Recurrent Acute Rhinosinusitis: A Single Blind Clinical Study of N-Acetylcysteine vs Ambroxol Associated to Corticosteroid Therapy

Abstract

The aim of rhinosinusitis treatment is to restore sinusal eutrophism and to normalize ventilation and mucociliary transport. Frequently the improvement of sinusal physiological conditions is associated with a reduction of infections and pulmonary symptoms. The treatment of these diseases often requires the combination of medical and surgical strategies. In particular, the aim of the medical therapy is multiple: to treat the infection (with antibiotics), to reduce the mucosal swelling (with corticosteroids) and to improve mucus drainage (with mucolytics or muco-regulators), The use of atomized nasal douche, as a washing of the nasal fossas, is chosen because of its local action minimizing systemic adverse effects. The surgical treatment is secondary to medical failure, and it is focused on clearing the sinusal ostia in the sphenoethmoidal recess and the osteomeatal complex. In case of recurrent sinonasal diseases the importance of the surgical operation is represented by the fact that the medical treatment better reaches the target in the sinusal space. This study is focused on the primary medical treatment of acute recurrent rhinosinusitis. The patients who immediately needed surgical treatment were excluded from the study (because of the presence of an anatomical obstruction of the osteomeatal complex and/or the sphenoethmoidal recess, hence non-susceptible to improvement by medical therapy alone), and these patients were immediately addressed to undergo a CT scan examination in order to be involved in a future surgical programme. The medical treatment for those forms which do not require antibiotics (i.e, when infections are not involved), is based on the use of topical corticosteroids. While there are controversies on the real efficacy of adding mucolytic agents to the steroids, they are commonly prescribed in clinical practice, with the rationale of reducing viscosity and improving clearance of mucus in order to help the restoration of the physiological sinus conditions. The primary aim of the medical treatment is to reduce the number of acute episodes and thus to increase the time between the exacerbations, allowing a good quality of life without necessitating surgical procedure.Functional modifications in mucociliary transport and secretion composition are among the principal causes ofrecurrent acute and chronic rhinosinusitis. The aim of the rhinosinusitis treatment is to restore sinusal eutrophism, normalizing ventilation and mucociliary transport. Frequently, the improvement of sinusal physiological conditions is associated with a reduction of infections and pulmonary symptoms. The treatment of these diseases often requires the combination of medical and surgical strategies. In particular, the aim

The effect of N -acetylcysteine on biofilms: Implications for the treatment of respiratory tract infections

“…In patients with rhinosinusitis, topical NAC (nasal douche) associated with flunisolide has been demonstrated to be more effective than ambroxol plus flunisolide in terms of symptom improvement and number of exacerbations at 3 and 6 months. Moreover, the time to first exacerbation was significantly increased with NAC compared with ambroxol [63]. The results of this study confirm that NAC added to standard flunisolide treatment via atomized nasal douche is an effective strategy to break the vicious circle of recurrent acute rhinosinusitis and improve patients' conditions for up to 6 months following the end of treatment (Fig.…”

Evidence-based management of acute rhinosinusitis with herbal products

“…Until the 1990s, evidence for the use of herbal products in acute rhinosinusitis remained largely anecdotal. However, in the past 20 years, randomized controlled trials in rhinosinusitis have been performed with a number of herbal products [6][7][8].…”

Conditions Under Which Glutathione Disrupts the Biofilms and Improves Antibiotic Efficacy of Both ESKAPE and Non-ESKAPE Species

“…The thiol-based antioxidant NAC has undergone clinical trials for use in respiratory related infections (Schito et al, 2007; Macchi et al, 2012). However, in some cases GSH has an added advantage in comparison to NAC alone, because in groups such as the immunocompromised, those with cystic fibrosis and liver dysfunction, as well as the elderly, the capacity to synthesis GSH has already significantly diminished.…”