The safety and efficacy of short‐term budesonide delivered via mucosal atomization device for chronic rhinosinusitis without nasal polyposis

Thamboo, Andrew; Manji, Jamil; Szeitz, András; Santos, Rachelle Dar; Hathorn, Iain; Gan, Eng Cern; Alsaleh, Saad; Javer, Amin R.

doi:10.1002/alr.21280

Cited by 38 publications

(49 citation statements)

References 39 publications

(54 reference statements)

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“…Thamboo et al 726 randomized 20 patients in an unblinded treatment comparison study to a 12-week course of either 1 mg budesonide via MAD, or 1 mg of budesonide in 120 mL of saline irrigations. Clinically significant improvements in SNOT-22 scores were seen in both arms, although only in the MAD group did this reach statistical significance.…”

Section: Viie1 Crs Management: Saline Irrigationmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

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548

888

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Section: Viie1 Crs Management: Saline Irrigationmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

Self Cite

548

888

View full text Add to dashboard Cite

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“…Although in principle articles containing patients below the age of 12 were excluded, two articles including patients from 9 to 11 were included, as most the patients in these articles was above the age of 12. One article could not be retrieved even after contacting the first author (18). …”

Section: Study Selection (Web Appendix 3)mentioning

confidence: 99%

Adrenal Insufficiency in Corticosteroids Use: Systematic Review and Meta-Analysis

Broersen

Pereira

Jørgensen

et al. 2015

The Journal of Clinical Endocrinology &Amp; Metabolism

325

307

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1) Adrenal insufficiency after discontinuation of glucocorticoid occurs frequently; 2) there is no administration form, dosing, treatment duration, or underlying disease for which adrenal insufficiency can be excluded with certainty, although higher dose and longer use give the highest risk; 3) the threshold to test corticosteroid users for adrenal insufficiency should be low in clinical practice, especially for those patients with nonspecific symptoms after cessation.

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“…However, when budesonide was used as a large‐volume nasal rinse, the concentration of drug and excipient was much lower and did not demonstrate an antibacterial action, as was seen at the higher concentrations in this study. Thamboo et al compared the effect of budesonide nasal rinses (high volume, low concentration) with budesonide delivered through MAD (low volume, high concentration) in postoperative patients with CRS with nasal polyps (CRSwNP) and found that although the quality of life as indicated by the 22 ‐item Sino‐Nasal‐Outcome Test (SNOT‐22) improved in both the groups, the final outcome did not differ between the groups. However, the patients using MAD had significant improvement in the SNOT‐22 scores compared with baseline when used over the short term (up to 60 days), without causing any adrenal suppression.…”

Section: Discussionmentioning

confidence: 99%

Effect of commercial nasal steroid preparation on bacterial growth

Cherian

Cooksley

Richter

et al. 2019

Int Forum Allergy Rhinol

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Background: Topical budesonide (Pulmicort; AstraZeneca AB, Sodertalje, Sweden) is commonly used in the management of chronic rhinosinusitis (CRS). Although its use is due to its perceived anti-inflammatory effect, studies have suggested that it may also have antibacterial properties. To make the hydrophobic steroid molecule suitable for topical administration, pharmaceutical excipients are used in commercial steroid formulations. Herein we investigated the antibacterial action of commercial budesonide and its excipients. Methods:Planktonic and biofilm forms of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) were treated with Pulmicort or its excipients at clinically relevant concentrations. Bacterial growth was determined by optical density, resazurin assays, colonyforming unit counts, and Giemsa staining. Minimum inhibitory concentration (MIC) studies assessed excipients' potentiation of antibiotics. Experiments were conducted in triplicate and results analyzed using one-way analysis of variance. Results:There was significant reduction in planktonic and biofilm growth of S aureus and MRSA on exposure to budesonide (p < 0.0001) and its excipients (p < 0.0001). Excipient ethylene diamine-tetraactic acid (EDTA) demonstrated an antibacterial property even at the low concentrations used in topical preparations (p < 0.0001). With amoxicillin, excipients exhibited a potential additive/synergistic effect on MIC, whereas erythromycin and aminoglycosides showed an antagonistic action. Conclusion:The commercial product Pulmicort has a direct antibacterial effect on the planktonic and biofilm forms of S aureus and MRSA. This effect is at least in part mediated through the excipient EDTA in the product. Excipients also influenced the antimicrobial activity of antibiotics depending on the bacterial strain and antibiotic tested. C 2019 ARS-AAOA, LLC.

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The safety and efficacy of short‐term budesonide delivered via mucosal atomization device for chronic rhinosinusitis without nasal polyposis

Abstract: The MAD is likely a safe and effective method of delivering budesonide to the sinuses in the short term.

Cited by 38 publications

References 39 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Adrenal Insufficiency in Corticosteroids Use: Systematic Review and Meta-Analysis

Effect of commercial nasal steroid preparation on bacterial growth

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