Safety of budesonide in saline sinonasal irrigations in the management of chronic rhinosinusitis with polyposis: lack of significant adrenal suppression.
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).


METHODS
Retrospective, descriptive review of patient charts.


METHODS
Tertiary care rhinology practice in an academic teaching hospital.


METHODS
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.


CONCLUSIONS
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.
Bhalla
Rajiv K
RK
Department of Surgery, University of Alberta, Edmonton, Alberta.
Payton
Keith
K
Wright
Erin D
ED
D000328:Adult; D019819:Budesonide / Q000008:administration & dosage* / Q000009:adverse effects; D002908:Chronic Disease; D015331:Cohort Studies; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D055556:Nasal Lavage; D009298:Nasal Polyps / Q000097:blood / Q000150:complications; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D012189:Retrospective Studies; D012220:Rhinitis / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012852:Sinusitis / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012965:Sodium Chloride; D016896:Treatment Outcome
D005938:Glucocorticoids; D012965:Sodium Chloride; D019819:Budesonide; D006854:Hydrocortisone