Intranasal Corticosteroids: Understanding OTC OptionsManagement of symptoms associated with seasonal allergic rhinitis hay fever in children and adults over 5 years of age. Astelin Nasal Spray Website. For seasonal allergic rhinitis 0. Azelastine and Fluticasone Propionate. Nasal Antihistamine and Nasal Steroid. Intranasal corticosteroid list allergic intranasao hay fever ages 12 and over. Age 6 and older 2 sprays each nostril once a day.
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By continuing to browse this site you agree to us using cookies as described in About Cookies. This review is one of six looking at the primary medical management options for patients with chronic rhinosinusitis.
The condition can occur with or without nasal polyps. Topical intranasal corticosteroids are used with the aim of reducing inflammation in the sinonasal mucosa in order to improve patient symptoms. To assess the effects of different types of intranasal steroids in people with chronic rhinosinusitis. The date of the search was 11 August Randomised controlled trials RCTs with a follow-up period of at least three months comparing first-generation intranasal corticosteroids e.
We used the standard methodological procedures expected by Cochrane. Our primary outcomes were disease-specific health-related quality of life HRQL , patient-reported disease severity and the commonest adverse event - epistaxis nosebleed. Secondary outcomes included general HRQL, endoscopic nasal polyp score, computerised tomography CT scan score and the adverse event of local irritation.
We included nine RCTs participants , including four different comparisons. None of the studies evaluated our first primary outcome measure, disease-specific HRQL.
We identified two small studies 56 participants with polyps that evaluated disease severity and looked at the primary adverse effect: We cannot report any numerical data but the study authors reported no difference between the two steroids.
The evidence was of very low quality. We identified only one study participants with polyps that evaluated disease severity nasal symptoms scores , which reported no difference no numerical data available. We found low quality evidence relating to disease severity and nasal polyps size, with results from the high-dose and low-dose groups being similar.
Although all studies reported more improvement in polyp score in the high-dose group, the significance of this is unclear due to the small size of the improvements. The primary adverse effect, epistaxis , was more common when higher doses were used risk ratio RR 2.
Most of the studies that contributed data to this outcome used a broad definition of epistaxis, which ranged from frank bleeding to bloody nasal discharge to flecks of blood in the mucus. We identified only one poorly reported study unclear number of participants for comparison of interest, 91 between three treatment arms , in which there were significant baseline differences between the participants in the two groups.
We were unable to draw meaningful conclusions from the data. We found insufficient evidence to suggest that one type of intranasal steroid is more effective than another in patients with chronic rhinosinusitis, nor that the effectiveness of a spray differs from an aerosol. We identified no studies that compared drops with spray. It is unclear if higher doses result in better symptom improvements low quality evidence , but there was moderate quality evidence of an increased risk of epistaxis as an adverse effect of treatment when higher doses were used.
This included all levels of severity of epistaxis and it is likely that the proportion of events that required patients to discontinue usage is low due to the low numbers of withdrawals attributed to it. If epistaxis is limited to streaks of blood in the mucus it may be tolerated by the patient and it may be safe to continue treatment. However, it may be a factor that affects compliance. There is insufficient evidence to suggest that the different types of corticosteroid molecule or spray versus aerosol have different effects.
Lower doses have similar effectiveness but fewer side effects. Clearly more research in this area is needed, with specific attention given to trial design, disease-specific health-related quality of life outcomes and evaluation of longer-term outcomes and adverse effects.
Se incluyeron nueve ECA participantes , incluyendo cuatro comparaciones diferentes. Las pruebas fueron de muy baja calidad. No fue posible extraer conclusiones significativas a partir de los datos. No se identificaron estudios que compararan gotas con spray. Sin embargo, puede ser un factor que afecta el cumplimiento. Las dosis inferiores presentan una efectividad similar pero menos efectos secundarios. We reviewed the evidence for the benefits and harms of different types of intranasal in the nose steroids given to people with chronic rhinosinusitis.
Chronic rhinosinusitis is a common condition that is defined as inflammation of the nose and paranasal sinuses a group of air-filled spaces behind the nose, eyes and cheeks. Patients with chronic rhinosinusitis experience at least two or more of the following symptoms for at least 12 weeks: Some people will also have nasal polyps, which are grape-like swellings of the normal nasal lining inside the nasal passage and sinuses. Topical intranasal corticosteroids are used with the aim of reducing inflammation in order to improve patient symptoms.
We included nine randomised controlled trials RCTs with a total of participants in this review. The studies varied in size: Most studies recruited adult patients, but one study only included children. In all of the studies the participants had chronic rhinosinusitis with nasal polyps. The studies either compared different types of steroids three studies , high-dose versus low-dose steroids five studies , twice daily versus once daily steroids, or different delivery methods aqueous nasal spray versus aerosol - one study.
