Intranasal Glucocorticosteroids Research Articles

Evaluation of ongoing mepolizumab treatment in chronic rhinosinusitis with nasal polyps

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and paranasal sinuses. Eosinophilic inflammation is described as a common endotype. The anti-interleukin-5 (IL-5) antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe CRSwNP when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, therapy monitoring and follow-up documentation are required, and therapy discontinuation has not been adequately established yet. In this paper, recommendations for monitoring the course and efficacy of therapy as well as for reviewing the duration and possible termination of therapy are provided. For this purpose, a literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching MEDLINE, PubMed, and the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including October 2022 were considered. Based on the international literature and previous experience, recommendations for follow-up, adherence to therapy intervals and possible therapy breaks, as well as termination of therapy when using mepolizumab for the indication CRSwNP in the German health care system are given by an expert panel on the basis of a documentation sheet.

Study of the effect of a drug from the macromycetes Ganoderma lucidum on the phagocytic activity of peripheral blood neutrophils in patients with year-round allergic rhinitis

Modern complex therapy of patients with persistent (year-round, chronic) allergic rhinitis (AR), based on the use of antihistamines and intranasal glucocorticosteroids, in many cases is not effective enough, since drug therapy acts only on individual links in the pathogenesis, without preventing the progression of the allergic disease. At the same time, the quantitative and reserve capabilities of neutrophil granulocytes are depleted, which increases the level of antigenic load in patients with AR. The aim of this study is to investigate the phagocytic activity of neutrophils in patients with AR who received basic therapy and patients who received basic therapy and a course of the drug from the macromycetes Ganoderma lucidum "Astmagan". We examined 40 patients of both sexes with AR, the duration of the disease ranged from 6 months to 2 years. Patients were divided into 2 equal groups: The 1st group consisted of patients who received basic therapy (oral Loratadine and intranasal Nasonex). The 2nd group consisted of patients who received basic therapy and a course of "Astmagan". The treatment course lasted 90 days. The control group consisted of 25 healthy individuals. After the treatment, patients in both groups showed a statistically significant positive dynamics of phagocytic system activity: in group 1, the phagocytic index (FI) increased by 30 % (p=0.001), in the second group this indicator reached the normal level. Also, in patients of group 1, the phagocytic number (PN) increased by 35 % (p=0.0001), but did not reach the normal level.
 According to the results of comparative evaluation, a greater efficacy of the treatment complex with the additional use of "Astmagan" was established, which is manifested in the restoration of phagocytic activity of peripheral blood neutrophils, the effect persists for 6 months after treatment.

Efficacy and safety of the combination nasal spray olopatadine hydrochloride-mometasone furoate in the treatment of allergic rhinitis

Abstract Introduction Pharmacotherapy is the main pillar in the treatment of allergic rhinitis. While antihistamines (AH) and intranasal glucocorticosteroids (INCS) have long been part of the therapeutic standard, a pharmacological combination of both active substances in a nasal spray has so far only been implemented and made available in two preparations in Germany. Recently, an intranasal olopatadine hydrochloride-mometasone furoate (Olo-Mom) combination was introduced as a nasal spray for the treatment of seasonal and perennial allergic rhinitis. Methods In a literature search, treatment options for allergic rhinitis were analyzed and the available evidence was determined by searching Medline, PubMed, and the national and international study (ClinicalTrials.gov) and guideline registers and the Cochrane Library. Human studies published on the topic in the period up to and including August 2023 were taken into account. Results Based on the international literature and previous experience, the results are summarized and recommendations are given. The drugs used in the pharmacotherapy of AR primarily include INCS, intranasal and oral AH, leukotriene antagonists, intranasal cromoglicic acid preparations, intranasal and oral vasoconstrictors, and nasal rinses. For patients with intermittent and persistent allergic rhinitis, INCS are the first-line therapy, but in many patients they do not work sufficiently or quickly enough. The fixed combination Olo-Mom nasal spray showed significant improvements in the Reflective Total Nasal Symptom Score (rTNSS) in two phase II clinical trials with twice-daily and once-daily administration. In phase III studies, Olo-Mom nasal spray administered twice daily showed significant improvements in rTNSS compared to placebo, olopatadine monotherapy, and mometasone monotherapy. Conclusion In summary, AH and INCS will remain the main groups of active ingredients in the treatment of allergic rhinitis in the future. In combination preparations such as the new combination nasal spray olopatadine hydrochloride-mometasone furoate, they are highly effective and safe, thus opening up new perspectives, especially for patients with moderate and severe allergic rhinitis from the age of 12 years.

