinusitis with polyps; CRSw/oNP, chronic rhinosinusitis without polyps; Rhin., rhinorrhea; Ant., anterior; Post., posterior; VCID, common variable immunodeficiency; Tx, transplant
In the evaluation of difficult-to-treat patients, that is, those who had already undergone endoscopic sinonasal surgery without adequate clinical control with topical nasal corticosteroids in the form of spray and up to two cycles of oral antibiotics and/or corticosteroids in the preceding year, the present study demonstrated efficacy of high-volume nasal irrigation with a solution of budesonide, with 81.3% of success in clinical management

Summary

Introduction

Chronic rhinosinusitis (CRS) is defined as a chronic inflammatory process of nasal mucosa and paranasal sinuses, lasting more than 12 weeks, without complete resolution of symptoms.[1]. There is no consensus on the composition and duration of maximal clinical treatment,[7] with highly variable success rates.[8,9] In addition, the optimized and prolonged use of drugs such as oral antibiotics and corticosteroids can lead to significant adverse effects; there is an effort for replacing systemic therapy by topical nasal therapy to achieve control of CRS.[10] The direct administration of the drug to inflamed tissue allows an increased local concentration with less systemic absorption, enhancing therapeutic efficacy.[11] For this reason, surgery has been considered an essential step in treating CRS, by opening spaces and allow for an adequate distribution of the drug through nasal cavities.[10,12,13]

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