xRead - Nasal Obstruction (September 2024) Full Articles

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International consensus statement on rhinosinusitis

number of preparations marketed over the counter in Europe, the position paper, based on the revised literature, stated that herbal medicines were not recommended for the treatment of CRSsNP (grade of evidence D) because of lack of reliable clinical trials and, in some cases, even unknown composition of the herbal medications. Since then, a growing amount of scientific evidence has suggested that herbal medicine may be helpful as an adju vant treatment in RS. One systematic review aimed to assess the effectiveness and safety of herbal preparations on CRS was published by Anushiravan in 2018. The initial search of the literature, up to August 2016, identified 936 publications, among which only 4 studies met the inclusion criteria (RCTs, placebo controlled, published in English): Of the 4 articles selected, 2 were conducted in Sri Lanka, 1 in Taiwan, and 1 in Iran, all performed between 2010 and 2016 and included 244 patients, age range 18-78 years. One study 1112 was double blinded and the rest were single-blinded. Different herbal preparation were used in 3 studies, Vazifehkah’s study used only 1 plant. Herbal preparations were administered either as decoction, capsules or nasal drops. A clinical improve ment in symptoms was reported in all 4 studies as mea sured by the SNOT 22 questionnaire or by subjectively reported improvement by the patients. However, because of the bias (lack of standard questionnaires; lack of diag nostic tools and lack of long-term follow-up), the review’s authors felt the effectiveness of medicinal plants in the treatment of CRS needs to be further proven in the future through additional studies. “Phytoneering” from “phyto-engineering” is a method for the extraction of the phytopharmaceuticals contained in herbs. The method uses 3 biochemical and analyti cal phases, allowing the optimization of the extracts and enhancing their pharmaceutical effects. Herbal products developed using phytoneering techniques have shown improvements in performance compared with previous formulations. 1212 BNO 1011 is a herbal compound con taining the active pharmaceutical ingredients gentian root (Gentianae radix), cowslip flowers with calyx (Primulae flos cum calycibus), sorrel (Rumicisherba), elderflower (Sambuciflos), and vervain (Verbenaeherba) at a ratio of 1:3:3:3:3. This extract has shown several pharmacody namic properties such as antiviral, antimicrobial, anti inflammatory and secretolytic effects in experimental animals. 915 It has also been found to be efficacious in reducing the symptoms of acute and recurrent RS in chil dren and the adult population in vivo , while demonstrat ing a high level of tolerability and safety. Concerning CRS, Cho 915 tested BNO 1011 extract in 30 New Zealand white rabbits after development of CRS. Treatment groups were oral placebo (n = 10), BNO 1011 (low dose 25 mg/kg/d) (n = 10), or BNO 1011 (high dose 125 mg/kg/d) (n = 10);

32% of experts use nasal decongestants forCRS. 6% use nasal decongestants for CRSwNP.

TABLE IX-38 Evidence for CRS management with decongestants Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Kirtsreesakul 1199 2016 2 Randomized control trial (n = 68) CRSwNP Nasal symptom score. Peak inspiratory flow index. Nasal MCC time. Total nasal polyps score. The use of nasal steroids with oxymetazoline was more effective over 6 weeks than nasal steroids. There was no evidence of rebound congestion after 4 weeks of oxymetazoline treatment. Passali 1198 2006 5 Survey CRSsNP CRSwNP

Kaszuba 1197 2006 5 Survey CRS 38% of respondents use topical decongestants for 1 week.

47% of respondents use oral decongestants for 2 weeks