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Steroid Nasal Wash Appears to Improve Health Status of Patients With Chronic Rhinosinusitis Without Affecting Adrenal Gland Function |
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CHICAGO -- A nasal
wash containing the corticosteroid budesonide appears to reduce symptoms of
chronic rhinosinusitis without suppressing the function of the adrenal glands, a
known complication of this type of drug that would indicate absorption
throughout the whole body, according to a report in the March issue of Archives
of OtolaryngologyHead & Neck Surgery, one of the JAMA/Archives
journals. |
Chronic
rhinosinusitisa persistent inflammation of the nose and sinuses behind the
noseaffects up to 14 percent of the U.S. population, according to background
information in the article. An aqueous nasal spray containing budesonide has
been shown to be safe and have a benefit for those with chronic rhinosinusitis
and recurring allergies. The medication is also available in respulessmall,
plastic liquid-containing devices that can be opened and mixed with saline to
produce a nasal wash. According to the authors, no previous studies have been
conducted to demonstrate the safety of such a preparation. Neil
S. Sachanandani, B.S., and colleagues at the Washington University School of
Medicine, St. Louis, assessed the effects of budesonide on adrenal function in
nine patients between 2005 and 2006. Participants were instructed to use a nasal
wash composed of 0.25 milligrams of budesonide and 5 milliliters of saline in
each nostril once daily for 30 days. At clinic visits before and after the
treatment period, participants completed a questionnaire assessing their
rhinosinusitis symptoms and related quality of life. Their cortisol levels were
measured after injection with cosyntropin, a compound that stimulates the
release of cortisol by the adrenal glandsa standard method of testing adrenal
function. |
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All
patients showed an adequate adrenal response to cosyntropin before and after
budesonide therapy, the authors report. Total scores on the questionnaire
assessing symptoms improved clinically and statistically following therapy. All
patients reported some form of overall improvement with the use of budesonide,
and six of the nine patients (67 percent) would recommend this drug to a friend,
the authors write. The
clinical significance of this study is that budesonide nasal respules appear
safe for short-term use for the relief of symptoms associated with chronic
sinusitis, they continue. Budesonide respules seem to provide an effective
treatment option for the patient with chronic rhinosinusitis with minimal fear
of systemic adverse effects. The
Food and Drug Administration has not approved the use of budesonide as a nasal
wash, so therefore this preparation would be an off-label use, they note.
Clinicians should discuss the risks associated with the use of the product.
Decreased bone mineral density is one potential complication of long-term use
and deserves further study, the authors conclude. (Arch
Otolaryngol Head Neck Surg. 2009;135[3]:303-307. Available pre-embargo
to the media at www.jamamedia.org.) Editor's
Note: This research was supported, in
part, by a grant from the National Institutes of Health Roadmap Predoctoral
Clinical Research Training Program and the Washington University General
Clinical Research Center. Please see the article for additional information,
including other authors, author contributions and affiliations, financial
disclosures, funding and support, etc. For
more information, contact JAMA/Archives Media Relations at 312/464-JAMA
(5262). |
| Source: http://jama.ama-assn.org/ |
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