Steroid Nasal Lavage Has No Harmful Effects On Chronic Rhinosinusitis

A small open-label study revealed that using steroid-saline nasal lavage daily for one month had no dangerous effects on adrenal sufficiency on chronic rhinosinusitis patients. The therapy offered a significant improvement in symptoms. The researchers used budesonide respules which can be used to deliver unit-dose medications in a sterile fashion.

The team of Dr. Jay Piccirillo said that their study is beneficial to physicians who want to use the method to explain potential risks and benefits to patients. Although the use of the medication as part of nasal lavage has not been approved by the FDA, researchers said that the off-label use of medications is legal and an accepted part of medical practice.

From Medpage today:

Nine patients with chronic rhinosinusitis were instructed to administer 0.25 milligrams of budesonide, diluted with 5.0 milliliters of isotonic saline daily for 30 days.

Their blood cortisol levels were measured before and after the 30 days using the standard cosyntropin stimulation test. Efficacy of the treatment was assessed using the Sino-Nasal Outcome Test-20 (SNOT-20).

Analysis showed:

• There was little difference in average post-stimulation cortisol levels at baseline and after 30 days -- 33.9 micrograms per deciliter compared with 35.2

• After 30 days, no patient had a post-stimulation cortisol level below the critical level (18 to 20 micrograms per deciliter) that would indicate adrenal insufficiency

• The total SNOT-20 score was 2.4 on average at baseline and 1.4 at the 30-day visit, an improvement that was both statistically and clinically significant (at P=0.02)

The team cautioned that the treatment protocol is off-label and still requires a randomized, placebo-controlled trial to assess other risks, such as loss of bone mineral density, as well as benefits in chronic rhinosinusitis. However, they claim that the treatment is effective since the decrease in SNOT-20 scores was consistent for all patients.