title: Medical management of chronic rhinosinusitis in cystic fibrosis: a systematic review.
abstract: OBJECTIVE
  To systematically review existing literature on the effectiveness of medical management of chronic rhinosinusitis (CRS) in cystic fibrosis (CF) patients.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  We performed a literature search of PubMed, Embase, and Cochrane CENTRAL from 1987 to 2012. Inclusion criteria included English language as containing original data, with five or more subjects, measurable clinical outcomes, and readily available interventions. Data were systematically collected on study design, patient demographics, clinical characteristics and outcomes, and level of evidence. Two investigators independently reviewed all manuscripts and performed a comprehensive quality assessment.
  
  
  RESULTS
  Of 415 abstracts identified, 12 articles were included. These 12 studies reported on 701 adult and pediatric CF patients who underwent medical therapy. Medical treatment included antibiotics (4/12), topical steroids (4/12), dornase alfa (3/12), and ibuprofen (1/12). Outcome measures included symptom scores (7/12), endoscopic findings (7/12), radiographic findings (4/12), pulmonary function testing (4/12), and rhinomanometry (2/12). Most studies found improvement in at least one of the outcome measures. There was statistical significance in clinical outcomes with dornase alfa, beclomethasone, and betamethasone. Most studies were level 3 or 4 evidence (9/12), but three studies were level 1 or 2 evidence (two dornase alfa studies, one betamethasone study).
  
  
  CONCLUSIONS
  Dornase alfa and, to a lesser extent, topical steroids demonstrated significant benefits in the medical treatment CRS in CF. There was a lack of evidence to support antibiotic therapy in the outcomes assessed. Further high-quality studies should be carried out to determine the efficacy of various medical therapies for CRS in CF.
  
  
  METHODS
  NA.
authors: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A.
authors: Jonathan
authors: J
authors: Liang
authors: Thomas
authors: T
authors: Higgins
authors: Stacey L
authors: SL
authors: Ishman
authors: Emily F
authors: EF
authors: Boss
authors: James R
authors: JR
authors: Benke
authors: Sandra Y
authors: SY
authors: Lin
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003550:Cystic Fibrosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003850:Deoxyribonuclease I / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013256:Steroids / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011994:Recombinant Proteins; D013256:Steroids; D003850:Deoxyribonuclease I; C568813:dornase alfa
keywords: Chronic rhinosinusitis; cystic fibrosis; dornase alfa; medical; topical steroid