Safety of long-term intranasal budesonide delivered via the mucosal atomization device for chronic rhinosinusitis
Date
2017
Type:
Artículo
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6
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ORCID:
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Publisher
John Wiley & Sons
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Abstract
BACKGROUND: Although short-term use (≤2 months) of atomized topical nasal steroids has been
shown to be safe and effective, the long-term safety has yet to be demonstrated. The aim of this
study was to determine the impact of long-term topical budesonide treatment via the mucosal
atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular
pressure (IOP).
METHODS: A cross-sectional study of patients with chronic rhinosinusitis (CRS), with or without
nasal polyposis, managed with daily nasal budesonide via MAD was conducted at a tertiary rhinology
center. Patients using systemic steroids within 3 months of assessment were excluded. HPAA impact
was assessed using the cosyntropin stimulation test for adrenal function and a survey of relevant
symptomatology. Patients also underwent tonometry to assess for elevated IOP potentially related
to corticosteroid use.
RESULTS: A total of 100 CRS patients were recruited with a mean budesonide treatment duration
of 23.5 months (range, 6-37 months). Stimulated cortisol response was diminished in 3 patients
(3%). No patients with adrenal suppression had relevant symptomatology. IOP was elevated in 6
patients (6%).
CONCLUSION: These findings suggest that there is a risk of adrenal suppression and raised IOP
associated with the long-term use of topical nasal budesonide via MAD. Otolaryngologists should
consider periodic surveillance for these adverse events in this patient cohort.
Description
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Citation
Manji J, Singh G, Okpaleke C, Dadgostar A, Al-Asousi F, Amanian A, Macias-Valle L, Finkelstein A, Tacey M, Thamboo A, Javer A. Safety of long-term intranasal budesonide delivered via the mucosal atomization device for chronic rhinosinusitis. Int Forum Allergy Rhinol. 2017 May;7(5):488-493. doi: 10.1002/alr.21910
Keywords
HPA axis, IOP, budesonide, chronic rhinosinusitis, mucosal atomization device, postoperative care, safety