Combined Oral and Intranasal Corticosteroid Therapy: An Advance in the Management of Nasal Polyposis?

Editorials1 March 2011Combined Oral and Intranasal Corticosteroid Therapy: An Advance in the Management of Nasal Polyposis?Joaquim Mullol, MD, PhD and Isam Alobid, MD, PhDJoaquim Mullol, MD, PhDFrom Rhinology Unit and Smell Clinic, Hospital Clínic i Universitari, IDIBAPS, CIBERES, 08036 Barcelona, Spain. and Isam Alobid, MD, PhDFrom Rhinology Unit and Smell Clinic, Hospital Clínic i Universitari, IDIBAPS, CIBERES, 08036 Barcelona, Spain.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-5-201103010-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Chronic rhinosinusitis with nasal polyps is a common health problem, affecting 2% to 5% of the general population. Although the condition is not life-threatening, it is costly in terms of health care expenditures, decreased quality of life, and negative effects on lower airway disease (1–3). European guidelines recommend intranasal corticosteroids as first-line treatment for chronic rhinosinusitis with nasal polyps and reserve oral steroid therapy for patients with severe or uncontrolled symptoms and endoscopic sinus surgery for patients with inadequate improvement despite oral steroid therapy (1, 4). After surgery, many patients must continue medical management to prevent relapse (5–7). Yet, these ...References1. Fokkens W, Lund V, Mullol J; European Position Paper on Rhinosinusitis and Nasal Polyps Group. European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl. 2007;:1-136. [PMID: 17844873] MedlineGoogle Scholar2. Alobid I, Benitez P, Pujols L, Maldonado M, Bernal-Sprekelsen M, Morello A, et al. Severe nasal polyposis and its impact on quality of life. The effect of a short course of oral steroids followed by long-term intranasal steroid treatment. Rhinology. 2006;44:8-13. [PMID: 16550943] MedlineGoogle Scholar3. 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Pujols L, Mullol J, Picado C. Importance of glucocorticoid receptors in upper and lower airways. Front Biosci. 2010;15:789-800. [PMID: 20036846] CrossrefMedlineGoogle Scholar9. Pujols L, Fuentes-Prado M, Fernández-Bertolín L, Alobid I, Roca-Ferrer J, Mullol J, et al. Lower sensitivity of nasal polyp fibroblasts to glucocorticoid anti-proliferative effects. Respir Med. 2011;105:218-25. [PMID: 20829014] CrossrefMedlineGoogle Scholar10. Martínez-Antón A, deBolós C, Alobid I, Benítez P, Roca-Ferrer J, Picado C, et al. Corticosteroid therapy increases membrane-tethered while decreases secreted mucin expression in nasal polyps. Allergy. 2008;63:1368-76. [PMID: 18547287] CrossrefMedlineGoogle Scholar11. Pujols L, Alobid I, Benítez P, Martínez-Antón A, Roca-Ferrer J, Fokkens WJ, et al. Regulation of glucocorticoid receptor in nasal polyps by systemic and intranasal glucocorticoids. Allergy. 2008;63:1377-86. [PMID: 18671773] CrossrefMedlineGoogle Scholar12. Pujols L, Mullol J, Pérez M, Roca-Ferrer J, Juan M, Xaubet A, et al. Expression of the human glucocorticoid receptor alpha and beta isoforms in human respiratory epithelial cells and their regulation by dexamethasone. Am J Respir Cell Mol Biol. 2001;24:49-57. [PMID: 11152650] CrossrefMedlineGoogle Scholar13. Benítez P, Alobid I, deHaro J, Berenguer J, Bernal-Sprekelsen M, Pujols L, et al. A short course of oral prednisone followed by intranasal budesonide is an effective treatment of severe nasal polyps. Laryngoscope. 2006;116:770-5. [PMID: 16652085] CrossrefMedlineGoogle Scholar14. Hissaria P, Smith W, Wormald PJ, Taylor J, Vadas M, Gillis D, et al. Short course of systemic corticosteroids in sinonasal polyposis: a double-blind, randomized, placebo-controlled trial with evaluation of outcome measures. J Allergy Clin Immunol. 2006;118:128-33. [PMID: 16815148] CrossrefMedlineGoogle Scholar15. Van Zele T, Gevaert P, Holtappels G, Beule A, Wormald PJ, Mayr S, et al. Oral steroids and doxycycline: two different approaches to treat nasal polyps. J Allergy Clin Immunol. 2010;125:1069-1076. [PMID: 20451040] CrossrefMedlineGoogle Scholar16. Alobid I, Benítez P, Bernal-Sprekelsen M, Roca J, Alonso J, Picado C, et al. Nasal polyposis and its impact on quality of life: comparison between the effects of medical and surgical treatments. Allergy. 2005;60:452-8. [PMID: 15727575] CrossrefMedlineGoogle Scholar17. Bonfils P, Halimi P, Malinvaud D. Adrenal suppression and osteoporosis after treatment of nasal polyposis. Acta Otolaryngol. 2006;126:1195-200. [PMID: 17050313] CrossrefMedlineGoogle Scholar18. Rajasekaran K, Seth R, Abelson A, Batra PS. Prevalence of metabolic bone disease among chronic rhinosinusitis patients treated with oral glucocorticoids. Am J Rhinol Allergy. 2010;24:215-9. [PMID: 20537290] CrossrefMedlineGoogle Scholar19. Vaidyanathan S, Barnes M, Williamson P, Hopkinson P, Donnan PT, Lipworth B. Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids. A randomized trial. Ann Intern Med. 2011;154:293-302. [PMID: 20537290] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Rhinology Unit and Smell Clinic, Hospital Clínic i Universitari, IDIBAPS, CIBERES, 08036 Barcelona, Spain.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0153.Corresponding Author: Joaquim Mullol, MD, PhD, Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic i Universitari, IDIBAPS, Villarroel 170, 08036 Barcelona, Catalonia, Spain; e-mail, [email protected]ub.es.Current Author Addresses: Ds. Mullol and Alobid: Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic i Universitari, IDIBAPS, Villarroel 170, 08036 Barcelona, Catalonia, Spain. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTreatment of Chronic Rhinosinusitis With Nasal Polyposis With Oral Steroids Followed by Topical Steroids Sriram Vaidyanathan , Martyn Barnes , Peter Williamson , Pippa Hopkinson , Peter T. Donnan , and Brian Lipworth Combined Oral and Intranasal Corticosteroid Therapy for Nasal Polyps Sriram Vaidyanathan , Martyn Barnes , Peter Williamson , Pippa Hopkinson , Peter T. 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Donnan, MD, and Brian Lipworth, MD 1 March 2011Volume 154, Issue 5Page: 365-367KeywordsAdverse eventsBoneBone densityCorticosteroid therapyPropionatesQuality of lifeSmellSteroid therapySteroidsSurgery ePublished: 1 March 2011 Issue Published: 1 March 2011 CopyrightCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...