Nasal irrigation with corticosteroids in Brazil: the clinical response of 1% compounded budesonide drops and betamethasone cream

Luz‐Matsumoto, Gabriela Ricci; Cabernite-Marchetti, Erika; Sasaki, Layla Sayuri Kaczorowski; Marquez, Germana Jardim; Lacerda, Laura Schmitt de; Almeida, Thiago Ribeiro de; Kosugi, Eduardo Macoto

doi:10.1016/j.bjorl.2021.06.008

Cited by 6 publications

(19 citation statements)

References 16 publications

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“…The whole retrieved sample (excluding reviews) included 1182, 722 cases and 460 controls. Its distribution was clearly asymmetric, as a single study [13] provided 50.1% of the whole included sample. The mean sample size was 62.2 while the median was 30, 9 being the minimum sample size [14] and 592 the maximum [13].…”

Section: Results Of the Included Studiesmentioning

confidence: 98%

The Role of Corticosteroid Nasal Irrigations in the Management of Chronic Rhinosinusitis: A State-of-the-Art Systematic Review

Calvo-Henríquez¹,

Viera‐Artiles

Rodriguez-Iglesias³

et al. 2023

JCM

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Chronic rhinosinusitis (CRS) is a highly prevalent condition. CRS is usually managed with intranasal corticosteroids, useful both before as well as after endoscopic sinus surgery (ESS). However, the greatest drawback of these low-volume sprays is the inadequate delivery into the paranasal sinuses, even after ESS. Recent studies have shown that high-volume steroid nasal rinse (HSNR) has a significantly better penetration of the paranasal sinuses. The purpose of this state-of-the-art review is to systematically overview the current literature about the role of nasal rinses with steroids in CRS. Four authors examined four databases (Embase, Pubmed, Scielo, Cochrane). This review identified 23 studies answering 5 research questions. It included 1182 participants, 722 cases, and 460 controls. Available evidence suggests a potential positive effect of HSNR, which seems to be higher in CRS with nasal polyps. More well-designed studies are needed in order to obtain solid conclusions. The evidence is solid regarding the safety of this treatment modality in the short and long-term. We expect that this lack of severe negative effects will facilitate the acceptance of this treatment modality and the development of future studies.

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Section: Results Of the Included Studiesmentioning

confidence: 98%

The Role of Corticosteroid Nasal Irrigations in the Management of Chronic Rhinosinusitis: A State-of-the-Art Systematic Review

Calvo-Henríquez¹,

Viera‐Artiles

Rodriguez-Iglesias³

et al. 2023

JCM

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“…Penetration of nasal sprays beyond the nasal cavities into the paranasal sinuses has been shown to be limited. Data favor corticosteroid drops and corticosteroids delivered by nasal irrigation over corticosteroids sprayed intranasally [141][142][143]. Long-term administration of nasal steroids to the respiratory mucosa, evaluated by a systematic review (studies duration ranging from 5 days to 5.5 years), showed no evidence of damage to the nasal mucosa [144].…”

Section: Nasal Steroidsmentioning

confidence: 99%

Targeting Epithelium Dysfunction and Impaired Nasal Biofilms to Treat Immunological, Functional, and Structural Abnormalities of Chronic Rhinosinusitis

Petalas

Goudakos

Konstantinou

2023

IJMS

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Chronic rhinosinusitis (CRS) with (CRSwNP) or without (CRSsNP) nasal polyps is a prevalent and heterogeneous disorder existing as a spectrum of clinical conditions with complex underlying pathomechanisms. CRS comprises a broad syndrome characterized by multiple immunological features involving complex interactions between the genes, the microbiome, host- and microbiota-derived exosomes, the epithelial barrier, and environmental and micromilieu exposures. The main pathophysiological feature is an epithelial barrier disruption, accompanied by microbiome alterations and unpredictable and multifactorial immunologic overreactions. Extrinsic pathogens and irritants interact with multiple epithelial receptors, which show distinct expression patterns, activate numerous signaling pathways, and lead to diverse antipathogen responses. CRSsNP is mainly characterized by fibrosis and mild inflammation and is often associated with Th1 or Th17 immunological profiles. CRSwNP appears to be associated with moderate or severe type 2 (T2) or Th2 eosinophilic inflammation. The diagnosis is based on clinical, endoscopic, and imaging findings. Possible CRS biomarkers from the peripheral blood, nasal secretions, tissue biopsies, and nasally exhaled air are studied to subgroup different CRS endotypes. The primary goal of CRS management is to maintain clinical control by nasal douching with isotonic or hypertonic saline solutions, administration of nasal and systemic steroids, antibiotics, biologic agents, or, in persistent and more severe cases, appropriate surgical procedures.

