Chronic rhinosinusitis (CRS) with nasal polyposis is a common problem resulting in nasal blockage, facial pain, and hy- posmia. Responses to therapy are frequently incomplete, and relapses are common. Although oral steroids are recommended when specialty care is required, little is known about their efficacy. In a study reported in the Annals of Internal Medicine, 60 adults with CRS and moderate-sized or larger nasal polyps who were referred by their primary physicians for specialty care received oral prednisolone, 25 mg/d, or placebo for 2 weeks, followed in both groups by fluticasone propionate nasal drops, 400 µg twice daily, for 8 weeks and then fluticasone propionate nasal spray, 200 µg twice daily, for 18 weeks. Initial oral steroid therapy followed by topical steroid therapy seems to be more effective over 6 months than topical steroid therapy alone in decreasing polyp size and improving olfaction in patients referred for specialty care of CRS with at least moderate nasal polyposis.
Will this study modify your practice?
Interested in hearing how others go about administering nasal steroid drops given that flixonase nasules (used in this study) are not available in the US. One method I've read about (by Hamilos) is Pulmicort (budesonide) respules 0.5 mg in 5 mL saline to each nostril followed by head-positioning QD.
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