Re: Intranasal steroids were as good as saline alone in Samter's Triad Patients

[Guest guest]

I just found this article on the web it was posted less than a month ago. It is

a real disappointment to me because I just completed my second sinus

surgery(hopeful that it would be my last) and was looking fowarded to starting

a prescription of Budesonide via Nasoneb inhaler. Does this article go with or

against anyone's personal experience with this drug? Is their any steroid that

could be used via Nasoneb inhaler that may be stronger?

>

>

> CHICAGO – Intranasal steroids were as good as saline alone as postoperative

care in a randomized, double-blinded study of patients with chronic

rhinosinusitis and Samter's triad.

>

> There was no difference in disease recurrence rate, complications, or quality

of life at 6 months and 1-year postoperative using intranasal saline, saline

plus budesonide, or saline and budesonide combined.

>

> Dr. Rotenberg

>

> The surprising finding runs contrary to general practice and has several

implications including how best to counsel patients for postoperative care, lead

author Dr. Rotenberg said at the Combined Otolaryngology Spring Meetings.

>

> " If nasal steroids as done in this population don't confer any additional

benefit postoperatively, should we still prescribe them? " he asked. " Should we

be prescribing something different or perhaps nothing at all? Is there a

potential plus side here in terms of health-care cost savings? "

>

> During a discussion of the study, an attendee expressed concern that insurers

would interpret the results too broadly and deny coverage of postoperative nasal

steroids for all patients with rhinosinusitis and polyposis, and not just those

with Samter's triad, a condition consisting of asthma, aspirin sensitivity, and

nasal polyposis.

>

> Another attendee agreed that nasal steroids are not potent enough in this

population and said a pulse course of oral steroids 60 mg for 4 days can knock

down symptoms in 80% of those with recurrence and be maintained with topical

steroids. In the absence of a federally approved product for nasal use, he also

suggested that dexamethasone eye drops can be effective.

>

> Dr. Rotenberg replied that all patients received 3 weeks of postoperative oral

prednisone, but that pulse-dosing of steroids was limited to one patient with

early recurrence.

>

> The 60 patients in the analysis had failed medical management for chronic

rhinosinusitis with nasal polyposis and had a minimum preoperative Lund-Kennedy

score of 8 out of 12. Nineteen patients were randomized to saline, 21 to saline

plus budesonide, and 20 to saline/budesonide combination. Their mean Lund-Mackay

scores were 20.6, 19.9, and 20.5, respectively.

>

> Exclusion criteria included revision functional endoscopic sinus surgery, use

of corticosteroids for other medical conditions, smoking, and concurrent disease

with steroid contraindication.

>

> At 6 months postoperatively, there were no significant differences between the

saline, saline plus budesonide, and saline/budesonide combination groups with

regard to Lund-Kennedy scores (1.5, 0.9, and 1.2, respectively),

adrenocorticotropic hormone (ACTH) ranges (all normal), and intraocular pressure

(12.4, 12.9, and 13.9 mm Hg, respectively), said Dr. Rotenberg of the University

of Western Ontario in London, Ontario. Quality of life as assessed using the

21-item Sino-Nasal Outcome Test (SNOT-21) was also similar at a mean of 29.7,

27.4 and 28.2, respectively.

>

> At 1 year of follow-up, once again there were no significant differences

between the saline, saline plus budesonide, and saline/budesonide groups in

Lund-Kennedy scores (3.7, 4.4, and 4.1, respectively), Lund-Mackay scores (11.8,

12.7, and 13.4, respectively), SNOT-21 scores (42.5, 47.9, and 42.2,

respectively), intraocular pressure (13.1, 13.4,and 12.9 mm Hg, respectively).

ACTH ranges were all normal.

>

> A within-group analysis showed a significant improvement in all outcomes from

baseline to 6 months, and a general worsening of outcomes at 1 year compared

with the first 6 months, although they were still improved over baseline, Dr.

Rotenberg said.

>

> He pointed out that the literature is lacking in evidence guiding the

postoperative management of patients with chronic rhinosinusitis with nasal

polyps undergoing surgery. One study reported that steroid nasal spray did not

influence polyp recurrence rate after surgery (Clin. Exp. Allergy.

2004;34:1395-400), while another showed that normal and buffered hypertonic

saline nasal sprays had no beneficial effect on postoperative symptoms compared

with no treatment (Am. J. Rhinol. 2006;20:191-6).

>

> Dr. Rotenberg reported no relevant financial disclosures.

>

[Guest guest]

I posted back in January as I had been on the Nasoneb Nebulizer for a couple of

months. It has now been about 8 months I still can breathe through my nose and

sleep well. Some SOS is back. Polyps small but stll there. Don't know which of

the saline or budesonide is the one working but together they work for me. Don't

know of any long term effects. Have follow up in a couple of weeks with my

allergist. My ENT is very happy with my progress.

