慢性鼻-鼻窦炎合并哮喘术后短程局部使用糖皮质激素辅助治疗的安全性和有效性

doi:10.6040/j.issn.1673-3770.0.2024.357

Abstract

Abstract: Objective To compare and analyze the safety and efficacy of short-course postoperative topical glucocorticoid(budesonide, nasal drops or spray)adjunctive mometasone furoate therapy for eosinophilic chronic rhinosinusitis with nasal polyps(eCRSwNP)combined with asthma. Methods 87 postoperative patients with eCRSwNP combined with asthma were randomly divided into 3 groups and treated with budesonide nasal drops(group A, n=29)and budesonide nasal rinse(group B, n=29)in combination with mometasone furoate nasal spray, versus mometasone furoate nasal spray alone(group C, n=29). The rates of symptom reduction, quality of life improvement, and glucocorticoid treatment sensitivity rate were compared among the 3 groups 1 w after treatment. The total nasal symptom scale(TNSS), endoscopic nasal polyp(NP)score, and Chinese version of sinonasal outcome test-22(SNOT-22)were used on the 1st of treatment(D1), the 7th d of treatment(D7), 1 and 3 months after treatment to evaluated the symptoms and quality of life of patients. The occurrence of adverse reactions in the three groups was observed and compared. Results The symptom reduction rate, quality of life improvement rate and glucocorticoid treatment sensitivity rate in group A and group B were higher than that in group C at 1 w after treatment(P<0.05), but the difference between group A and group B was not statistically significant(P>0.05). After 1 w of treatment, the TNSS, endoscopic NP and SNOT-22 scores were significantly reduced in all 3 groups, and there was a decreasing trend at 1 and 3 months after treatment(P<0.05). The scores of group A and group B were significantly lower than those in group C(P<0.05), but the difference between group A and group B was not statistically significant(P>0.05). There were no serious adverse reactions in any of the 3 groups. Conclusion Short-course topical glucocorticoid can be used to treat eCRSwNP combined with asthma with a favorable safety profile. Budesonide nasal drops in combination with mometasone nasal spray improved clinical symptoms and the quality of life of patients better than mometasone furoate nasal spray alone.The efficacy of two modes of administration, budesonide nasal drops or nasal rinse in the treatment of patients with eCRSwNP combind with asthma was comparable.

Key words: Eosinophils, Chronic rhinosinusitis with nasal polyps, Asthma, Glucocorticoids, Budesonide, Mometasone furoate

CLC Number:

R765.4+1

CAO Zhengyong, LI Xiaobo. Comparison of the safety and efficacy of short-course postoperative topical glucocorticoid adjuvant therapy for eCRSwNP combined with asthma[J].Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(2): 43-50.

