A recent study concluded that budesonide in saline nasal rinse results in improvement of chronic rhinosinusitis symptoms. The study was published in the Journal of the American Medical Association Otolaryngology-Head & Neck Surgery and was conducted by researchers at Washington University School of Medicine in St. Louis, Missouri. The researchers wanted to learn what the effect would be of adding budesonide to a large-volume, low-pressure saline sinus irrigation for patients suffering with chronic rhinosinusitis (CRS).

What is Rhinosinusitis?

Rhinosinusitis is one of the most frequent complaints reported to family physicians. It involves inflammation of the sinuses and nasal passages, mucus buildup and congestion, facial pain, loss of smell, and more.  Most cases are acute and can be managed effectively with hydration, nasal cleansing, and antibiotics. However, some individuals will experience chronic rhinosinusitis, which is when symptoms last for more than 12 weeks despite attempts at treatment.

What is Budesonide?

Budesonide is a corticosteroid that is the active ingredient in the brand-name inhaler product Pulmicort. It is available in multiple forms including inhalers, pills, and rectal suppositories. It has been used in different forms for decades to treat a variety of conditions including asthma, COPD, rhinosinusitis, Crohn’s disease, ulcerative colitis, and more. For treating a condition like asthma, it must be used on a daily basis and can not be used “as-needed” for an asthma attack.  Nasal sprays are sometimes used to treat allergy symptoms and must be used in a similar way. Some patients may find relief within a day or two but others will need to continue using the spray for up to two weeks before noticing results.

How the Study Was Conducted

The participants in the Washington University study included 80 adult patients with CRS. They were each given a sinus rinse kit with saline and either budesonide or lactose capsules for the control group. Both capsules were identical so the participants did not know if they were being treated with a medication. The capsules were dissolved in the saline and the solution was used to irrigate the nasal passages. The treatment for both groups was used once daily for 30 days.

Sino-Nasal Outcome Test (SNOT-22)

The Sino-Nasal Outcome Test (SNOT-22) was used in the study. The SNOT-22 is a list of questions related to symptoms of a nasal disorder. The test asks the patient to rate symptoms on a scale from 0-5, with 0 representing no problem and 5 representing the most severe problem. The list has 22 symptoms that the patient rates. These symptoms range from “need to blow nose” and “loss of smell or taste” to symptoms like fatigue, frustration, and concentration. After a patient rates each symptom, the results are added up to get a SNOT-22 score.

In the Washington University study, the average change in SNOT-22 scores for the budesonide group was 20.7 points and for the lactose group was 13.6 points. These results clearly show that budesonide added to a saline rinse helps patients with chronic rhinosinusitis.

Compounded Budesonide Nasal Rinse

Our compounding pharmacy makes budesonide for use with a nasal rinse or atomizer device. We are able to make a variety of dosages depending on the patient’s needs. For more information on compounded budesonide for intranasal use, please call the pharmacy at (805) 497-8258.

Research

• Effect of Budesonide Added to Large-Volume, Low-pressure Saline Sinus Irrigation for Chronic Rhinosinusitis: A Randomized Clinical Trial – JAMA Otolaryngology-Head & Neck Surgery