Kris

> >>

> >>

> >> CHICAGO – Intranasal steroids were as good as saline alone as postoperative

> >> care in a randomized, double-blinded study of patients with chronic

> >> rhinosinusitis and Samter's triad.

> >>

> >> There was no difference in disease recurrence rate, complications, or

quality

> >> of life at 6 months and 1-year postoperative using intranasal saline,

saline

> >> plus budesonide, or saline and budesonide combined.

> >>

> >> Dr. Rotenberg

> >>

> >> The surprising finding runs contrary to general practice and has several

> >> implications including how best to counsel patients for postoperative care,

> >> lead author Dr. Rotenberg said at the Combined Otolaryngology Spring

> >> Meetings.

> >>

> >> " If nasal steroids as done in this population don't confer any additional

> >> benefit postoperatively, should we still prescribe them? " he asked. " Should

> >> we be prescribing something different or perhaps nothing at all? Is there a

> >> potential plus side here in terms of health-care cost savings? "

> >>

> >> During a discussion of the study, an attendee expressed concern that

insurers

> >> would interpret the results too broadly and deny coverage of postoperative

> >> nasal steroids for all patients with rhinosinusitis and polyposis, and not

> >> just those with Samter's triad, a condition consisting of asthma, aspirin

> >> sensitivity, and nasal polyposis.

> >>

> >> Another attendee agreed that nasal steroids are not potent enough in this

> >> population and said a pulse course of oral steroids 60 mg for 4 days can

> >> knock down symptoms in 80% of those with recurrence and be maintained with

> >> topical steroids. In the absence of a federally approved product for nasal

> >> use, he also suggested that dexamethasone eye drops can be effective.

> >>

> >> Dr. Rotenberg replied that all patients received 3 weeks of postoperative

> >> oral prednisone, but that pulse-dosing of steroids was limited to one

patient

> >> with early recurrence.

> >>

> >> The 60 patients in the analysis had failed medical management for chronic

> >> rhinosinusitis with nasal polyposis and had a minimum preoperative

> >> Lund-Kennedy score of 8 out of 12. Nineteen patients were randomized to

> >> saline, 21 to saline plus budesonide, and 20 to saline/budesonide

> >> combination. Their mean Lund-Mackay scores were 20.6, 19.9, and 20.5,

> >> respectively.

> >>

> >> Exclusion criteria included revision functional endoscopic sinus surgery,

use

> >> of corticosteroids for other medical conditions, smoking, and concurrent

> >> disease with steroid contraindication.

> >>

> >> At 6 months postoperatively, there were no significant differences between

> >> the saline, saline plus budesonide, and saline/budesonide combination

groups

> >> with regard to Lund-Kennedy scores (1.5, 0.9, and 1.2, respectively),

> >> adrenocorticotropic hormone (ACTH) ranges (all normal), and intraocular

> >> pressure (12.4, 12.9, and 13.9 mm Hg, respectively), said Dr. Rotenberg of

> >> the University of Western Ontario in London, Ontario. Quality of life as

> >> assessed using the 21-item Sino-Nasal Outcome Test (SNOT-21) was also

similar

> >> at a mean of 29.7, 27.4 and 28.2, respectively.

> >>

> >> At 1 year of follow-up, once again there were no significant differences

> >> between the saline, saline plus budesonide, and saline/budesonide groups in

> >> Lund-Kennedy scores (3.7, 4.4, and 4.1, respectively), Lund-Mackay scores

> >> (11.8, 12.7, and 13.4, respectively), SNOT-21 scores (42.5, 47.9, and 42.2,

> >> respectively), intraocular pressure (13.1, 13.4,and 12.9 mm Hg,

> >> respectively). ACTH ranges were all normal.

> >>

> >> A within-group analysis showed a significant improvement in all outcomes

from

> >> baseline to 6 months, and a general worsening of outcomes at 1 year

compared

> >> with the first 6 months, although they were still improved over baseline,

Dr.

> >> Rotenberg said.

> >>

> >> He pointed out that the literature is lacking in evidence guiding the

> >> postoperative management of patients with chronic rhinosinusitis with nasal

> >> polyps undergoing surgery. One study reported that steroid nasal spray did

> >> not influence polyp recurrence rate after surgery (Clin. Exp. Allergy.

> >> 2004;34:1395-400), while another showed that normal and buffered hypertonic

> >> saline nasal sprays had no beneficial effect on postoperative symptoms

> >> compared with no treatment (Am. J. Rhinol. 2006;20:191-6).

> >>

> >> Dr. Rotenberg reported no relevant financial disclosures.

> >>

> >

> >

> >

> >

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