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Neil S. Sachanandani, BS; Jay F. Piccirillo, MD; Maggie A. Kramper, RN, CNS, COR; Stanley E. Thawley, MD; Anna Vlahiotis, MA

Arch Otolaryngol Head Neck Surg. 2009;135(3):303-307.

Objectives  To evaluate whether nasal administration of budesonide in adults with chronic rhinosinusitis for 30 days suppresses adrenal function and to assess its clinical efficacy.

Design  An open-label prospective study.

Setting  Academic medical center.

Patients  We assessed adrenal function in 9 patients using the cosyntropin test before and after budesonide therapy.

Intervention  Budesonide respule therapy.

Main Outcome Measure  Scores from the Sino-Nasal Outcome Test–20 (SNOT-20), a tool for assessing rhinosinusitis health and quality of life, were used to assess efficacy of budesonide treatment.

Results  All of our patients showed adequate adrenal response to cosyntropin stimulation before and after the budesonide trial. The mean difference in SNOT-20 scores was –1 (95% confidence interval, –1.77 to –0.23; P = .02), indicating clinically significant improvement after therapy.

Conclusion  Our findings suggest that using budesonide nasal wash may be clinically effective in decreasing the symptoms of chronic rhinosinusitis and does so without suppression of the hypothalamic-pituitary-adrenal axis in patients with chronic rhinosinusitis.

Author Affiliations: Division of Clinical Outcomes Research, Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri.

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