Safety of long-term intranasal budesonide delivered via the mucosal atomization device for chronic rhinosinusitis.
Although short-term use (≤2 months) of atomized topical nasal steroids has been shown to be safe and effective, the long-term safety has yet to be demonstrated. The aim of this study was to determine the impact of long-term topical budesonide treatment via the mucosal atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular pressure (IOP).



A cross-sectional study of patients with chronic rhinosinusitis (CRS), with or without nasal polyposis, managed with daily nasal budesonide via MAD was conducted at a tertiary rhinology center. Patients using systemic steroids within 3 months of assessment were excluded. HPAA impact was assessed using the cosyntropin stimulation test for adrenal function and a survey of relevant symptomatology. Patients also underwent tonometry to assess for elevated IOP potentially related to corticosteroid use.



A total of 100 CRS patients were recruited with a mean budesonide treatment duration of 23.5 months (range, 6-37 months). Stimulated cortisol response was diminished in 3 patients (3%). No patients with adrenal suppression had relevant symptomatology. IOP was elevated in 6 patients (6%).



These findings suggest that there is a risk of adrenal suppression and raised IOP associated with the long-term use of topical nasal budesonide via MAD. Otolaryngologists should consider periodic surveillance for these adverse events in this patient cohort.
St. Paul's Sinus Centre, Vancouver, British Columbia, Canada.|Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Jamil
J
Manji
St. Paul's Sinus Centre, Vancouver, British Columbia, Canada.
Gurkaran
G
Singh
St. Paul's Sinus Centre, Vancouver, British Columbia, Canada.
Christopher
C
Okpaleke
St. Paul's Sinus Centre, Vancouver, British Columbia, Canada.
Anali
A
Dadgostar
St. Paul's Sinus Centre, Vancouver, British Columbia, Canada.
Fahad
F
Al-Asousi
St. Paul's Sinus Centre, Vancouver, British Columbia, Canada.
Ameen
A
Amanian
Hospital Español de México, Facultad Mexicana de Medicina Universidad La Salle Mexico City, Mexico.
Luis
L
Macias-Valle
Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Chile.
Andres
A
Finkelstein
Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Mark
M
Tacey
St. Paul's Sinus Centre, Vancouver, British Columbia, Canada.
Andrew
A
Thamboo
St. Paul's Sinus Centre, Vancouver, British Columbia, Canada.
Amin
A
Javer
D000281:Administration, Intranasal; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000188:drug therapy; D009330:Nebulizers and Vaporizers; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D012220:Rhinitis / Q000188:drug therapy; D012852:Sinusitis / Q000188:drug therapy
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D019819:Budesonide
HPA axis; IOP; budesonide; chronic rhinosinusitis; mucosal atomization device; postoperative care; safety