Chronic Rhinosinusitis Outcomes of Patients With Aspirin-Exacerbated Respiratory Disease Treated With Budesonide Irrigations: A Case Series

Abstract

Background: Pathophysiology-targeting treatments exist for aspirin-exacerbated respiratory disease (AERD) through aspirin desensitization and biologics, such as dupilumab. With increasing attention paid to these treatments, which may be associated with significant side effects and/or cost, there is little description of chronic rhinosinusitis with nasal polyps (CRSwNP) response to treatment with intranasal corticosteroids and saline irrigations in AERD. Objective: To determine the effect of intranasal budesonide irrigations for the treatment of CRSwNP in AERD. Methods: This is an observational study of 14 AERD patients presenting to a rhinology clinic for CRS who were treated with twice daily high volume, low pressure irrigations with 240 mL of saline to which a 0.5 mg/2 mL respule of budesonide was added. All participants completed a 22-item Sinonasal Outcome Test (SNOT-22) at enrollment and at follow up 1 to 6 months later. Polyp scores were also calculated at each time point. Results: SNOT-22 scores ranged from 26 to 98 (median: 40.5) at enrollment and 3 to 85 (median: 38.5) at follow-up. Polyp scores ranged from 2 to 6 (median: 4) at enrollment at 0 to 6 (median: 2) at follow-up. Over the treatment period, change in SNOT-22 score ranged from −38 to 16 (median: −18) and change in polyp score ranged from −2 to 0 (median: −0.5). Approximately 57% of participants experienced at least 1 minimal clinically important difference in SNOT-22 score and 21% of participants had a SNOT-22 score <20 at follow-up. Conclusion: Medical management with intranasal corticosteroids and saline irrigations alone leads to significant improvement in sinonasal symptomatology in a subset of AERD.

The Role of Corticosteroid Nasal Irrigations in the Management of Chronic Rhinosinusitis: A State-of-the-Art Systematic Review

“…Rotenberg et al [23] could not identify any differences between the use of HSNR and saline rinses alone. Talat et al [31] found a reduction in SNOT-22 and nasal polyps score, but the study was not placebo controlled.…”

“…Regarding the type of steroid, 15 studies used budesonide [6,13,14,16,18,[21][22][23][24][25][27][28][29][30][31], 2 mometasone [15,20], 1 fluticasone [26], and 1 bethametasone [13,17].…”

“…Jang et al [18] also performed subgroup analysis in AERD, showing a lower reduction in the SNOT-20 and Lund-Kennedy scores compared to the overall sample. Interestingly, Talat et al [31] and Rotenberg et al [23] performed their study only in CRSwNP patients with AERD. Rotenberg et al [23] could not identify any differences between the use of HSNR and saline rinses alone.…”

“…Previous surgery: Five authors report on patients with and without previous ESS [13,14,16,27,31]. Among them, only three performed subgroup analysis.…”

Lung Function and Asthma Clinical Control in N-ERD Patients, Three-Year Follow-Up in the Context of Real-World Evidence

“…9,10 In the last years, few studies have evaluated these objectives from therapeutic (antileukotriene therapy, nebulized steroids, and aspirin desensitization) and surgical maneuvers on sinus outcomes in a second time with variable results. [11][12][13][14] However, the use of standard therapy for asthma control in N-ERD long-time has not been sufficiently described, has only been described that the combination of ICS plus long-acting β2-agonists (LABA, ICS/LABA) and antileukotrienes diminishes bronchial symptoms during aspirin oral challenge in N-ERD patients. 15 N-ERD has been considered a severe asthma phenotype for many years, 16 requiring the use of multiple medicines or large doses for asthma control.…”