Monitoring mepolizumab treatment in chronic rhinosinusitis with nasal polyps (CRSwNP): Discontinue, change, continue therapy?

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and sinuses. Eosinophilic inflammation is described as a common endotype. The anti-IL-5 antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, it has not yet been adequately specified how this therapy should be monitored, what follow-up documentation is necessary, and when it should be discontinued if necessary. A literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries, and the Cochrane Library. Human studies published in the period up to and including 10/2022 were considered. Based on the international literature and previous experience by an expert panel, recommendations for follow-up, adherence to therapy intervals, and possible therapy breaks as well as discontinuation of therapy when using mepolizumab for the indication CRSwNP in the German healthcare system are given on the basis of a documentation sheet. Understanding the immunological basis of CRSwNP opens up new non-surgical therapeutic approaches with biologics for patients with severe, uncontrolled courses. Here, we provide recommendations for follow-up, adherence to therapy intervals, possible therapy pauses, or discontinuation of therapy when mepolizumab is used as add-on therapy with intranasal glucocorticosteroids to treat adult patients with severe CRSwNP that cannot be adequately controlled with systemic glucocorticosteroids and/or surgical intervention.

Problems of polypragmasia and drug interaction in the treatment of uncomplicated acute rhinosinusitis

This publication discusses polypragmasia and drug interactions in the treatment of uncomplicated acute rhinosinusitis in children and adults. Treatment of rhinosinusitis on an outpatient basis in multimorbid patients may be accompanied by multiple prescriptions, which increases the risk of drug interactions. The article reflects the most significant inappropriate combinations of both medicines and biologically active additives, herbal preparations. The advantages of using drugs with proven effectiveness, in particular intranasal glucocorticosteroids, are considered.

The Effect of Intranasal Steroid on Nasal Mucociliary Clearance in Allergic Rhinitis

Intranasal glucocorticosteroids are the most effective treatment for allergic rhinitis and are recommended as first-line therapy for patients with moderate to severe Allergic Rhinitis, particularly when nasal congestion is the prominent symptom. The use of intranasal corticosteroids showed to affect the mucociliary action by decreasing the prolonged mucociliary clearance time and increasing the mucociliary clearance rate. Keywords: AR- Allergic Rhinitis, INCS- Intranasal corticosteroid, NMC- Nasomucociliary clearance, MCT- Mucociliary Clearance Time, MCR- Mucociliary clearance rate, OAH- Oral antihistamine

Intranasal drugs possibilities in the treatment of patients with rhinitis medicamentosa

Introduction. The article presents the physiology of nasal breathing, as well as the problem of nasal obstruction and the mechanisms of its development. Topical issues of rhinitis medicamentosa are discussed, based on the pathogenic links of this condition. It has been established that there is no single treatment regimen for rhinitis medicamentosa at the moment.Objectives. To evaluate the effectiveness and safety of the use of intranasal drugs in patients with medical rhinitis.Materials and methods. A comparative study of the clinical use of the complex preparation Frinozol®, the active substances of which are the decongestant phenylephrine and the antihistamine drug cetirizine, intranasal glucocorticosteroid Nosefrin®, as well as their combinations, was carried out in patients with rhinitis medicamentosa.Results. The results showed that the use of Frinozol®, Nozefrin®, as well as a combination of these drugs leads to a decrease in the frequency of use of nasal decongestants, and in a larger percentage of cases or to the complete cessation of their use by patients with drug-induced rhinitis. The combination of Frinozol – Nozefrin is somewhat more effective. However, a number of patients resume the use of nasal decongestants after some time, which leads to the need for additional courses of conservative therapy. In the course of the observational study, we noted excellent and good tolerability of the drugs, and patient satisfaction with the treatment in all groups.Conclusions. The problem of drug-induced rhinitis remains unresolved, which is why the search for optimal and effective schemes for the conservative treatment of this disease continues. The use of intranasal glucocorticosteroids and topical antihistamines can significantly reduce the frequency of use of nasal decongestants, or completely abandon their use.

