Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
Ann Otol Rhinol Laryngol. 2022 Oct;131(10):1130-1136. doi: 10.1177/00034894211054948. Epub 2021 Nov 14.
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.
To determine the effect of intranasal budesonide irrigations for the treatment of CRSwNP in AERD.
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.
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.
Medical management with intranasal corticosteroids and saline irrigations alone leads to significant improvement in sinonasal symptomatology in a subset of AERD.
通过阿司匹林脱敏和生物制剂（如度普利尤单抗）治疗，可针对阿司匹林加重的呼吸系统疾病（AERD）进行病理生理学靶向治疗。随着对这些治疗方法的关注度越来越高，尽管这些治疗方法可能会带来显著的副作用和/或成本，但对于 AERD 患者，经鼻皮质类固醇和盐水冲洗治疗慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）的反应却鲜有描述。
确定鼻内布地奈德冲洗治疗 AERD 中 CRSwNP 的效果。
这是一项观察性研究，共纳入 14 名因 CRS 就诊于鼻科诊所的 AERD 患者，他们接受了每日两次高容量、低压力冲洗，每次使用 240ml 生理盐水，加入 0.5mg/2ml 的布地奈德Respule。所有参与者在入组时和 1 至 6 个月后随访时完成了 22 项鼻-鼻窦结局测试（SNOT-22）。在每个时间点还计算了息肉评分。
SNOT-22 评分范围为 26 至 98（中位数：40.5），随访时为 3 至 85（中位数：38.5）。息肉评分范围为 2 至 6（中位数：4），随访时为 0 至 6（中位数：2）。在治疗期间，SNOT-22 评分的变化范围为-38 至 16（中位数：-18），息肉评分的变化范围为-2 至 0（中位数：-0.5）。约 57%的参与者的 SNOT-22 评分至少有 1 个最小临床重要差异，21%的参与者在随访时的 SNOT-22 评分<20。
单独使用鼻内皮质类固醇和盐水冲洗进行药物治疗可使 AERD 患者的鼻-鼻窦症状得到显著改善。
