| 1. What
is rhinosinusitis? |
Rhinosinusitis
denotes an inflammatory reaction in the lining of the nasal and
paranasal sinuses, which also involves the nasal cavity to a greater
or lesser extent. Rhinosinusitis is characterised by major symptoms,
such as nasal congestion or obstruction, mucopurulent nasal
discharge, and facial pain or headache, as well as minor symptoms,
such as cough or halitosis.
Although
definitions of rhinosinusitis may not be globally acknowledged, the
condition has generally been defined as acute, sub-acute,
acute-recurrent, chronic, and chronic with acute exacerbations,
according to the duration of symptoms of rhinosinusitis; chronic
rhinosinusitis is defined as symptoms persisting for at least 3
months (Lanza & Kennedy 1997).
|
| 2. What
are the treatment options for rhinosinusitis? |
Rhinosinusitis
has traditionally been treated with combinations of antibiotics,
anti-inflammatory agents and anti-allergy therapies, together with
decongestants and nasal saline douches. In general, the treatment of
chronic rhinosinusitis is similar to treatment of acute
rhinosinusitis, although one exception is the length of antibiotic
courses prescribed. However, chronic rhinosinusitis is often
difficult to treat successfully as symptoms persist even after
treatment with antibiotics. Moreover, when medical treatment
fails, surgery may be the only alternative.
|
| 3. What
is the role of Rhinocort® in the treatment of rhinosinusitis? |
Studies
have shown that intranasal corticosteroids are effective at reducing
the symptoms of rhinosinusitis when used as an adjunct to antibiotic
therapy (Meltzer et al 1993; 2000). However,
partly due to difficulties in defining the condition and establishing
a clinically relevant patient population, few controlled trials of
medical therapy have been undertaken. Given the efficacy of
Rhinocort® in other inflammatory nasal conditions, it might be
anticipated that this preparation would also be effective in patients
with rhinosinusitis.
|
| 4. Can
Rhinocort® effectively reduce the symptoms of chronic
rhinosinusitis? |
A
randomised, placebo-controlled, 20-week study has shown Rhinocort®
Aqua™ 128 µg bid to be an efficacious and well-tolerated
treatment for patients with chronic rhinosinusitis (Lund et al 2004).
Rhinocort® Aqua™ produced significant
(p<0.05) reductions in nasal congestion and discharge scores, and
improved patients’ sense of smell (morning only), versus
placebo. Furthermore, compared with placebo, Rhinocort® Aqua™-treated patients reported a significant improvement
in morning (p=0.005) and evening (p=0.012) combined symptom
scores (the sum of the scores for four groups of symptoms: 1] facial
pain, pressure or headache; 2] facial congestion, nasal obstruction
or blockage; 3] nasal discharge; 4] impairment of the sense of smell)
(Figures 1a, 1b).
Figure 1a.
Figure
1b. Changes in a) morning and b) evening combined symptom scores in
167 patients with chronic rhinosinusitis following 20 weeks’
treatment with either Rhinocort® Aqua™ 128 µg twice
daily or placebo (Lund et al 2004)
Rhinocort®
Aqua™ treatment also produced a significant (p<0.01)
improvement in peak nasal inspiratory flow (PNIF) in patients with
chronic rhinosinusitis and atopy as well as in patients with chronic
rhinosinusitis, but no skin test positivity (Lund et al 2004),
suggesting some clinical benefit for patients with allergic or
non-allergic rhinosinusitis (Table 1). Further studies are required
to confirm this effect.
| |
|
Change from baseline |
| |
|
Adjusted mean change in PNIF (L/min) |
p-value |
| Allergic patients |
Rhinocort® Aqua™ 128µg twice daily |
65.3 |
- |
| |
Placebo |
21.0 |
- |
| |
Rhinocort® Aqua™ versus placebo |
44.3 |
0.003 |
| |
|
|
|
| Non-allergic patients |
Rhinocort® Aqua™ 128µg twice daily |
44.2 |
- |
| |
Placebo |
9.3 |
- |
| |
Rhinocort® Aqua™ versus placebo |
34.9 |
0.002 |
| PNIF = peak nasal inspiratory flow |
|
| Lund et al 2004 |
|
|
Table
1. Change in peak nasal inspiratory flow (PNIF) from baseline for
allergic and non-allergic patients (Lund et al 2004)
|
| 5. References |
Lanza
DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head
Neck Surg 1997; 117: S1–7.
Lund
V, Black JH, Szabó LZ, et al. Efficacy and tolerability of
budesonide aqueous nasal spray in chronic rhinosinusitis patients.
Rhinology 2004; 42:57-62.
Meltzer
EO, Orgel HA, Backhaus JW, et al. Intranasal flunisolide spray as an
adjunct to oral antibiotic therapy for sinusitis. J Allergy Clin
Immunol 1993; 92: 812–823.
Meltzer
EO, Charous BL, Busse WW, Zinreich SJ, Lorber RR, Danzig MR. Added
relief in the treatment of acute recurrent sinusitis with adjunctive
mometasone furoate nasal spray. The Nasonex Sinusitis Group. J
Allergy Clin Immunol 2000; 106: 630–637.
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