title: Effect of budesonide transnasal nebulization in patients with eosinophilic chronic rhinosinusitis with nasal polyps.
abstract: BACKGROUND
  There is little evidence on the efficacy of glucocorticoid transnasal nebulization therapy in patients with eosinophilic chronic rhinosinusitis with nasal polyps (CRSwNP).
  
  
  OBJECTIVE
  We sought to evaluate the immunologic and remodeling effects of budesonide transnasal nebulization in patients with eosinophilic CRSwNP.
  
  
  METHODS
  Sixty patients with eosinophilic CRSwNP were randomized to receive budesonide or placebo treatment for 14 days by means of transnasal nebulization in a double-blind manner. Endoscopic polyp size scores (maximum = 6 points, Kennedy score) and visual analog scale scores for nasal symptoms were assessed before and after treatment. Similarly, polyp samples were evaluated for inflammatory cytokines, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs) by using an immunoassay; collagen by using histochemistry; eosinophils by using hematoxylin and eosin stain; and T-cell subsets by using flow cytometry.
  
  
  RESULTS
  Budesonide transnasal nebulization significantly reduced polyp size compared with placebo (mean difference between groups, -0.73 units; 95% CI, -1.15 to -0.32 units; P = .002) and improved symptoms. Polyp IL-5 and eotaxin expression decreased significantly, whereas TGF-β and IL-10 expression increased. Expression of IFN-γ and IL-17 was not altered. Budesonide transnasal nebulization consistently reduced eosinophil infiltration and TH2 cell frequency and increased natural regulatory T-cell and type 1 regulatory T-cell frequencies. Indices of remodeling, including albumin, MMP-2, MMP-7, MMP-8, and MMP-9, were significantly decreased, whereas collagen deposition and TIMP-1, TIMP-2, and TIMP-4 levels were significantly increased. Budesonide transnasal nebulization did not suppress the hypothalamic-pituitary-adrenal axis or cause any serious side effects.
  
  
  CONCLUSIONS
  Short-term budesonide transnasal nebulization is an effective and safe treatment option in patients with eosinophilic CRSwNP, achieving clinical improvement by regulating remodeling, cytokine expression, and T-cell subset distribution.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China.
authors.forename: Chengshuo
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China.
authors.forename: Hongfei
authors.initials: H
authors.lastname: Lou
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China.
authors.forename: Erzhong
authors.initials: E
authors.lastname: Fan
authors.affiliation: Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.affiliation: Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Upper Airways Research Laboratory, Department of Oto-Rhino-Laryngology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Claus
authors.initials: C
authors.lastname: Bachert
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China; Key Laboratory of Otolaryngology-Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, China. Electronic address: dr.luozhang@gmail.com.
authors.forename: Luo
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019819:Budesonide / Q000008:administration & dosage* / Q000009:adverse effects; D002908:Chronic Disease; D016207:Cytokines / Q000378:metabolism; D004804:Eosinophils / Q000473:pathology; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications; D009330:Nebulizers and Vaporizers; D012220:Rhinitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001993:Bronchodilator Agents; D016207:Cytokines; D018836:Inflammation Mediators; D019819:Budesonide
keywords: Eosinophilic chronic rhinosinusitis; T-cell subsets; budesonide; inflammatory cytokine; nasal polyps; tissue remodeling; transnasal nebulization