The British analysis of six prior studies
found that the sprays confer only a small degree of benefit, and only after
being taken for three weeks at relatively high doses.
The
disappointing observation comes amid growing public health concerns that the
more common use of antibiotics for short-term sinusitis symptoms is both
ineffective and potentially dangerous because the drugs contribute to bacterial resistance.
"Looking
at all the trials together, we found that nasal steroids seem to give a small
benefit for patients with acute sinusitis," said study co-author Matthew
Thompson, a senior clinical scientist in the department of primary care health
sciences at the University of Oxford, in England. "In fact, they work
about as well as antibiotics do."
"When
we compared patients who were given steroid nasal spray with those who were
given an [inactive] spray, we found that patients given the steroid spray got
better faster," he added. "However, although we see this effect after
taking the spray for 14 days, the big difference only occurs at 21 days. We
also found that a larger dose of the nasal steroids worked better than a lower
dose."
Thompson
and his colleagues discuss their observations in the May/June issue of the
journal Annals of
Family Medicine.
Although
chronic sinusitis cases (driven by fungal exposure, bacterial infection,
or anatomical complications such as polyps or a deviated nasal septum) can endure
well beyond the three-month mark, short-term (acute) sinusitis typically lasts
just a few weeks.
Thompson
pointed out, however, that such acute cases (typified by cold-like symptoms
such as a congested or runny
nose, accompanied by face pain) send about 31 million Americans to the
doctor every year.
Although
the condition usually resolves itself without serious complications, doctors
have few tools to address the pain and misery that can afflict patients while
the sinusitis runs its course.
Antibiotics
are the standard first-line treatment, given to almost 90 percent of patients.
But the study authors pointed out that only one in 15 patients seem to get any
benefit from the approach.
On the
other hand, steroid sprays have been cited as helpful in the treatment of a
range of respiratory illnesses among both children and adults.
Enter
the Oxford team, which set out to analyze the findings of six acute sinusitis
studies conducted through early 2011 in the United States, the United Kingdom
and Turkey.
In all,
the studies involved nearly 2,500 acute sinusitis patients, both children and
adults. No chronic sinusitis patients were included, and all studies explored
the potential benefit of three types of corticosteroid nasal sprays: budesonide
(Rhinocort), fluticasone propionate (Flonase, Flovent) and mometasone furoate
(Nasonex). In five of the studies, antibiotics also were prescribed.
The
bottom-line: The analysis revealed that the nasal sprays appeared to provide a
"small but significant benefit" within two to three weeks of
treatment.
Facial
pain and nasal congestion were the two symptoms cited as being most responsive
to spray treatment. And, in that respect, more was more: Higher doses and
longer treatment plans (those lasting three weeks) seemed to provide the
greatest relief.
The
team was somewhat tepid on the degree of benefit, however, noting that
two-thirds of the patients saw their symptoms improve or disappear altogether
within two to three weeks after taking "dummy" sprays with no
corticosteroid in them. Taking the actual nasal spray appeared to help only 7
percent more patients, the researchers noted.
Thompson
said the findings suggest that, although nasal sprays are "not a game
changer," they may offer a treatment alternative.
But Dr.
John Hickner, chairman of the department of family medicine at the Cleveland
Clinic Lerner College of Medicine at Case Western Reserve University School of
Medicine in Cleveland, was not impressed.
In an
editorial accompanying the study, Hickner said such sprays are of "minimal
value" for sinusitis patients.
"Nasal steroids are
great for nasal allergies," he noted. "For hay fever, for example,
but not for acute sinusitis. The study of previous studies shows that they work
a little but not that much and not right away, which is what patients want. And
they cost about $60 for a bottle, so you just don't get a lot of bang for your
buck."
"I
would say the best thing for these patients to do is to
take zinc," Hickner said. "Zinc studies are pretty reliable, and they
suggest that taking zinc lozenges for five days might reduce symptoms for one
to two days, and they might not get so severe. And perhaps take some ibuprofen
and Sudafed (pseudoephedrine) as a decongestant. All of that is much cheaper
and probably just as effective."
More
information: For
more on sinusitis, visit the U.S. National Library of Medicine.
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© 2012 HealthDay. All rights reserved.
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