title: Comparison of intranasal fluticasone spray, budesonide atomizer, and budesonide respules in patients with chronic rhinosinusitis with polyposis after endoscopic sinus surgery.
abstract: BACKGROUND
  Nasal steroids are a critical part of the management of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) after endoscopic sinus surgery (ESS). Increasingly, practitioners are using budesonide respules delivered to the sinonasal cavities, which is an off-label use, in lieu of traditional nasal steroids. There has been little research comparing budesonide with traditional nasal steroids and the most effective delivery method of budesonide.
  
  
  METHODS
  A randomized controlled trial was performed on patients after ESS for CRSwNP in a tertiary care center. Patients were randomized into 1 of 3 groups: group A received fluticasone nasal spray twice daily; group B received budesonide respules via a mucosal atomization device (MAD) twice daily; and group C received budesonide respules instilled via the vertex-to-floor (VF) position twice daily. Primary endpoints were 22-item Sino-Nasal Outcome Test (SNOT-22) and Lund-Kennedy scores at 6 months.
  
  
  RESULTS
  Thirty-two patients were enrolled in the study, 23 of whom completed the 6-month trial. There were no significant differences among groups A, B, and C with respect to age, gender, asthma, aspirin sensitivity, or previous ESS. Group B had a statistically significant greater reduction in SNOT-22 and Lund-Kennedy scores at the primary endpoint of 6 months compared to groups A and C. Group C had the next greatest reduction, which was statistically significant, followed by group A.
  
  
  CONCLUSIONS
  Patients treated with budesonide after ESS for CRSwNP had greater improvement in SNOT-22 and Lund-Kennedy scores compared to fluticasone at 6 months. The data supports the use of budesonide respules, particularly with a MAD, over fluticasone for CRSwNP patients after ESS.
authors.affiliation: Section of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Neubauer
authors.affiliation: Yale School of Medicine, New Haven, CT.
authors.forename: Zachary G
authors.initials: ZG
authors.lastname: Schwam
authors.affiliation: Section of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT.
authors.forename: R Peter
authors.initials: RP
authors.lastname: Manes
mesh_terms: D000328:Adult; D019819:Budesonide / Q000627:therapeutic use*; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D000068298:Fluticasone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000188:drug therapy* / Q000601:surgery; D059085:Nasal Sprays; D009330:Nebulizers and Vaporizers; D010256:Paranasal Sinuses / Q000187:drug effects* / Q000601:surgery; D012220:Rhinitis / Q000188:drug therapy* / Q000601:surgery; D012225:Rhinoplasty; D012852:Sinusitis / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D059085:Nasal Sprays; D019819:Budesonide; D000068298:Fluticasone
keywords: administration topical drug; chronic disease; off-label use; sinusitis; surgical procedure endoscopic