Non-specific bronchial hyperresponsiveness is a risk factor for steroid insensitivity in nasal polyposis.
OBJECTIVE
Management of nasal polyposis should be primarily medical. Resorting to intranasal ethmoidectomy should not be envisaged before a trial of dual steroid therapy. Nevertheless, no risk factor for steroid insensitivity in patients with nasal polyposis is actually defined. The aim of this study is to evaluate whether the presence of asthma and/or non-specific bronchial hyperresponsiveness (BHR) can be considered a risk factor for steroid insensitivity.


METHODS
This study focused on the evaluation of a dual modality, topical and systemic, over a follow-up period of 3 years. A total of 55 subjects with and 45 subjects without BHR were treated according to a standardized therapeutic protocol combining short-term oral administration of prednisolone and a daily intranasal spray of beclomethasone.


RESULTS
Over the follow-up period of 3 years, this dual modality proved to be successful in 93.4% of subjects without BHR and without aspirin idiosyncrasy, in 82.2% of subjects with BHR and without aspirin idiosyncrasy and in 60% of subjects with BHR and aspirin idiosyncrasy. The percentage of patients who underwent surgery after the failure of medical treatment was significantly larger in patients with than without BHR (p < 0.05) and in patients with than without aspirin idiosyncrasy (p < 0.02).


CONCLUSIONS
The presence of BHR and/or aspirin idiosyncrasy can be considered a major risk factor for steroid insensitivity in patients with nasal polyposis.
Bonfils
Pierre
P
ENT Research Laboratory and Department of Otolaryngology, Head and Neck Surgery I, European Hospital Georges Pompidou, Faculty Necker-Enfants Malades, University René Descartes, Paris, France. pierre.bonfils@egp.ap-hop-paris.fr
Avan
Paul
P
D000284:Administration, Oral; D000336:Aerosols; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects; D001249:Asthma / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D001507:Beclomethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D016535:Bronchial Hyperreactivity / Q000150:complications* / Q000188:drug therapy; D001985:Bronchial Provocation Tests; D004342:Drug Hypersensitivity / Q000150:complications; D004351:Drug Resistance; D005005:Ethmoid Sinus / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D012307:Risk Factors; D013607:Tablets; D007507:Therapeutic Irrigation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000336:Aerosols; D018927:Anti-Asthmatic Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018931:Antineoplastic Agents, Hormonal; D005938:Glucocorticoids; D013607:Tablets; D011239:Prednisolone; D001507:Beclomethasone; D001241:Aspirin