References

[1] 胡守亮, 李辉, 朱天民, 等. 慢性鼻-鼻窦炎的病因及发病机制研究进展[J]. 实用医学杂志, 2019, 35(11): 1846-1849. doi:10.3969/j.issn.1006-5725.2019.11.033 HU Shouliang, LI Hui, ZHU Tianmin, et al. The Journal of Practical Medicine, 2019, 35(11): 1846-1849. doi:10.3969/j.issn.1006-5725.2019.11.033
[2] 王成硕, 张罗. 慢性鼻窦炎伴鼻息肉诊疗迈入精准治疗时代[J]. 中国耳鼻咽喉头颈外科, 2019, 26(12): 635-638. doi:10.16066/j.1672-7002.2019.12.001 WANG Chengshuo, ZHANG Luo. Precision medicine for chronic rhinosinusitis with nasal polyps[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2019, 26(12): 635-638. doi:10.16066/j.1672-7002.2019.12.001
[3] Lou HF, Zhang N, Bachert C, et al. Highlights of eosinophilic chronic rhinosinusitis with nasal polyps in definition, prognosis, and advancement[J]. Int Forum Allergy Rhinol, 2018, 8(11): 1218-1225. doi:10.1002/alr.22214
[4] 陈兴雪, 张广玲, 武天义, 等. 抗IL-4Rα单克隆抗体与鼻内镜手术治疗嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉的疗效分析[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 43-54. doi:10.6040/j.issn.1673-3770.0.2024.093 CHEN Xingxue, ZHANG Guangling, WU Tianyi, et al. Analysis of anti-IL-4Rα monoclonal antibody and endoscopic sinus surgery in the treatment of eosinophilic chronic rhino sinusitis with nasal polyps[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(4): 43-54. doi:10.6040/j.issn.1673-3770.0.2024.093
[5] 崔宁, 王云梦, 杨景朴. 2型固有淋巴细胞在慢性鼻窦炎中的作用及调节机制研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 153-159. doi:10.6040/j.issn.1673-3770.0.2022.192 CUI Ning, WANG Yunmeng, YANG Jingpu. Research progress on the role and regulatory mechanism of group 2 innate lymphoid cells in chronic rhino-sinusitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(4): 153-159. doi:10.6040/j.issn.1673-3770.0.2022.192
[6] Jarvis D, Newson R, Lotvall J, et al. Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe[J]. Allergy, 2012, 67(1): 91-98. doi:10.1111/j.1398-9995.2011.02709.x
[7] Cahill KN. Fevipiprant in CRSwNP and comorbid asthma: wrong target population or wrong PGD2 receptor?[J]. J Allergy Clin Immunol, 2022, 149(5): 1587-1589. doi:10.1016/j.jaci.2022.03.001
[8] 资昊坤,肖旭平,李云秋. 口服糖皮质激素在慢性鼻窦炎伴鼻息肉围手术期的应用现状[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 98-103. doi:10.6040/j.issn.1673-3770.0.2020.428 ZI Haokun, XIAO Xuping, LI Yunqiu. Application status of oral corticosteroids during the perioperative period of chronic rhinosinusitis with nasal polyps[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 98-103. doi:10.6040/j.issn.1673-3770.0.2020.428
[9] 张思远, 曹志伟. 口服糖皮质激素治疗慢性鼻-鼻窦炎伴鼻息肉[J]. 国际耳鼻咽喉头颈外科杂志, 2019, 43(4): 234-237. doi:10.3760/cma.j.issn.1673-4106.2019.04.012 ZHANG Siyuan, CAO Zhiwei. Oral glucocorticoids for chronic rhinosinusitis with nasal polyps[J]. International Journal of Otolaryngology-Head and Neck Surgery, 2019, 43(4): 234-237. doi:10.3760/cma.j.issn.1673-4106.2019.04.012
[10] 王阳, 黄嫣然, 娄鸿飞, 等. 三种激素剂型治疗嗜酸性粒细胞型鼻息肉的疗效及安全性研究[J]. 中国耳鼻咽喉头颈外科, 2019, 26(4): 199-203. doi:10.16066/j.1672-7002.2019.04.008 WANG Yang, HUANG Yanran, LOU Hongfei, et al. Efficacy and safety of three routes of corticosteroids in eosinophilic nasalpolyps[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2019, 26(4): 199-203. doi:10.16066/j.1672-7002.2019.04.008
[11] Neubauer PD, Schwam ZG, Peter Manes R. Comparison of intranasal fluticasone spray, budesonide atomizer, and budesonide respules in patients with chronic rhinosinusitis with polyposis after endoscopic sinus surgery[J]. Int Forum Allergy Rhinol, 2016, 6(3): 233-237. doi:10.1002/alr.21688
[12] 白玉, 李元惠, 高云海. 慢性鼻-鼻窦炎术前应用布地奈德联合鼻腔冲洗的临床疗效观察[J]. 北京医学, 2022, 44(9): 795-798. doi:10.15932/j.0253-9713.2022.09.005 BAI Yu, LI Yuanhui, GAO Yunhai. The clinical effect observation of budesonide combined with nasal irrigation before surgery in chronic rhinosinusitis[J]. Beijing Medical Journal, 2022, 44(9): 795-798. doi:10.15932/j.0253-9713.2022.09.005
[13] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 中国慢性鼻窦炎诊断和治疗指南(2018)[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(2): 81-100. doi:10.3760/cma.j.issn.1673-0860.2019.02.001 Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and NeckSurgery; Subspecialty Group of Rhinology, Society of Otorhinolaryngology Head and Neck Surgery, ChineseMedical Association. Chinese guidelines for diagnosis and treatment of chronic rhinosinusitis(2018)[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2019, 54(2): 81-100. doi:10.3760/cma.j.issn.1673-0860.2019.02.001
