The Effect of Antileukotrienes on the Results of Postoperative Treatment of Paranasal Sinuses in Patients with Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease

Int Arch Allergy Immunol. 2019;179(4):281-289. doi: 10.1159/000499134. Epub 2019 May 15.

Abstract

Background: Based on endoscopic examination, chronic rhinosinusitis (CRS) is divided into chronic inflammation with (CRSwNP) or without nasal polyps (CRSsNP). On the basis of the pathomechanism of inflammation, CRS is divided into endotypes. Eosinophilic CRSwNP with coexisting bronchial asthma and hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is a real therapeutic challenge.

Aim: Comparative analysis of the results of treatment of patients with CRSwNP, bronchial asthma, or hypersensitivity to NSAIDs (NSAID-exacerbated respiratory disease, NERD), using antileukotrienes (leukotriene receptor antagonists, LTRAs) or intranasal glucocorticoids or both drugs together after endoscopic sinus surgery (ESS).

Material and methods: 33 patients (11 male, 33%) with NERD divided into three groups treated with LTRAs or intranasal glucocorticoids or both drugs together were assessed in terms of general well-being, state of pathological changes, and olfactory disorders using the following tools: Sino-Nasal Outcome Test, Visual Analogue Scale, Brief Identification Smell Test, and Lund-Kennedy score before and at 12 months after surgery. CT assessments were made prior to surgery using the Lund-MacKay scale.

Results: Comparable efficacy of treatment with nasal steroids and antileukotrienes was found after 12 months of observation of patients.

Conclusions: The results suggest comparable efficacy of treatment with nasal steroids and antileukotrienes in patients with NERD after ESS. Treatment with montelukast and mometasone has not been shown to be superior to both drugs administered separately.

Keywords: Antileukotrienes; Asthma; Endoscopic sinus surgery; Nasal glucocorticosteroids; Non-steroidal anti-inflammatory drug-exacerbated respiratory disease; Sinusitis.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Asthma, Aspirin-Induced / complications
  • Asthma, Aspirin-Induced / drug therapy*
  • Asthma, Aspirin-Induced / surgery
  • Chronic Disease
  • Female
  • Follow-Up Studies
  • Humans
  • Leukotriene Antagonists / therapeutic use*
  • Male
  • Middle Aged
  • Nasal Polyps / drug therapy*
  • Nasal Polyps / surgery
  • Paranasal Sinuses / drug effects*
  • Paranasal Sinuses / surgery
  • Postoperative Period
  • Rhinitis / drug therapy*
  • Rhinitis / surgery
  • Sinusitis / drug therapy*
  • Sinusitis / surgery
  • Steroids / therapeutic use
  • Treatment Outcome

Substances

  • Leukotriene Antagonists
  • Steroids