Patients who suffer from chronic rhinosinusitis can safely use daily steroid-saline nasal lavage every day for 30 days. This is because study shows that this treatment has no harmful effect on adrenal sufficiency.

In the study made by the group of Dr. Jay Piccirillo, they found out that the therapy offered a clinically significant improvement in symptoms. However, they clarify that the treatment protocol is off-label and still requires a randomized, placebo-controlled trial to assess other risks, such as potential loss of bone mineral density, as well as benefits in chronic rhinosinusitis.

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)

Although the use of the medication as part of nasal lavage has not been approved by the FDA, the researchers said that the off-label use of medications is legal and an accepted part of medical practice. The decrease in SNOT-20 scores, which is consistent to all patients, shows that the intervention is effective. They claim that the study will help physicians who want to use the method explain potential risks and benefits to patients.

Tags: chronic rhinosinusitis, Dr. Piccirillo, steroid lavage

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