- 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).
- 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.
- 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.
- 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)
- 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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