Empfehlungen zur Überprüfung der Wirksamkeit und Verlaufsdokumentation von Mepolizumab bei chronischer Rhinosinusitis mit Nasenpolypen (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC)

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and sinuses. Eosinophilic inflammation is described as a common endotype. The anti-IL5 antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, it has not yet been adequately specified how this therapy is to be monitored, what follow-up documentation is necessary, and when it should be terminated if necessary. A literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 10/2022 were considered. Based on the international literature and previous experience by an expert panel, recommendations for follow-up, adherence to therapy intervals and possible therapy breaks, as well as termination of therapy when using mepolizumab for the indication CRSwNP in the German health care system are given on the basis of a documentation sheet. Understanding the immunological basis of CRSwNP opens up new non-surgical therapeutic approaches with biologics for patients with severe, uncontrolled courses. Here, we provide recommendations for follow-up, adherence to therapy intervals, possible therapy pauses, or discontinuation of therapy when mepolizumab is used as add-on therapy with intranasal glucocorticosteroids to treat adult patients with severe CRSwNP that cannot be adequately controlled with systemic glucocorticosteroids and/or surgical intervention.

Полипозный риносинусит: возможности противовоспалительной терапии

Current treatments for polypous rhinosinusitis (PRS) relieve symptoms but do not eliminate recurrence rates, highlighting research relevance, molecular targets, inflammation, and nasal mucosal function. Patients and methods. Formed 2 groups of patients (main (n = 44) and comparison (n = 20)) diagnosed with PRS. Patients of the main group were additionally prescribed the anti-inflammatory oral drug "Reglisam" for 90 days in the treatment regimen. In dynamics, the groups underwent endoscopy of the nasal cavity, scoring by VAS (from 0 to 3 points) of complaints and local symptoms of inflammation. Results. By the 45th day, in patients of the main group, the severity of sneezing, coughing, headache/facial pain was lower by 77, 56 and 87%, respectively, relative to the comparison group (p < 0.05), differences in the severity of symptoms of nasal congestion, discharge, postnasal drip was 24–34% (p < 0.05). By the 90th day in the main group, sneezing, headache/facial pain, and cough were completely stopped, in the comparison group, the symptoms persisted. In the main group, the degree of nasal congestion and nasal discharge were minimal, postnasal drip – 60% lower relative to comparison (p < 0.05). The proportion of patients in the main group with complaints of postnasal drip and nasal discharge by day 90 decreased by 41% and 32%, respectively (p < 0.05), sneezing, headache/facial pain and cough were absent. In the comparison group, the frequency of symptoms over time did not change significantly. According to endoscopy in the main group on the 90th day of treatment, mucous discharge was absent in 55% of patients (n = 24), edema was not recorded in 16% (n = 7). In the comparison group, mucous discharge was absent only in 30% (n = 6), edema persisted in all patients. The severity of mucous secretions and edema in patients of the main group was more than 2.5 times less than in the comparison group (p < 0.05). Conclusion. Treatment of PRS with the inclusion "Reglisam", in comparison with monotherapy with intranasal glucocorticosteroids, more effectively allows to stop swelling and inflammation in the nasal mucosa, improve mucociliary transport and drainage of the paranasal sinuses, normalize nasal breathing and improve the quality of life of patients.

Влияние назальной обструкции на газово-электролитный баланс организма

According to statistics, the most common complaint to an ENT doctor is difficulty in nasal breathing. The leading cause of such complaints is the curvature of the nasal septum, vasomotor and hypertrophic rhinitis. These conditions cause changes in the quality of life in the human body, and most importantly, the development of chronic diseases. The purpose of the study: to identify general patterns in patients with nasal obstruction, to develop recommendations for managing patients in the postoperative period. Patients and methods. In the period from 2018 to 2020, we examined 96 people aged 20 to 40 years: 72 of them were men, 24 were women with varying severity of nasal obstruction syndrome. The control group consisted of 16 people who did not complain of difficulty in nasal breathing. The patients were divided into two groups: those who received conservative treatment, and the group that was planned to undergo a surgical intervention aimed at eliminating nasal obstruction. Further, in patients of both groups, indicators of the acid-base state of venous blood were evaluated. Results. Indicators of the acid-base state of venous blood in patients of the group treated with a course of nasal decongestants and intranasal glucocorticosteroids remained practically unchanged after the treatment. Recovery of indicators of the acid-base state of venous blood in patients who underwent surgery is fully determined by the third month after the surgical treatment. Conclusions: The prevalence of diseases, including the hypoxic component, determines the need to study and understand the mechanisms of hypoxia, as well as the issues of eliminating oxygen deficiency, the process of adaptation to it.

