Management of chronic rhinosinusitis in CF

Abstract

Routine CF management often does not include upper airway (UAW) assessment although CFTR defects equally affect the sinonasal mucosa. Up to 50% of CF patients have chronic rhinosinusitis (CRS) and/or nasal polyps, and almost 100% reveal UAW abnormalities on CT scan. CRS impairs quality of life. UAW dysfunction in filtering, humidifying, and warming inspired air affects lower airways and the UAW is a potential site of first colonization and a reservoir for opportunistic bacteria. Therefore, UAW pathology substantially affects overall health in CF. Standard treatments are scarce and mostly lack evidence. Nasal douche can remove mucus and crusts. Recently, delivery of dornase alfa using a vibrating aerosol has shown potential as treatment for CF-related CRS. Surgery is indicated when conservative approaches fail but postoperative relapse is frequent. In summary, upper airway involvement in CF is undertreated and requires prospective investigation and an interdisciplinary consensus on diagnosis and therapy.

Cystic Fibrosis Chronic Rhinosinusitis: A Comprehensive Review

“…54,55 This was confirmed by Godoy et al 56 who showed a significant association between sinus cultures and lower airway cultures from bronchoalveolar lavage. Genotypes of sinus bacteria were also shown to be concordant with the lower airway, indicating the sinuses also may serve as a reservoir for recurrent lung infection, 57 increasing the importance of maximizing sinus health. There are increased patterns of antimicrobial resistance secondary to multiple antibiotic exposures and increased prevalence of resistant bacteria within the community, particularly S. aureus.…”

Role of the Known Mucolytics in Mucoviscidosis Therapy

“…Эти ситу-ации с трудом поддаются традиционным методам тера-пии [34]. Ранее указывалось, что полипы образуются к 6-10-летнему возрасту пациента, однако в нашем наблюдении, а также в других зарубежных источниках, можно отметить, что они значительно «помолодели» [35].…”

Peculiarities of Dornase Alfa and Kinesitherapy Use in Children With Cystic Fibrosis

“…Для лечения и профилактики обострений хроническо-го полипозного синусита вводится дополнительная инга-ляция (2 ампулы) через небулайзер [21,22].…”