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“…One of the more studied corticosteroid flushing agents is budesonide and 9 of the 13 studies we summarized studied budesonide. Budesonide is an effective local corticosteroid with approximately 1,000 times the local anti-inflammatory potency of cortisol, and most of the relevant studies have used it for postoperative irrigation of CRS [ 33 – 39 ], all of which concluded that budesonide is safe and effective for postoperative irrigation of CRS and facilitates postoperative management of CRS. There is also a significant clinical benefit for patients with refractory CRS [ 40 ] or CRS who have not undergone sinus surgery [ 41 ].…”

Section: Studies Related To the Composition Of Nasal Rinse Solutionmentioning

confidence: 99%

“…Fluticasone propionate may have higher potency and lower systemic bioavailability compared with budesonide; therefore, Man et al [ 43 ] used fluticasone propionate for postoperative rinsing in CRS and found no changes in intraocular pressure, blood, and urine cortisol and considered it a safe treatment option. Studies [ 38 , 39 ] using mometasone NI in the treatment of CRS have found that the efficacy is better than that with mometasone topical spray.…”

Section: Studies Related To the Composition Of Nasal Rinse Solutionmentioning

confidence: 99%

“…NI is generally considered to be a highly safe treatment. It has rare and usually mild adverse effects, including a sensation of ear stuffiness, burning or stinging of the nasal mucosa, rhinorrhea, nausea, and headache, with no serious adverse effects [ 39 ]. High-volume devices cause a greater incidence of local irritation discomfort, burning, and eustachian tube dysfunction compared with small-volume devices [ 88 ].…”

Section: Adverse Effects Of Nimentioning

confidence: 99%

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Application of nasal irrigation in the treatment of chronic rhinosinusitis

Jin,

Fan,

2023

Asia Pacific Allergy

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Nasal irrigation (NI) for the local treatment of chronic rhinosinusitis (CRS) has some specificity due to the deep anatomical site of the sinuses. The purpose of this review is to help standardize the application of NI in healthcare practice, improve the prevention and treatment of CRS, and facilitate further research on the local treatment of CRS in the future. We searched the PubMed database for 342 articles in the last decade, using the keywords “saline nasal irrigation” and “chronic rhinosinusitis.” We summarize the studies on the mechanism of action, rinsing solution, rinsing apparatus, and rinsing method of NI for CRS. NI plays an important role in the treatment of CRS, and it is a beneficial low-risk treatment. Isotonic saline is the most accepted flushing solution, and large-volume low-pressure flushing bottles are the flushing devices with the best flushing effect and are generally tolerated by patients. Phage, colloidal silver, and hydrogen can be further studied as components of rinses. NI plays an important role in the treatment of CRS, and it is a beneficial low-risk treatment. Further high-quality and expanded sample size studies on other flushing solutions, flushing head position, flushing frequency, and treatment courses are still needed, and lessons learned in practice.

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Nasal irrigation with corticosteroids in Brazil: the clinical response of 1% compounded budesonide drops and betamethasone cream

Cited by 6 publications

References 16 publications

The Role of Corticosteroid Nasal Irrigations in the Management of Chronic Rhinosinusitis: A State-of-the-Art Systematic Review

The Role of Corticosteroid Nasal Irrigations in the Management of Chronic Rhinosinusitis: A State-of-the-Art Systematic Review

Targeting Epithelium Dysfunction and Impaired Nasal Biofilms to Treat Immunological, Functional, and Structural Abnormalities of Chronic Rhinosinusitis

Application of nasal irrigation in the treatment of chronic rhinosinusitis

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