Long-term Use of Budesonide Nasal Irrigation Effective for Comorbid CRS With Nasal Polyps, Asthma

Patients with comorbid chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma reported signficant reductions in endoscopic sinus score and severity, as well as decreased doses of oral steroids and antibiotics after long-term use of budesonide nasal irrigation (BNI). Study findings were published in the Journal of Clinical Medicine.

In asthmatic patients with CRSwNP, a high recurrence rate of nasal polyps has been shown even in those who have undergone endoscopic sinus surgery (ESS). Due to the high revision rate linked with ESS, oral steroids have been used to treat repeated exacerbation and prevent recurrence in these populations.

However, long-term or frequent use of oral steroids was noted by reserachers to carry a high risk of systemic side effects.

“Recently, the efficacy of BNI has been widely reported in patients with CRS,” the authors wrote. ”Through this method, a large amount of steroids can effectively reach the entire nasal sinus and sinus mucosa at a higher pressure without systemic side effects.”

They sought to further investigate the long-term effects and usefulness of BNI in patients with CRSwNP and asthma, as well as find out the effective irrigation period for treatment.

The investigators performed a retrospective chart analysis of 33 patients with CRSwNP accompanied by well-controlled asthma (mean [SD] age, 52.48 [14.41] years) who performed BNI for more than 12 months at the Department of Otolaryngology-Head & Neck Surgery, Hanyang University College of Medicine, Seoul, South Korea. Of the study cohort, 21 patients performed BNI after ESS and 12 patients performed BNI without surgery.

Participants were compared on oral steroid and antibiotic dosages, and nasal endoscopy scores (Lund-Kennedy [LK] endoscopy polyp score) before and every 6 months after BNI. The 22-item Sinonasal Outcomes Test (SNOT-22) was also performed to identify the effect of BNI on patients’ subjective symptoms and quality of life, with the resulting score compared between 2 time points: before irrigation and 12 months after irrigation.

Compared with before BNI, the 6-month dosages of oral steroids and antibiotics prescribed were significantly decreased at all time points after BNI. When the dosages were compared at the time point immediately preceding 6 months, oral steroid intake decreased significantly until 12 months and antibiotic intake decreased until 6 months.

The LK endoscopy polyp score was also improved at all 6-month time points compared with before BNI. Analysis of the cutoff point showed a significant improvement in the LK score up to 12-month irrigation, but there was no significant improvement after that compared with the previous 6 months. A significant improvement in the SNOT-22 score was observed, from a mean (SD) score of 40.03 (14.5) points before BNI to 17.27 (10.68) points after irrigation (P < .001).

“When BNI was used for more than 12 months, many patients improved, and even after using it for up to 36 months, it was safely used without side effects. For those patients who do not improve after long-term BNI, the use of biologics can be considered,” concluded the study authors.

Reference

Jung SM, Kwak JH, Kim MK, Tae K, Cho SH, Jeong JH. The long-term effects of budesonide nasal irrigation in chronic rhinosinusitis with asthma. J Clin Med. 2022;11(10):2690. doi:10.3390/jcm11102690