He said that treatment for eicosanoid imbalance might be worthwhile even in a wide range of patients. The question is: Is this really something to use even in aspirin-tolerant patients? I think yes. I think the eicosonoid metabolism is certainly a parameter that is relevant also in polypous chronic rhinosinusitis, where you do not see a clinical impact of aspirin sensitivity, he said. And, as we have learned from all this interest we have in aspirin sensitization, there is effective treatment in hand and therefore it is worthwhile evaluating this as a therapeutic target also in those patients.
Explore This IssueOctober 2009
Dr. Cervin said that corticosteroids still sit at the top of the heap when it comes to treating nasal polyps. It’s the old steroids that are still the mainstay in our treatment, combined with nasal douche.
The goals of treatment for nasal polyposis include establishing nasal patency, reducing runny nose, improving the sense of smell, delaying or slowing the growth of polyps, helping with or delaying surgery, and reducing the number of infections.
Glucocorticoids work by reducing vasodilation, reducing recruitment of inflammatory cells, reducing MMP-9 that breaks down the extracellular matrix, and reducing IgE production.
The differences between different intranasal corticosteroids appear limited and safety differences have been described as more theoretical than based on clinical observation, he said.
A 2008 study (Derendorf H et al. Allergy 2008;63:1292-1300) found that absorption into the system was similar for many types of the drugs. The biovailability of flunisolide was 50%, whereas it was just less than 50% for triamcinolone and beclomethasone. The bioavailability for budesonide was about 35%, the study found.
Clinical trials that evaluated the effects of intranasal corticosteroids on HPA axis function and growth in children found that they generally do not affect growth (Moller C et al. Clin Exp Allergy 2003;33: 816-22; Skoner DP et al. Ann Allergy Asthma Immunol 2003;90:56-62). One early study (Wolthers OD et al. Acta Paediatri 1993;82:635-40), though, found that they caused slower growth of the lower leg.
Studies have found that a twice-a-day dose of mometasone furoate nasal spray (MFNS) is better than once-a-day. Patients getting 200 mcg of MFNS have reported significantly better symptom relief than those on a placebo. The improvements included better breathing, less interference with daily activities, and less disturbance of sleep (Stjarne P et al. Acta Otolaryngol 2006; 132:179-85). But there was no significant difference between the groups when it came to taste and smell improvements.