[14] Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020[J]. Rhinology, 2020, 58(S29): 1-464. doi:10.4193/Rhin20.600
[15] 中华医学会呼吸病学分会哮喘学组. 支气管哮喘防治指南(2020年版)[J]. 中华结核和呼吸杂志, 2020, 43(12): 1023-1048. doi:10.3760/cma.j.cn112147-20200618-00721 Asthma group of Chinese Throacic Society. Guidelines for bronchial asthma prevent and management(2020 edition)Asthma group of Chinese Throacic Society[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2020, 43(12): 1023-1048. doi:10.3760/cma.j.cn112147-20200618-00721
[16] Xu ZF, Luo X, Xu L, et al. Effect of short-course glucocorticoid application on patients with chronic rhinosinusitis with nasal polyps[J]. World Allergy Organ J, 2020, 13(6): 100131. doi:10.1016/j.waojou.2020.100131
[17] Tamasauskiene L, Gasiuniene E, Sitkauskiene B. Translation, adaption and validation of the total nasal symptom score(TNSS)for Lithuanian population[J]. Health Qual Life Outcomes, 2021, 19(1): 54. doi:10.1186/s12955-020-01659-8
[18] Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: developing guidance for clinical trials[J]. J Allergy Clin Immunol, 2006, 118(5): 17-61. doi:10.1016/j.jaci.2006.09.005
[19] 吕威, 亓放, 高志强, 等. 汉化版SNOT-22评价慢性鼻-鼻窦炎患者生存质量的初步研究[J]. 中华耳鼻咽喉头颈外科杂志, 2008, 43(1): 18-21. doi:10.3321/j.issn: 1673-0860.2008.01.006 LÜ Wei, QI Fang, GAO Zhiqiang, et al. Quality of life survey on patients with chronic rhinosinusitis by using Chinese version of the 22-item sinonasal outcome test(SNOT-22)[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2008, 43(1): 18-21. doi:10.3321/j.issn: 1673-0860.2008.01.006
[20] 伏飞达, 杨明, 王旭, 等. 不同糖皮质激素对CRSwNP鼻内窥镜手术患者鼻黏膜功能、鼻黏膜重塑及术后出血的影响[J]. 川北医学院学报, 2022, 37(3): 290-293. doi:10.3969/j.issn.1005-3697.2022.03.004 FU Feida, YANG Ming, WANG Xu, et al. Effects of different glucocorticoids on nasal mucosa function, remodeling of nasal mucosa and postoperative bleeding in patients undergoing CRSwNP nasal endoscopic surgery[J]. Journal of North Sichuan Medical College, 2022, 37(3): 290-293. doi:10.3969/j.issn.1005-3697.2022.03.004
[21] Maza-Solano J, Callejon-Leblic A, Martin-Jimenez D, et al. Omalizumab treatment in uncontrolled asthma and CRSwNP patients, with previous endoscopic sinus surgery, to improve quality of life and endoscopic outcomes: a two-year real-life study[J]. Curr Allergy Asthma Rep, 2023, 23(10): 555-566. doi:10.1007/s11882-023-01106-w
[22] Winblad L, Larsen CG, Håkansson K, et al. The risk of osteoporosis in oral steroid treatment for nasal polyposis: a systematic review[J]. Rhinology, 2017, 55(3): 195-201. doi:10.4193/Rhino15.367
[23] Ikeda K, Ito S, Hibiya R, et al. Postoperative management of eosinophilic chronic rhinosinusitis with nasal polyps: impact of high-dose corticosteroid nasal spray[J]. Int Arch Otorhinolaryngol, 2019, 23(1): 101-103. doi:10.1055/s-0038-1668515
[24] 孟凡超, 褚静元, 于向阳. 维生素D联合布地奈德喷鼻剂对慢性鼻-鼻窦炎患者术后治疗的效果[J]. 实用临床医学, 2021, 22(2):34-36,78. doi: 10.13764/j.cnki.lcsy.2021.02.012 MENG Fanchao, CHU Jingyuan, YU Xiangyang. Efficacy of vitamin D combined with budesonide nasal spray in postoperative patients with chronic rhinosinusitis[J]. Practical Clinical Medicine, 2021, 22(2):34-36,78. doi: 10.13764/j.cnki.lcsy.2021.02.012
[25] Moffa A, Costantino A, Rinaldi V, et al. Nasal delivery devices: a comparative study on cadaver model[J]. Biomed Res Int, 2019, 2019: 4602651. doi:10.1155/2019/4602651
[26] 杨双元, 杨婷, 李陈, 等. 慢性鼻窦炎术后局部激素不同给药方式的研究进展[J]. 中国耳鼻咽喉颅底外科杂志, 2021, 27(5): 606-610, 614. doi:10.11798/j.issn.1007-1520.202121006 YANG Shuangyuan, YANG Ting, LI Chen, et al. Research progress of local glucocorticoids administered in different ways after endoscopic sinus surgery for chronic sinusitis[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2021, 27(5): 606-610, 614. doi:10.11798/j.issn.1007-1520.202121006
[27] 龚燕茂. 鼻腔冲洗对合并鼻窦炎的哮喘患者哮喘控制的影响[J]. 航空航天医学杂志, 2020, 31(10): 1173-1174. doi:10.3969/j.issn.2095-1434.2020.10.009
[28] 张霞. 功能性鼻内镜手术联合糖皮质激素鼻腔冲洗对慢性鼻窦炎患者鼻黏膜纤毛功能及鼻腔微生态的影响[J]. 中国耳鼻咽喉头颈外科, 2022, 29(9): 602-603. doi:10.16066/j.1672-7002.2022.09.015 ZHANG Xia. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2022, 29(9): 602-603. doi:10.16066/j.1672-7002.2022.09.015
[29] 唐红莉. 慢性鼻窦炎鼻息肉经功能性鼻内镜术后鼻腔冲洗联合糠酸莫米松喷雾剂治疗疗效及并发症观察[J]. 贵州医药, 2021, 45(5): 725-726. doi:10.3969/j.issn.1000-744X.2021.05.020
[30] Huang ZZ, Chen XZ, Huang JC, et al. Budesonide nasal irrigation improved Lund-Kennedy endoscopic score of chronic rhinosinusitis patients after endoscopic sinus surgery[J]. Eur Arch Otorhinolaryngol, 2019, 276(5): 1397-1403. doi:10.1007/s00405-019-05327-6

