Avamys Dosing and Duration for Chronic Sinusitis with Turbinate Hypertrophy
For chronic sinusitis with turbinate hypertrophy in adults, use Avamys (fluticasone furoate) 110 mcg (2 sprays) per nostril once daily for a minimum of 12 weeks, with consideration for long-term maintenance therapy given the chronic nature of the condition. 1, 2
Standard Dosing Regimen
- Adults and adolescents ≥12 years: 110 mcg once daily (2 sprays per nostril, total 110 mcg/day) 1, 3
- Children 2-11 years: 55 mcg once daily (1 spray per nostril) 3, 4
- For severe symptoms initially unresponsive to standard dosing, consider 110 mcg twice daily (220 mcg/day total) for the first 2-4 weeks, then reduce to maintenance dosing once symptoms are controlled 1, 5
Treatment Duration
- Minimum duration: 12 weeks for chronic rhinosinusitis to allow adequate time for mucosal healing and turbinate size reduction 1, 2
- Objective CT evidence demonstrates significant reduction in turbinate mucosal area and thickness requires 3 months of continuous therapy 2
- Long-term daily maintenance therapy is safe and appropriate for chronic conditions, as intranasal corticosteroids do not cause rebound congestion 6
- Studies demonstrate safety with continuous use up to 52 weeks without hypothalamic-pituitary-adrenal axis suppression 7, 8
Evidence Supporting This Approach
The European Position Paper on Rhinosinusitis demonstrates that fluticasone furoate nasal spray produces significant improvements in nasal obstruction, rhinorrhea, and postnasal drip in chronic rhinosinusitis patients, with maximal efficacy reached over several weeks 1. For turbinate hypertrophy specifically, CT-documented evidence shows fluticasone propionate (the predecessor molecule to fluticasone furoate) produces statistically significant reductions in turbinate mucosal area and nasal mucosa thickness after 3 months of continuous therapy 2.
Fluticasone furoate has the highest glucocorticoid receptor affinity and longest tissue retention of available intranasal steroids, providing potent and prolonged anti-inflammatory activity 3, 4. This enhanced pharmacology makes it particularly suitable for chronic inflammatory conditions like turbinate hypertrophy.
Administration Technique to Maximize Efficacy
- Use the contralateral hand technique: hold the spray bottle in the opposite hand relative to the nostril being treated 6
- Aim slightly away from the nasal septum to reduce epistaxis risk by four-fold 6
- Do not close the opposite nostril during administration 6
- Regular daily use rather than as-needed dosing is essential for chronic conditions 6
Timeline for Symptom Relief
- Onset of action begins approximately 12-24 hours after first dose 1, 8
- Maximal efficacy for turbinate reduction requires days to weeks of continuous therapy 7, 2
- Objective turbinate size reduction on CT imaging becomes evident after 3 months 2
Safety Profile
- Common adverse events include headache, epistaxis, nasal burning/irritation, and pharyngitis—all generally mild 1, 3
- No suppression of hypothalamic-pituitary-adrenal axis at recommended doses, even with continuous use up to 52 weeks 7, 8
- Systemic bioavailability <1% after intranasal administration, making systemic side effects unlikely even at double the usual dose 5
- Safe for long-term use in chronic conditions 1, 6
Clinical Pitfalls to Avoid
- Do not discontinue prematurely: Many patients discontinue therapy before 12 weeks, preventing adequate mucosal healing and turbinate reduction 1, 2
- Do not use intermittently: Chronic conditions require daily maintenance therapy, not as-needed dosing 6
- Do not confuse with acute sinusitis: The evidence for intranasal corticosteroids in acute post-viral rhinosinusitis shows only modest benefit (number needed to treat of 14), whereas chronic rhinosinusitis with turbinate hypertrophy requires prolonged therapy 1