Beer Helen, Southern Kevin W, Swift Andrew C
ENT Department, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK.
Cochrane Database Syst Rev. 2013 Apr 30(4):CD008253. doi: 10.1002/14651858.CD008253.pub3.
Nasal polyps frequently occur in people with cystic fibrosis. Sinus infections have been shown to be a factor in the development of serious chest complications in these people. Nasal polyps have been linked to a higher risk of lower respiratory tract infections with Pseudomonas aeruginosa . Topical nasal steroids are of proven efficacy for treating nasal polyposis in the non-cystic fibrosis population. There is no clear current evidence for the efficacy of topical steroids for nasal polyps in people with cystic fibrosis.
To assess the effectiveness of topical nasal steroids for treating symptomatic nasal polyps in people with cystic fibrosis.
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Latest search: 25 January 2013.
Randomised and quasi-randomised controlled comparing the effects of topical nasal steroids to placebo in people with nasal polyps with cystic fibrosis.
Two authors independently assessed risk of bias in the included trial and extracted data.
One single-centred trial (46 participants) was identified comparing a topical steroid (betamethasone) to placebo. Twenty-two participants received the active drug.Subjective symptom scores, change in polyp size, and side effects were assessed. There was no difference in nasal symptom scores between the treatment and placebo groups. Betamethasone was effective in reducing the size of polyps, but was associated with increased reports of mild side effects, nasal bleeding and discomfort.Risk of bias was high since over 50% of people enrolled did not complete the study. Follow-up of patients was short (six weeks) also reducing the significance of the results for clinical practice.
AUTHORS' CONCLUSIONS: This review suggests topical steroids for nasal polyposis in patients with cystic fibrosis have no demonstrable effect on subjective nasal symptom scores. They have some effect in reducing the size of the polyps, but due to the small sample size, poor study completion rates and lack of follow-up, the study is at high risk of bias and evidence for efficacy is limited. Overall there is no clear evidence for using topical steroids in people with cystic fibrosis and nasal polyposis.A well-designed randomised controlled trial of adequate power and long-term follow-up is needed. Validated measures of symptoms and physical findings should be performed and quality of life issues addressed.
鼻息肉在囊性纤维化患者中经常出现。鼻窦感染已被证明是这些患者发生严重胸部并发症的一个因素。鼻息肉与铜绿假单胞菌引起的下呼吸道感染风险较高有关。局部鼻用类固醇对治疗非囊性纤维化人群的鼻息肉病已被证明有效。目前尚无明确证据表明局部类固醇对囊性纤维化患者的鼻息肉有效。
评估局部鼻用类固醇治疗囊性纤维化患者有症状鼻息肉的有效性。
我们检索了Cochrane囊性纤维化和遗传疾病小组试验注册库，该注册库包含从全面电子数据库检索以及对相关期刊和会议论文摘要集的手工检索中识别出的参考文献。最新检索日期：2013年1月25日。
随机和半随机对照试验，比较局部鼻用类固醇与安慰剂对囊性纤维化鼻息肉患者的影响。
两位作者独立评估纳入试验的偏倚风险并提取数据。
确定了一项单中心试验（46名参与者），比较局部类固醇（倍他米松）与安慰剂。22名参与者接受了活性药物治疗。评估了主观症状评分、息肉大小变化和副作用。治疗组和安慰剂组的鼻部症状评分没有差异。倍他米松在缩小息肉大小方面有效，但与轻度副作用、鼻出血和不适的报告增加有关。由于超过50%的入组者未完成研究，偏倚风险较高。患者随访时间短（六周），这也降低了结果对临床实践的意义。
本综述表明，局部类固醇对囊性纤维化患者的鼻息肉病在主观鼻部症状评分方面没有明显效果。它们在缩小息肉大小方面有一定作用，但由于样本量小、研究完成率低和缺乏随访，该研究存在较高的偏倚风险，疗效证据有限。总体而言，没有明确证据支持在囊性纤维化和鼻息肉患者中使用局部类固醇。需要进行一项设计良好、有足够效力且长期随访的随机对照试验。应采用经过验证的症状和体格检查测量方法，并解决生活质量问题。