All of the studies had a placebo group. Two small studies 56 participants, unclear risk of bias evaluated disease severity and looked at the primary adverse effect, epistaxis nosebleed , but no other outcomes. No difference was found between the two steroids but we assessed the evidence to be of very low quality. One study participants, unclear risk of bias found no difference in disease severity nasal symptoms scores.
We assessed this evidence to be of very low quality. Effectiveness disease severity and nasal polyps size was similar between the high-dose and low-dose groups low quality evidence. Although all studies reported more improvement in polyp score in the high-dose group, the significance of this is unclear because the improvements seen were small. The primary adverse effect, epistaxis, was more common when higher doses were used moderate quality evidence. We identified only one poorly reported study with a high risk of bias.
It was unclear how many participants there were: There had also been significant differences between the participants in the two groups when they started the study.
We were unable to draw any meaningful conclusions from this study. We found no evidence that one type of intranasal steroid is more effective than another in patients with chronic rhinosinusitis, nor that higher doses are better than lower, nor that the effectiveness of a spray differs from an aerosol. We found no studies that compared nasal drops with spray. We did find moderate quality evidence of an increased risk of epistaxis nosebleed as an adverse effect of treatment when higher doses were used.
More research in this area is clearly needed. In the future studies should be well designed: Todos los estudios tuvieron un grupo de placebo. No se encontraron diferencias entre los dos corticosteroides aunque las pruebas se evaluaron como de muy baja calidad.
Estas pruebas se consideraron de muy baja calidad. No fue posible establecer conclusiones significativas a partir de este estudio. Se encontraron pruebas de calidad moderada de un riesgo mayor de epistaxis hemorragia nasal como un efecto adverso del tratamiento al administrar dosis mayores.
Lokalni intranazalni kortikosteroidi se koriste s ciljem smanjenja upale i simptoma pacijenata. Procijenili smo da su dokazi bili vrlo niske kvalitete. Nije bilo jasno koliko je imalo sudionika po skupinama; samo je navedeno da je 91 ispitanik razvrstan u tri skupine. We considered all studies to be at unclear to high risk of selective reporting and attrition bias. The evidence was very low quality due to very serious imprecision and very serious risk of bias concerns.
Study 1 fluticasone propionate versus beclomethasone dipropionate: Study 2 fluticasone propionate versus beclomethasone dipropionate: Study 3 fluticasone propionate versus mometasone furoate: Summary of findings 2 High-dose versus low-dose intranasal corticosteroids for chronic rhinosinusitis. There was a high risk of reporting bias. Studies tended to report enough information for meta-analysis only for statistically significant results.
One study, which had participants, reported very similar values for both intervention arms for all disease scores but had no information related to SD. We considered this to be indirectness of the evidence to patients without polyps but have not further downgraded the evidence. We downgraded this outcome once, after taking into consideration the inadequate blinding in one of the studies and the relatively small sample size. For analysis we only selected the most frequent types of local irritation from a list to avoid double counting.
This is a possible underestimation of overall event rates. The relatively low event rates and small sample size contributed to the large confidence intervals. The mean disease severity - overall symptoms, measured as average change from baseline at 4 months range 0 to 3 - average symptom score 3 domains without high-dose was.
The mean disease severity - overall symptoms, measured as average change from baseline at 4 months range 0 to 3 - average symptom score 2 domains without high-dose was. The mean disease severity - individual symptoms, measured as average change from baseline at 4 months range 0 to 3 - nasal blockage without high-dose was.
The mean disease severity - individual symptoms, measured as average change from baseline at 4 months range 0 to 3 - rhinorrhoea without high-dose was. The mean disease severity - individual symptoms, measured as average change from baseline at 4 months range 0 to 3 - loss of sense of smell without high-dose was.
Symptoms must have continued for at least 12 weeks. Symptoms, including nasal obstruction, nasal discharge, facial pain, anosmia and sleep disturbance, have a major impact on quality of life, reportedly greater in several domains of the SF than angina or chronic respiratory disease Gliklich Acute exacerbations, inadequate symptom control and respiratory disease exacerbation are common.
Complications are rare, but may include visual impairment and intracranial infection. Two major phenotypes of chronic rhinosinusitis have been identified based on the presence or absence of nasal polyps on examination. Nasal polyps are tumour-like hyperplastic swellings of the nasal mucosa, most commonly originating from within the ostiomeatal complex Larsen Chronic rhinosinusitis with nasal polyps CRSwNP is diagnosed when polyps are seen on direct or endoscopic examination bilaterally in the middle meatus.
Although the aetiology of chronic rhinosinusitis is not fully understood, it may involve abnormalities in the host response to irritants, commensal and pathogenic organisms and allergens, obstruction of sinus drainage pathways, abnormalities of normal mucociliary function, loss of the normal mucosal barrier or infection.