Corticosteroid treatment in chronic rhinosinusitis: the possibilities and the limits.
Chronic rhinosinusitis, including nasal polyps, is an inflammatory disease of the nose and sinuses. The medical treatment, mainly topical intranasal and oral corticosteroids, constitutes its first line of therapy. Long-term treatment with corticosteroid nasal spray reduces inflammation and nasal polyp size, and improves nasal symptoms such as nasal blockage, rhinorrea, and the loss of smell. Corticosteroid intranasal drops may be used when intranasal spray fails to demonstrate efficacy. Short courses of oral steroids are recommended in severe chronic rhinosinusitis with nasal polyps or when a rapid symptomatic improvement is needed. Endoscopic sinus surgery is only recommended when the medical treatment fails. Intranasal corticosteroids should be continued postoperatively. When using intranasal corticosteroids, care should be taken in selected populations such as children, pregnant women, and elderly patients; especially in those patients with comorbid conditions such as asthma, in which the overall steroid intake can be high due to the administration of both intranasal and inhaled corticosteroids.
Mullol
Joaquim
J
Unitat de Rinologia & Clínica de l'Olfacte, Department of Otorhinolaryngology, Hospital Clínic, c/Villarroel, 170 Barcelona 08036, Catalonia, Spain. jmullol@clinic.ub.es
Obando
Andrés
A
Pujols
Laura
L
Alobid
Isam
I
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002908:Chronic Disease; D004333:Drug Administration Routes; D005260:Female; D006801:Humans; D009298:Nasal Polyps; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D012220:Rhinitis / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D012852:Sinusitis / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology
D000305:Adrenal Cortex Hormones