Control of hormonal rhinitis symptoms in patients with hypothyrosis: pathogenetic and clinical aspects

One of the poorly studied sections of the pathology of ENT organs is chronic rhinitis in patients with hypothyroidism, the pathogenesis of which has not been fully understood, the diagnosis causes significant difficulties, and there are no recommendations for treatment. Despite receiving replacement therapy with levothyroxine, the symptoms of rhinitis persist. To study the effectiveness of the use of intranasal glucocorticosteroids in patients with chronic rhinitis and hypothyroidism. Patients with chronic rhinitis and hypothyroidism used mometasone nasal spray 100 mcg 1 time per day for a course of treatment of 2 months (n=60). To assess the symptoms of rhinitis, a visual analog scale (0-10 points), endoscopic examination of ENT organs, anterior active rhinomanometry were used. Evaluation of mucociliary transport was used a saccharin test. The concentration of transforming growth factor (TGF-β1) in nasal secretion and blood serum was studied by ELISA (Enzyme-Linked Immunosorbent Assay), the number of metabolites of NO - nitrites+nitrates (NOx) was recorded by colorimetric method. The use of mometasone nasal spray in patients with hypothyroidism helped to reduce complaints on a visual-analog scale (difficulty in nasal breathing, rhinorrhea) and improve nasal breathing according to anterior active rhinomanometry. The concentrations of TGF-β1 and NOx in nasal secretions before mometasone treatment were higher than after treatment, which probably indicates the contribution of these substances to the formation of edematous hypertrophic changes from the nose in patients with hypothyroidism.

Antileukotriene drugs as a tool for improving the quality of life in patients with allergic rhinitis

Introduction. Allergic rhinitis (AR) is immunoglobulin E (IgE) mediated disease. Which, after exposure to allergens, manifests itself with various symptoms such as sneezing, runny nose, nasal itching, and nasal congestion, which seriously affects the quality of life of patients. In some patients, AR poses a risk of developing serious mental disorders. Currently, various medicines are used for treatment. Objective. Consideration of the effectiveness of AR therapy with antileukotriene drugs, depending on the mental state of the patient. Materials and methods. The study involved 200 people diagnosed with AR. The patients were divided into 2 groups: group 1 (100 people) with basic therapy with intranasal glucocorticosteroids (inGCS – mometasone furoate) and group 2 (100 people) – inhalers in combination with an antileukotriene drug (montelukast). All were screened for the presence of a depressive disorder. The tactics of case management and prescription of drugs were defined by the level of depression. Patients with AR have mental health problems that correlate with AR symptoms. Results. Patients of the 1st group, who did not achieve complete relief of AR symptoms, when assessing their mental state using the PHQ-2 and PHQ-9 questionnaires, showed a mild depression (23 people). The symptoms of AR were stopped, when an anti-leukotriene drug was added to the therapy. Conclusions. With the ineffectiveness of the basic therapy of inGCS and a negative assessment of the patient’s mental state, the use of an antileukotriene drug is justified to improve the level of depressive mood and complete relief of symptoms of AR.

Possibilities of combined intranasal drugs in the treatment of patients with rhinosinusitis

Rhinosinusitis – an inflammatory process in the nasal cavity and paranasal sinuses is a global problem of practical medicine, which remains relevant for many years. The most common cause of acute rhinosinusitis is a viral infection, only in 0.2–5 % of patients the disease is further complicated by the formation of a bacterial focus of inflammation. Treatment of patients withARS involves the use of etiotropic, pathogenetic and symptomatic therapy. National clinical guidelines consider the use of systemic and topical etiotropic drugs, intranasal glucocorticosteroids, topical decongestants, irrigation- elimination procedures, mucoactive therapy, standardized herbal medicine, drainage of the paranasal sinuses, antihistamines (with concomitant allergies) and some other activities. Local administration of drugs in patients with rhinosinusitis provides targeted delivery of the active substance to the pathological focus and the creation of its required concentration, the virtual absence of systemic action due to low absorption, as well as a favorable softening, moisturizing, enveloping effect of auxiliary components. One of these drugs is the combined nasal spray containing tuaminoheptane sulfate and acetylcysteine. The effectiveness and safety of the use of this combination has been demonstrated by the results of a fairly large amount of research. The mild and sufficiently long vasoconstrictive effect of tuaminoheptane sulfate, the direct mucolytic, antioxidant and anti-inflammatory effects of acetylcysteine and the high safety of this combination determine its therapeutic value in children from 6 years of age and adult patients with rhinitis and rhinosinusitis.

