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Budesonide transnasal nebulization effective for patients with chronic rhinosinusitis, polyps

Short-term budesonide transnasal nebulization effectively and safely treated patients with chronic rhinosinusitis with nasal polyps when compared with placebo, according to study results.

In a double blind trial, researchers in Beijing studied 60 patients with eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP), who were randomly assigned budesonide or placebo for 14 days. Evaluation of endoscopic polyp size scores and visual analog scale scores for nasal symptoms were conducted before and after treatment.

Immunoassay was used to evaluate polyps for inflammatory cytokines, matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs); collagen was assessed by histochemistry; hematoxylin and eosin stain were used to ascertain eosinophils; and T-cell subsets were assessed by flow cytometry.

Polyp size in the budesonide transnasal nebulization treatment cohort was significantly reduced compared with placebo patients (mean difference between groups, –0.73 units; 95% CI, –1.15 to –0.32 units), and symptoms were improved. There was a significant decrease in polyp IL-5 and eotaxin expression, and an increase in TGF-B and IL-10 expression. No changes were observed in expressions of IFN-g and IL-17.

“Budesonide transnasal nebulization consistently reduced eosinophil infiltration and T_H2 cell frequency and increased natural regulatory T-cell and type 1 regulatory T-cell frequencies,” the researchers wrote. “Indices of remodeling, including albumin, MMP-2, MMP-7, MMP-8 and MMP-9, were significantly decreased, whereas collagen deposition and TIMP-1, TIMP-2 and TIMP-4 levels were significantly increased.”

There was no suppression or serious side effects of the hypothalamic-pituitary-adrenal axis from budesonide transnasal nebulization.

“Short-term budesonide inhalation suspension through a pulsating atomization devise (ie, budesonide transnasal nebulization) is an effective and safe treatment in patients with eosinophilic CRSwNP,” the researchers concluded.

Disclosure: See the study for a full list of relevant disclosures.