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Comments

Recommended 10

[1]	ZHOU Bin,LI Bin . Endoscopic sinus surgery for 75 patients with chronic sinusitis and nasal polyps[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 24 -26 .
[2]	. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 200 -203 .
[3]	QIAO Yi,NI Guan-sen,CHEN Wen-wen . Effect of H-UPPP and nasal operations on obstructive sleep apnea syndrome in 38 cases [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 206 -208 .
[4]	WANG Xiao-feng,LIN Chang,CHENG Jin-mei . Expression of ABAD in inner ears and its clinical significance in different age mice[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 207 -211 .
[5]	FAN Qi-jun,HUANG Zhi-wu,MEI Ling,XIAO Bo-kui . Expression of the heat shock protein 27 in rat cochlea induced by sodium salicylate injection by the FQ-PCR technique[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 212 -214 .
[6]	LIN Feng,LIANG Yong,LU Yong-tian,WAN Li-xia . Classification and surgical treatment for nasal inverted papilloma[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 231 -233 .
[7]	PANG Tai-zhong,LIU Bing, CHENG Liang-jun . Septum corrective treatment for allergic rhinitis [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 237 -238 .
[8]	WANG Zong-feng,ZHANG Zhi-li,LI Jian-dong,LI Jian-ge . Effects of controlled hypotension at different levels on definition of surgical field and cerebral blood flow[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 239 -241 .
[9]	BAI Guang-ping,LI Jun,DONG Pin . Endscopic surgery for chronic nasosinusitis and nasal polyps in 180 cases[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 242 -243 .
[10]	. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 275 -275 .

