Objective To evaluate the safety of intranasal use of beclomethasone dipropionate, budesonide, fluticasone propionate and mometasone for adults and children with chronic sinusitis/nasal polyps and allergic rhinitis. Methods Randomized controlled trials were located. Study quality was evaluated by two researchers independently. RevMan 4.2 was used for meta-analysis. Results Seven RCTs involving 826 patients were included. Compared with placebo, local use of fluticasone proprionate in adults showed no statistically significant trend to increase incidence of acute sinusitis (OR 16.87, 95% CI 0.87 to 301.62), but no significant difference was seen for epistaxis (OR 7.76, 95% CI 0.38 to 157.14): 1 trial, 60 patients. In another trial, no cases of nasal atrophy were reported in either fluticasone or placebo groups. No significant differences were seen between local use ofbudesonide and placebo in adults for dryness of nasal mucosa (OR 3.38, 95%CI 0.66 to 17.18) and epistaxis (OR 2.20, 95%CI 0.39 to 12.32): 1 trial, 193 participantions. No significant difference was seen between budesonide and pollinex for headache (OR 1.71, 95%CI 0.52 to 5.62). No differences were seen between placebo and fluticasone propionate in children for epistaxis (OR 0.85, 95%CI 0.20 to 3.66), headache (OR 0.25, 95%CI 0.02 to 2.83), plasma cortisol concentration (OR 1.56, 95%CI 0.06 to 38.69) and dryness of nasal mucosa (OR 4.76, 95%CI 0.25 to 89.54). Beclomethasone dipropionate in children showed no statistical differences for dryness of nasal mucosa (OR 0.51, 95%CI 0.14 to 1.87), epistaxis (OR 0.68, 95%CI 0.26 to 1.73) and rhinitis (OR 0.47, 95%CI 0.04 to 5.36). No decrease of plasma cortisol concentration was detected in either group. Mometasone and placebo showed no significant differences in children for epistaxis (OR 1.57, 95%CI 0.41 to 5.95), rhinitis (OR 0.33, 95%CI 0.01 to 8.22) or headache (OR 0.33, 95%CI 0.01 to 8.22). Decrease of plasma cortisol concentration was not detected. Conclusions According to this systematic review, long term intranasal use of steroid for adults and children may be safe based on the two high quality, four moderate quality trials and one with b bias. High quality studies with larger sample sizes and in other languages are needed to provide ber evidence.
Objective To study the effect of Bi Yuan Shu Liquid on melioration of clinical symptoms and signs of chronic nasal sinusitis or nasal polyp patients after Functional Endosoopic Sinus Surgery (FESS), and discuss the effectiveness of Chinese composite medicine in the overall treatment after FESS. Methods A total of 340 patients were randomly allocated to treatment group (n =170) and control group (n =170) according to simple randomization procedure. Patients in treatment group were administrated with quinolone, steroid, and Bi Yuan Shu Liquid, which were compared with those in control group who were given quinolone and steroid. Results The apparent effect of treatment group and control group were 30.6% and 42.4% of 42.4% of ITT. Results by Wilcoxon signed rank test indicated that there was a statistically significant difference. Conclusions Bi Yuan Shu Liquid may improve the effectiveness of sinus surgery, reduce the time course of antibiotics and hormones, and with out toxicity and side-effect.
Since the launch of anti-interleukin 5 monoclonal antibodies (anti-IL-5 mAbs), they have been widely used in various disease fields. The classic indications include severe eosinophilic asthma (SEA), chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic granulomatosis with polyangiitis (EGPA), hypereosinophilic syndrome (HES), and chronic obstructive pulmonary disease (COPD). Moreover, there is evidence suggesting that anti-IL-5 mAbs can also be used in the treatment of allergic bronchopulmonary aspergillosis (ABPA) and other uncommon eosinophil (EOS)-related diseases. To standardize the clinical application of anti-IL-5 mAbs by clinicians, the expert group formulated a consensus by extensive review of high-quality clinical research data and authoritative guideline documents. The consensus paper was written based on the current best clinical evidence and Chinese clinical practice experience, aiming to provide authoritative reference and practical guidance for clinical colleagues in the standardized clinical use of anti-IL-5 mAbs. The content of this consensus covers the mechanism of anti-IL-5 mAbs, dosing regimens for different diseases, management strategies, etc. It emphasizes the importance of individualized diagnosis and treatment guided by biomarkers, long-term standardized follow-up, and multidisciplinary team collaboration.