The Effect of Nasally Administered Budesonide Respules on Adrenal Cortex Function in Patients With Chronic Rhinosinusitis

Objectives: To evaluate whether nasal administration of budesonide in adults with chronic rhinosinusitis for 30 days suppresses adrenal function and to assess its clinical efficacy. Design: An open-label prospective study. Setting: Academic medical center. Patients: We assessed adrenal function in 9 patients using the cosyntropin test before and after budesonide therapy. Intervention: Budesonide respule therapy. Main Outcome Measure: Scores from the Sino-Nasal Outcome Test-20 (SNOT-20), a tool for assessing rhinosinusitis health and quality of life, were used to assess efficacy of budesonide treatment. Results: All of our patients showed adequate adrenal response to cosyntropin stimulation before and after the budesonide trial. The mean difference in SNOT-20 scores was -1 95% confidence interval, -1.77 to -0.23; (P = .02), indicating clinically significant improvement after therapy. Conclusion: Our findings suggest that using budesonide nasal wash may be clinically effective in decreasing the symptoms of chronic rhinosinusitis and does so without suppression of the hypothalamic-pituitary-adrenal axis in patients with chronic rhinosinusitis.