Comparison of the safety and efficacy of short-course postoperative topical glucocorticoid adjuvant therapy for eCRSwNP combined with asthma

PDF (PC)

Abstract

Cite this article

share this article

References

Related Articles 15

Metrics

Comments

Recommended 10

[1]	ZHANG Guangling, CHEN Xingxue, WU Tianyi, SUN Zhanwei, WANG Weiwei, LI Shichao,WANG Guangke. The expression and function of Tespa1 in chronic rhinosinusitis with nasal polyps [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(2): 35-42.
[2]	ZHANG Jie, NIMA Jizong, XU Xiaodong, ZHOU Jing, LIU Jianmin, LUO Yirui, DU Jintao, BA Luo. Effect of Crocin on Type 2 inflammation in eosinophilic chronic rhinosinusitis with nasal polyps [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(1): 61-67.
[3]	WANG Zhenxiao, SHI Guanggang, HE Mingqiang, SHI Lei. Treatment options and management strategies for patients with acute laryngotracheobronchitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(5): 136-144.
[4]	CHEN Xingxue, ZHANG Guangling, WU Tianyi, WANG Weiwei, SUN Zhanwei, LI Shichao, WANG Guangke. Analysis of anti-IL-4Rα monoclonal antibody and endoscopic sinus surgery in the treatment of eosinophilic chronic rhinosinusitis with nasal polyps [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(4): 43-54.
[5]	LI Shuting, ZHAO Hui, SI Mingwei, CUI Wenxuan, YANG Mengyao, WANG Hong. Fungal endophthalmitis in a patient with no history of vegetative trauma: a case report and literature review [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(2): 103-108.
[6]	CHONG Weikun, WANG Juan. Efficacy of Omalizumab in children with moderate and severe allergic asthma and chronic sinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(1): 21-26.
[7]	SUN Xiwen, LUO Chunyu, LI Zhipeng, ZHANG Weitian. Role of ferroptosis in inflammatory diseases of the respiratory tract: a review of recent advances [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 24-32.
[8]	WANG Lixue, ZENG Yi, WANG Lixin, PENG Xianbing. Clinical observation of the effect of infiltrating Biprofen Gelatin Sponge after functional endoscopic sinus surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(5): 16-25.
[9]	LU Gan, DENG Yuqin, TAO Zezhang. Relationship between allergic diseases and diabetes mellitus and underlying mechanisms [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(5): 215-222.
[10]	YUAN Yue, FU Shengyao, JIANG Yan, CHEN Min. Research progress of pyroptosis in chronic airway inflammatory disease [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(4): 166-171.
[11]	SUN Yan, YAO Hao, GU Li'an. Clinical efficacy of intratympanic administration of budesonide combined with ambroxol hydrochloride in the treatment of secretory otitis media in adults [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(6): 77-82.
[12]	LIANG Xu,SHI Li. Research progress in biologic targeted drug therapy for chronic sinusitis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 30-35.
[13]	SHI Shuai, ZHENG Quan,CHENG Lei. Research advances of dupilumab in the treatment of chronic rhinosinusitis with nasal polyps [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 36-42.
[14]	YI Ruonan,CHEN Fuquan. Eosinophils and Olfactory Dysfunction [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 50-55.
[15]	WANG Na,CHAI Xiangbin. Research progress on prostate-derived ETS factor in asthma and inflammatory diseases of the nasal mucosa [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 136-141.