Budesonide respules used in nasal irrigations as part of chronic rhinosinusitis management are usually at a dose of 0.25 mg to 2 mg, which is substantially higher compared to budesonide nasal spray, typically ranging from 64 to 256 micrograms. Hence, there has been interest in investigating its therapeutic efficacy and safety profile. This was a systematic review with meta-analysis to evaluate this, encompassing 26 studies including 12 randomised controlled trials, 12 cohort studies and three case series with a cumulative sample size of 1464 patients (569 had CRSwNP). Twelve studies used 0.5 mg budesonide in saline irrigation following endoscopic sinus surgery, seven studies used 1 mg budesonide and three studies used 2 mg. Lund-Kennedy Endoscopic Score (seven studies, 548 patients): budesonide nasal irrigation (BNI) had significant greater improvement in Lund-Kennedy Endoscopic Score compared to saline nasal irrigation (SNI). SNOT-22 scores (seven studies, 564 patients) showed greater improvement with the use of BNI compared to SNI. Intraocular pressure (two studies, 172 patients): no significant difference found between use of BNI and SNI. Serum cortisol (four studies) remained at normal value following BNI. This study suggests favourable efficacy and safety profile with the use of BNI, although the evidence base is limited by small sample sizes and short durations of previous studies.
Budesonide nasal irrigation for chronic rhinosinusitis: is it effective and safe?
Reviewed by Richard (Wei Chern) Gan
Budesonide nasal irrigation for chronic rhinosinusitis: a meta-analysis of therapeutic and safety profile.
CONTRIBUTOR
Richard (Wei Chern) Gan
Hull University Teaching Hospitals NHS Trust, UK.
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