Medicolegal Implications of Common Rhinologic Medications

Poetker, David M.; Smith, Timothy L.

doi:10.1016/j.otc.2015.05.009

Cited by 8 publications

(3 citation statements)

References 30 publications

(46 reference statements)

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“…Cardiovascular disease is mainly associated with high dose and long‐term use, primarily hypertension and acute myocardial infarction are described [100, 119 ].…”

Section: Adverse Effects Of Systemic Gcsmentioning

confidence: 99%

Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper

Hox

Lourijsen

Jordens

et al. 2020

Clin Transl Allergy

135

111

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Because of the inflammatory mechanisms of most chronic upper airway diseases such as rhinitis and chronic rhinosinusitis, systemic steroids have been used for their treatment for decades. However, it has been very well documented that—potentially severe—side-effects can occur with the accumulation of systemic steroid courses over the years. A consensus document summarizing the benefits of systemic steroids for each upper airway disease type, as well as highlighting the potential harms of this treatment is currently lacking. Therefore, a panel of international experts in the field of Rhinology reviewed the available literature with the aim of providing recommendations for the use of systemic steroids in treating upper airway disease.

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“…Cardiovascular disease is mainly associated with high dose and long‐term use, primarily hypertension and acute myocardial infarction are described [100, 119 ].…”

Section: Adverse Effects Of Systemic Gcsmentioning

confidence: 99%

Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper

Hox

Lourijsen

Jordens

et al. 2020

Clin Transl Allergy

135

111

View full text Add to dashboard Cite

show abstract

“…There is an urgent need to develop more effective treatment options for CRS in the elderly population. While the mainstays of medical therapy for CRS include antibiotics and systemic corticosteroids, both of these options are associated with increased risks of adverse complications in elderly patients [21][22][23][24][25] . Several studies also suggest that advanced age may be a risk factor for serious complications following sinus surgery 26,27 .…”

Section: Introductionmentioning

confidence: 99%

Chronic rhinosinusitis in elderly patients is associated with an exaggerated neutrophilic proinflammatory response to pathogenic bacteria

Morse

Ely

et al. 2019

Journal of Allergy and Clinical Immunology

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Background: Potential effects of aging on chronic rhinosinusitis (CRS) pathophysiology have not been well defined, but may have important ramifications given a rapidly aging U.S. and world population. Objective:The goal of the current study was to determine whether advanced age is associated with specific inflammatory CRS endotypes or immune signatures.Methods: Seventeen mucus cytokines and inflammatory mediators were measured in 147 CRS patients. Hierarchical cluster analysis was used to identify and characterize inflammatory CRS endotypes as well as determine whether age was associated with specific immune signatures.Results: A CRS endotype with a pro-inflammatory, neutrophilic immune signature was enriched with older patients. In the overall cohort, patients 60 years and older had elevated mucus levels of IL-1β, IL-6, IL-8, and TNF-α when compared to their younger counterparts.

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“…Recent studies have highlighted multiple doses and duration-dependent complications associated with oral corticosteroids, including hyperglycemia, infection, poor wound healing, avascular necrosis, and increased intraocular pressures, among others. 29,30 As we appreciate these adverse effects of long-term use, the paradigm has shifted away from oral corticosteroids and now focuses on improved delivery of topical corticosteroids. A recent randomized controlled trial (RCT) demonstrating no additional benefit of postoperative prednisone over placebo for CRS without nasal polyp patients highlighted the worse psychological scores in those receiving prednisone.…”

Section: Treatment Updatementioning

confidence: 99%

New Developments in Allergic Fungal Rhinosinusitis Pathophysiology and Treatment

Cameron

Luong

2023

Am J Rhinol�Allergy

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Background Allergic fungal rhinosinusitis (AFRS) is an endotype of chronic rhinosinusitis (CRS) with nasal polyps characterized by eosinophilic mucin laden with fungal hyphae entrapped in expanded sinus cavities with an exaggerated hypersensitivity to fungal elements. The last decade has elucidated fungi-driven inflammatory pathways contributing to the pathophysiology of chronic inflammatory respiratory diseases. In addition, novel therapeutic biologic options have become available for CRS over the last several years. Objective To review the current literature examining AFRS, focusing on recent developments in our understanding of its pathophysiology and implications for treatment options. Methods Review article. Results Fungi-driven respiratory inflammation has been linked to fungal proteinases and toxin activity. In addition, AFRS patients demonstrate a local sinonasal immunodeficiency in antimicrobial peptides and hence limited antifungal activity, along with an exaggerated type 2 inflammatory response, highlighting a possible imbalanced type 1, type 2, and type 3 profile. The elucidation of these dysregulated molecular pathways has highlighted novel potential therapeutic targets. As such, the clinical management of AFRS, which once included surgery and extended courses of oral corticosteroids, is transitioning away from long courses of oral corticosteroids to incorporate novel delivery mechanisms of topical therapeutic targets and biologics for recalcitrant disease. Conclusion AFRS is an endotype of CRS with nasal polyps (CRSwNP) for which the molecular pathways leading to its inflammatory dysfunction are beginning to be illuminated. In addition to affecting treatment options, these understandings may shape necessary changes to diagnostic criteria and the extrapolated effects of environmental changes on AFRS. More critically, a better appreciation of fungi-driven inflammatory pathways may have implications for the understanding of broader CRS inflammation.

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Medicolegal Implications of Common Rhinologic Medications

Cited by 8 publications

References 30 publications

Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper

Benefits and harm of systemic steroids for short- and long-term use in rhinitis and rhinosinusitis: an EAACI position paper

Chronic rhinosinusitis in elderly patients is associated with an exaggerated neutrophilic proinflammatory response to pathogenic bacteria

New Developments in Allergic Fungal Rhinosinusitis Pathophysiology and Treatment

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