Steroid nasal wash appears to improve health of patients with chronic rhinosinusitis

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 Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.

Chronic rhinosinusitis—a persistent inflammation of the nose and sinuses behind the nose—affects 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 respules—small, 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 glands—a standard method of testing adrenal function.

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.