From the Guidelines
Topical corticosteroid sprays are the first-line treatment for reducing inflammation in nasal polyps, with fluticasone propionate (Flonase) 1-2 sprays per nostril daily or mometasone furoate (Nasonex) 2 sprays per nostril daily being recommended options, as supported by the most recent and highest quality study 1. The use of topical corticosteroids for nasal polyps is well-established, with a strong evidence base demonstrating their effectiveness in reducing symptoms and improving quality of life 1.
- Key benefits of topical corticosteroids include:
- Reducing inflammation by suppressing inflammatory cell recruitment, decreasing cytokine production, and inhibiting inflammatory mediators
- Shrinking polyps and improving nasal breathing
- Minimizing adverse events, which are generally minor and may include epistaxis, headache, and nasal itching
- Proper administration technique is crucial, and patients should be instructed to:
- Shake the bottle before use
- Keep their head upright during application
- Direct the spray away from the septum
- Breathe in gently during application
- For severe cases, a short course of oral steroids like prednisone (20-40mg daily for 5-7 days) may be prescribed initially to reduce polyp size before starting topical therapy, as suggested by 1.
- Saline nasal irrigation twice daily before using the steroid spray can improve medication delivery, as noted in 1.
- If symptoms persist after 3 months of consistent use, consulting a doctor for consideration of biologics like dupilumab may be necessary for refractory cases.
From the FDA Drug Label
Corticosteroids are natural substances found in the body that help fight inflammation. Fluticasone propionate is a synthetic, trifluorinated corticosteroid with anti-inflammatory activity. Corticosteroids have been shown to have a wide range of effects on multiple cell types (e.g., mast cells, eosinophils, neutrophils, macrophages, and lymphocytes) and mediators (e.g., histamine, eicosanoids, leukotrienes, and cytokines) involved in inflammation.
The fluticasone propionate nasal spray can be used as an inflammation-reducing topical application in patients with nasal polyps, as it has anti-inflammatory activity.
- The spray works by reducing the symptoms of allergic reactions and the stuffiness, runniness, itching, and sneezing that can bother patients with rhinitis.
- Fluticasone propionate has been shown to decrease nasal mucosal eosinophils and basophils in patients with allergic rhinitis 2, 2.
- It is essential to use the spray as directed by a doctor and follow the instructions provided with the medication.
From the Research
Inflammation Reducing Topical Applications in Nasal Polyp Treatment
- Topical corticosteroids have been shown to be effective in reducing inflammation and polyp size in patients with nasal polyps 3, 4, 5.
- The mechanism of action of corticosteroids involves binding to a specific cytoplasmic glucocorticoid receptor, leading to a reduction in the number of antigen-presenting cells, T cells, mast cells, and eosinophils 3.
- Topical corticosteroids such as betamethasone sodium phosphate nose drops, beclomethasone dipropionate, fluticasone propionate, and budesonide nasal sprays have been demonstrated to be effective in reducing polyp size and rhinitis symptoms 3, 5.
- Beclomethasone dipropionate, flunisolide, and budesonide sprays have also been shown to delay the recurrence of polyps after surgery 3, 5.
Benefits of Topical Corticosteroids
- Topical corticosteroids improve overall symptom scores and reduce polyp size 4.
- They also prevent polyp recurrence after surgery 4.
- Subgroup analyses have shown that patients who have undergone sinus surgery may have a greater response to topical corticosteroids 4.
- Topical corticosteroids are generally well-tolerated, with minor adverse effects 4, 6.
Current Recommendations
- Intranasal saline irrigations and topical steroids are mainstays of CRSwNP treatment 6.
- Alternative steroid delivery methods and adjunctive treatments may be beneficial for certain patient populations, but more research is needed to confirm their effectiveness 6.
- Topical steroid therapy is clearly effective for CRSwNP, and recent studies demonstrate the safety and efficacy of high-dose nasal steroid rinses 6.