Combination therapy of allergic rhinitis: efficacy, safety and impact on quality of life

Currently, allergic rhinitis is one of the most common allergic diseases, and its significance is often underestimated by both doctors and patients, resulting in increased severity, decreased physical, professional, and social activity, sleep disturbance, and the impairment of the quality of life.
 Despite modern drug availability, the control level over allergic rhinitis symptoms in routine clinical practice remains low. Patients who do not receive a quick result from using intranasal glucocorticosteroids, which have anti-inflammatory and pathogenetic properties, prefer fast-acting decongestants instead, which can lead to chronization and adverse events. The use of intranasal glucocorticosteroids and antihistamines combination, which have additive effects on the key pathogenesis stages of allergic inflammation, allows for rapid treatment of the most severe rhinitis symptoms and can improve adherence to therapy.
 This review presents the results of clinical studies and key characteristics of the new nasal spray of the olopatadine and mometasone fixed combination, confirming the high efficacy and good safety profile of olopatadine + mometasone. The administration of olopatadine and mometasone fixed combination provides rapid relief from nasal and ocular symptoms in patients with allergic rhinitis, ultimately leading to an improvement in the quality of life.

The use of intranasal glucocorticosteroids in the treatment of persistent allergic rhinitis after COVID-19 infection

Introduction. Modern algorithms for the diagnosis and treatment of allergic rhinitis (AR) recommend a stepwise approach for managing symptoms of the disease. A part of patients with AR have symptoms that indicate to the past COVID-19 followed by significant impairment of the olfactory function. The article places special emphasis on the intranasal glucocorticosteroid option of treatment to manage nasal and general symptoms in persistent AR.The aim of the study is to evaluate the efficacy of mometasone furoate in patients with a confirmed diagnosis of persistent AR, olfactory disorders, and past COVID-19 infection.Materials and methods. A total of 72 patients with persistent AR were included in the randomized controlled prospective study. All patients had a history of olfactory dysfunction with varied severity, which persisted after COVID-19 infection.Results. Measuring the severity of nasal and general symptoms on Day 15 of treatment showed a positive outcome in both groups: the patients of the main group experienced changes, to a greater extent, in nasal congestion, rhinorrhea, olfactory disorders, the patients of the control group generally demonstrated a reduction in nasal congestion, rhinorrhea, itching and sneezing, and improvement of sleep. The final measuring of the severity of complaints on Day 30 of treatment showed that patients of the main group managed to cure the olfactory disorders (0.9 points on the VAS), nasal congestion (0.4 points on the VAS), rhinorrhea and itching (0.2 points on the VAS). Sleep disorders continued to disturb patients in both groups, its improvements in the main group were statistically insignificant.Conclusions. The complaints of nasal congestion, impaired olfactory function and sleep disorders were noted to prevail in patients with persistent form of AR after COVID-19. The followed measuring of the olfactory function using the SST-12 screening test showed that all patients had anosmia. It has been confirmed that the use of mometasone furoate in the treatment of persistent AR in patients with severe olfactory dysfunction after COVID-19 would be appropriate.

Real possibilities of treatment of patients with allergic rhinitis

Allergic rhinitis occupies a special place among diseases of the upper respiratory tract. Every year the urgency of the problem increases due to the annual increase in the incidence among all age groups of the population. Allergic diseases are often associated with other respiratory diseases or cause them, which requires early diagnosis and selection of competent therapy. Allergic reactions can range from seasonal allergens, such as tree or weed pollen, to year-round irritants, such as dust and pet dander. Currently, the pathogenesis of allergic rhinitis is being actively studied. There is still debate about the most accurate classification of allergic rhinitis, reflecting all its aspects, such as the time of onset and duration of symptoms, their impact on patients’ lives. This is necessary to find the best methods of treatment with maximum efficiency. The main clinical manifestations of allergic rhinitis are nasal itching, sneezing, swelling of the nasal mucosa and rhinorrhea. Often, to relieve symptoms, patients are forced to take many drugs for a long time, which has a significant impact on their quality of life. All over the world, new ways are being developed to optimize the treatment of this group of patients, among which combinations of several drugs used to treat allergic rhinitis, which meet all safety and efficacy requirements. The most commonly used and most effective combinations of drugs are combinations of intranasal glucocorticosteroids with topical histamine H1 receptor antagonists, as well as leukotriene receptor blockers with oral antihistamines.

