Safety of Budesonide in Saline Sinonasal Irrigations in the Management of Chronic Rhinosinusitis with Polyposis: Lack of Significant Adrenal Suppression

Bhalla, Rajiv K.; Payton, Keith; Wright, Erin D.
December 2008
Journal of Otolaryngology -- Head & Neck Surgery;Dec2008, Vol. 37 Issue 6, p821
Academic Journal
Objective: To evaluate the potential for hypothalamic-pituitary-adrenal (HPA) axis suppression by budesonide nasal irrigations in the treatment of refractory chronic rhinosinusitis with polyposis (CRSwP). Study Design: Retrospective, descriptive review of patient charts. Setting: Tertiary care rhinology practice in an academic teaching hospital. Patients: Eighteen adult subjects with CRSwP refractory to conservative medical therapy. Methods: The charts of consecutive patients identified as being treated with topical budesonide in saline for nasal irrigation from January to October 2006 were reviewed, in all cases, pre- and posttreatment morning cortisol levels had been measured following at least 8 weeks of uninterrupted therapy. In addition, a subset of patients who continued therapy longer than 8 weeks had undergone the more sensitive adrenocorticotropic hormone (ACTH) stimulation test. Results: All pre- and posttreatment morning cortisol levels were within the normal range. For an 8-week treatment period, there was no evidence of HPA axis suppression (p = .4171). For patients who continued treatment beyond 8 weeks, ACTH stimulation did not detect HPA axis suppression. Furthermore, there were no issues with compliance or acceptability, nor were any adverse side effects reported. Conclusion: Budesonide in saline sinonasal irrigation for the treatment of refractory CRSwP does not cause HPA axis suppression. The efficacy of this higher dose of steroid delivered locally would benefit from further study.


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