Safety of Budesonide in Saline Sinonasal Irrigations in the Management of Chronic Rhinosinusitis with Polyposis: Lack of Significant Adrenal Suppression
Safety of Budesonide in Saline Sinonasal Irrigations in the Management of Chronic Rhinosinusitis with Polyposis: Lack of Significant Adrenal Suppression
复制标题
DOI：
10.2310/7070.2008.oa0186
复制
发表时间：
2008-12-01
影响因子：
3.4
通讯作者：
Wright, Erin D.
中科院分区：
文献类型：
--
作者：
Bhalla, Rajiv K.;Payton, Keith;Wright, Erin D.
目的：评价布地奈德鼻腔冲洗抑制下丘脑-垂体-肾上腺(HPA)轴在治疗难治性慢性鼻窦炎合并息肉病(CRSwP)中的作用。研究设计：回顾、描述性回顾患者病历。背景：在一所教学医院的三级鼻科实习。患者：18例CRSwP患者，保守治疗无效。方法：回顾2006年1月至10月连续接受布地奈德生理盐水鼻腔冲洗的患者的病历。在所有病例中，治疗前和治疗后清晨皮质醇水平在至少8周的不间断治疗后进行了测量。此外，部分持续治疗超过8周的患者接受了更敏感的促肾上腺皮质激素(ACTH)刺激试验。结果：治疗前后晨间皮质醇水平均在正常范围内。在8周的治疗期间，没有证据表明HPA轴受到抑制(p=.4171)。对于持续治疗超过8周的患者，ACTH刺激没有检测到HPA轴的抑制。结论：布地奈德鼻腔冲洗治疗难治性CRSwP不会引起HPA轴抑制。更大剂量的类固醇局部给药的疗效将得益于进一步的研究。
Objective: To evaluate the potential for hypothalamic-pituitary-adrenal (HPA) axis suppression by budesonide nasal irrigations in the treatment of refractory chronic rhinosinusitis with polyposis (CRSwP).Study Design: Retrospective, descriptive review of patient charts.Setting: Tertiary care rhinology practice in an academic teaching hospital.Patients: Eighteen adult subjects with CRSwP refractory to conservative medical therapy.Methods: The charts of consecutive patients identified as being treated with topical budesonide in saline for nasal irrigation from January to October 2006 were reviewed. In all cases, pre- and posttreatment morning cortisol levels had been measured following at least 8 weeks of uninterrupted therapy. In addition, a subset of patients who continued therapy longer than 8 weeks had undergone the more sensitive adrenocorticotropic hormone (ACTH) stimulation test.Results: All pre- and posttreatment morning cortisol levels were within the normal range. For an 8-week treatment period, there was no evidence of HPA axis suppression (p = .4171). For patients who continued treatment beyond 8 weeks, ACTH stimulation did not detect HPA axis suppression. Furthermore, there were no issues with compliance or acceptability, nor were any adverse side effects reported.Conclusion: Budesonide in saline sinonasal irrigation for the treatment of refractory CRSwP does not cause HPA axis suppression. The efficacy of this higher dose of steroid delivered locally would benefit from further study.