The role of leukotriene receptor blockers in the treatment of allergic rhinitis in combination with chronic rhinosinusitis with nasal polyps

Background. Leukotrienes play an important role in the pathogenesis of allergic rhinitis (AR) and eosinophilic type of chronic rhinosinusitis with nasal polyps (CRSwNP). There is a phenotype of CRSwNP in combination with AR, which has specifics of local inflammation.The aim of our study was to investigate the efficacy of using an antileukotriene drug in the treatment of AR in combination with CRSwNP.Materials and methods. 63 patients with AR and bilateral CRSwNP after endoscopic bilateral polypotomy were randomly divided into 2 groups. In the 1st group 32 people (age 50.28 ± 1.37 years) were prescribed a basic therapy with nasal spray of mometasone furoate at a daily dose of 400 µg in combination with montelukast 1 tab. 10 mg at night, in the 2nd group 31 people (age 50.31 ± 1, 16 years old) received only mometasone furoate monotherapy. Endoscopic examination of the nasal cavity was performed once every 3 months. The follow-up period was 1 year.Results. After 3 months in the 1st group of patients there was a recurrence of polyp growth was observed in 25% of cases, in the 2nd group in 35.5% of patients (p < 0.05). After 6 months, the number of relapses of CRSwNP decreased to 15.6% of cases in group 1 and to 22.6% in group 2 (p < 0.05). After 9 months in group 1 recurrence of NP was recorded in 12.5% of patients and nasal polyps were completely absent during endoscopic examination in 9.4% of cases, in the 2nd group, relapse was detected in 19.35% of patients (p < 0.05). 1 year after surgery, in group 1, relapse of NP was found in 12.5% of patients with AR and in 12.5% of cases was remission of the pathological process with cancellation of basic therapy. In group 2, recurrence of NP was in 16.1% of cases, there were no reasons for withdraw treatment of intranasal glucocorticosteroids in this group.Discussion. The clinical effectiveness of the addition of Montelukast to basic therapy has been reflected in a reduction in the growth rate of polyposic vegetation, the number of repeated operations and the stabilization of the flow of chronic inflammatory process.Conclusions. In the case of the clinical phenotype of AR with CRSwNP, the addition of a leukotriene receptor blocker montelukast to the basic therapy of intranasal glucocorticosteroids made it possible to improve drug control of both diseases and reduce the frequency of CRSwNP relapses.

Transforming growth factors TGF- β1, TGF- β2 and TGF- β3 in the tissue of nasal polyps in different phenotypes of chronic rhinosinusitis with nasal polyps

