Topical corticosteroids in chronic rhinosinusitis: a randomized, double-blind, placebo-controlled trial using fluticasone propionate aqueous nasal spray

Chronic rhinosinusitis (CRS) is a recalcitrant inflammatory process which h as a mai ked detrimental impact on quality of life. At the present there is no cure for this condition, measures are taken to stop progression, and pr ovide symptomatic relief Topical corticosteroids are commonly prescribed in the management of CRS, but few trials show effectiveness in clinical setti ngs. We set up a randomized, double-blind, placebo-controlled trial to stud y the effectiveness of a topical coriticosteroid agent - fluticasone propio nate aqueous nasal spray (FPANS) in patients with CRS. We measured symptoms , diary card, and rigid endoscopy scores, acoustic Measurements were done a t the start of the trial, at 8 weeks, and 16 weeks where possible. Twenty-t wo patients completed the trial, 9 received FPANS, and 13 had placebo. Ther e was no difference between the 2 groups on all counts. When patients were considered as one group, there was an improvement in the diary card scores (p=0.054), comparing baseline to 8 or 16 weeks. There was no evidence that the regular use of topical corticosteroid increased the risk of developing an infection. An important observation was that the topical corticosteroid did not precipitate acute sinusitis. There is compelling evidence that topi cal corticosteroids down-regulate cytokine expression, and it is likely tha t a lame,; and longer multi-centre trial may prove their efficacy in CRS.