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Compared with placebo/no intervention or other pharmacological interventions (intranasal corticosteroids), how effective are short-course oral steroids for chronic rhinosinusitis?
There was an improvement in disease-specific, health-related quality of life and symptom severity at the end of the treatment course (2–3 weeks) in patients with chronic rhinosinusitis with nasal polyps taking oral corticosteroids, compared with placebo or no treatment. The quality of the evidence supporting this finding was low. At 3–6 months after the end of the oral steroid treatment period, there was little or no improvement in health-related quality of life or symptom severity for patients taking an initial course of oral steroids, compared with placebo or no treatment. There was an increase in adverse events in people receiving orals steroids, compared with placebo for gastrointestinal disturbances and insomnia, but no significant impact on mood.
All of the included studies only included adults with nasal polyps. No studies reported generic health-related quality of life or CT scan score as outcomes. The doses of oral steroids used in the trials differed (20–60mg/day prednisone-equivalent), and the information on adverse events was incomplete. Other methodological limitations included length of follow-up, validation of outcome instruments and the small size of the studies.
Chronic rhinosinusitis is a common condition involving inflammation of the lining of the nose and paranasal sinuses. It is characterised by nasal blockage and nasal discharge, facial pressure/pain and loss of sense of smell. The condition can occur with or without nasal polyps. Oral corticosteroids are used to control the inflammatory response and improve symptoms.
Head K et al. Short-course oral steroids alone for chronic rhinosinusitis. Cochrane Reviews, 2016, Issue 4. Art. No.: CD011991.DOI: 10.1002/14651858. CD011991.pub2. This review contains 8 studies involving 474 participants.
Pharmacist prescribers Linda Bryant and Leanne Te Karu discuss positive polypharmacy for heart failure. Current evidence shows the intensive implementation of four medications offers the greatest benefit to most patients with heart failure, with significant reductions in cardiovascular mortality, heart failure hospitalisations and all-cause mortality