Chronic rhinosinusitis with nasal polyps (CRSP) is a heterogenous disease. We have earlier detected differences in severity of clinical manifestations, cellular infiltration degree shown in nasal polyps, of eosinophil-to-neutrophil ratio, efficacy of intranasal glucocorticosteroid baseline therapy, and various inflammatory patterns for several cytokines on the mRNA expression level in different phenotypes with isolated CRSP cases, CRSP associated with respiratory allergy (RA), or non-allergic bronchial asthma.The purpose of this work was to study the cytokines of TGF-â family in the tissues of nasal polyps in patients with different CRSP phenotypes. The research involved 292 patients suffering from CRSP divided into 3 phenotypic groups. Group I consisted of patients with isolated CRSP free of associated BA and/or sensitization to atopic allergens. Group II included patients with CRSP combined with respiratory allergy and was further divided into two subgroups. I.e., Group 2a comprised patients with CRSP, allergic BA (aBA), and allergic rhinitis (AR), while the patients with CRSP, AR, and non-allergic BA were placed to the group 2b. The patients suffering from CRSP complicated with non-allergic BA were allocated to the group III. The patients with hypertrophic rhinitis served as control. The levels of TGF-â1, TGF-â2, and TGF-â3 proteins (pg/mg) were measured by means of multiplex immunoassay approach in supernates of tissue homogenates from nasal polyps removed by surgery, and in posterior parts of inferior nasal conchae. The total protein level was determined in tissue supernatant, with cytokine contents recalculated for the mg/ml protein concentration for standardization of measurements.In the control group, trace concentrations of all three growth factors were detected. Significant difference in protein contents was found for the studied cytokines, depending on CRSP phenotype. The levels of TGF-â1 and TGF-â2 were statistically lower in isolated CRSP than in other groups of comorbid CRSP patients. TGF-â1 and TGF-â2 concentrations were significantly lower in CRSP + allergic BA group IIa than in CRSP + nonallergic BA and CRSP + RA groups. The amount of TGF-â3 cytokine was maximal in CRSP + non-allergic BA group III compared to the patients with isolated CRSP of group I and CRSP + non-allergic BA group 2a.Conclusions.The high level of all three TGF-â isoforms in patients with CRSP compared to the control group suggested a high potential of mucous membranes of paranasal sinuses for active tissue remodeling followed by nasal polype formation.Different mechanisms were presumed for development of local pathological process in different clinical phenotypes of CRSP, depending on the comorbid pathology, especially, BA or respiratory disorders.Minimal TGF-â1 and TGF-â2 levels were detected in isolated CRSP.The highest concentrations of TGF-â1, TGF-â2, and TGF-â3 were discovered in the patients with CRSP accompanied by non-allergic BA as compared to the groups with isolated CRSP and CRSP+allergic BA.5. Determination of TGF-â1, TGF-â2, and TGF-â3 levels can serve as an additional criterion for differentiating between the mechanisms of mucous membrane damage in local pathological process in tissues of comorbid patients with different CRSP phenotypes.

The use of intranasal glucocorticosteroids in patients with chronic rhinosinusitis in the preoperative period

Introduction. Chronic rhinosinusitis is a disease that occurs everywhere, characterized by inflammation of the mucous membrane of the paranasal sinuses and nasal cavity. If it is impossible to eliminate the causes of the recurrent disease with medical therapy, the use of surgical treatment help to recover the normal functioning of the ostium, including the ostiomeatal complex to improve ventilation and drainage of the paranasal sinuses and recover nasal breathing to relieve chronic inflammation.Purpose of the study. Assessment of the degree of intraoperative bleeding in patients with chronic rhinosinusitis.Materials and methods. On the basis of the FGBU SPB Research Institute of ENT of the Ministry of Health of the Russian Federation in the period from 2020 to 2021. the study of the effect of local intranasal glucocorticosteroids (INGKS) in the intraoperative period in patients with chronic polypous rhinosinusitis was carried out. The total amount of blood loss during surgery for chronic polypous rhinosinusitis in patients who used mometasone furoate preoperatively and in patients not taking topical hormonal drugs was analyzed.Results. In the study group, the average blood loss per operation was 257 ml, in the control group – 401 ml. In patients who took intranasal glucocorticosteroids during surgery, the intensity of bleeding is less pronounced. Undoubtedly, there are many reasons that affect the intensity of bleeding in general, however, a decrease in the inflammatory response in the nasal cavity and a decrease in inflammatory metabolites have a beneficial effect on the state of the nasal mucosa.Conclusion. The use of intranasal glucocorticosteroids in the preoperative period has a positive effect on reducing the inflammatory process in the nasal cavity, which helps to reduce the intensity of intraoperative bleeding.

Features of adherence to treatment of patients with chronic rhinosinusitis with nasal polyps

Generalization of data on the significance and ways to increase adherence to treatment of patients with CPR. Materials of scientific publications included in the Cochrane Library, Russian Science Citation Index, MEDLINE, PubMed information bases were used as a data source. The material was selected based on the following keywords: "chronic rhinosinusitis", "nasal polyps", "intranasal glucocorticosteroids", "adherence to treatment". Despite the fact that inGCSs are one of the main pathogenetically justified methods of treating CPR, their use is limited by many factors, one of which is the level of patient compliance with the treatment regimen. Improving adherence to treatment is one of the important reserves for increasing the effectiveness of drug therapy for chronic polypous rhinosinusitis.