Large Particle Nebulized Saline Improves Symptoms of Chronic Nasal Obstruction

Emma Hitt, PhD

March 10, 2003

March 10, 2003 (Denver) — Eight weeks of twice-daily treatment with large-particle nebulized saline (LPNS) appears to improve chronic nasal obstruction in patients dissatisfied with previous therapy, new research suggests.

Dr. Martin Desrosiers with the Centre Hospitalier of Universite de Montreal, Canada, and colleagues presented their findings here at the 60th meeting of the American Academy of Allergy, Asthma, and Immunology on Saturday.

Saline irrigation of the nasal passages is indicated for nasal obstruction, but its efficacy has not been evaluated prospectively. Previous research suggests that LPNS improves nasal obstruction and quality of life in patients with refractory sinus disease.

In the current study, the researchers evaluated the efficacy of LPNS on chronic nasal obstruction in 59 adult subjects with at least moderate chronic nasal obstruction. Patients were all dissatisfied with previous treatments.

LPNS was delivered through the RinoFlow Nasal Wash and Sinus System (Respironics HealthScan, Inc.) for eight weeks, and patients were then observed for an additional four weeks.

At weeks 2, 4, and 8 during treatment and at 4 weeks' posttherapy, symptoms of nasal obstruction, pain and postnasal drip were assessed using a visual analogue scale from 0 to 100, and quality of life was evaluated using the Sino-Nasal Outcome Test (SNOT-16). Congestion and secretions were evaluated on a scale of 0 to 3.

Eight weeks of treatment appeared to be well tolerated, the researchers report. All parameters measured improved progressively with treatment. Specifically, from week 0 to week 8, obstruction decreased from 62 to 36, pain decreased from 23 to 16, and postnasal drip decreased from 42 to 28. In addition, SNOT-16 scores decreased from 18.5 to 11.3, congestion decreased from 1.82 to 1.32, and secretions decreased from 1.06 to 0.78.

"Decrease in obstruction appeared to be progressive from the beginning to the end of the study, suggesting that improvement is due to the LPNS rather than just an effect of patients receiving some type of treatment," Dr. Desrosiers said.

"LPNS may...offer an alternative, non-pharmacological therapy for chronic nasal obstruction," the researchers conclude in their presentation abstract.

"All subgroups of patients responded to this therapy," Dr. Desrosiers told Medscape, "but those that responded the best were those who had the longest duration of symptoms, which was surprising."

According to Dr. Desrosiers, it is unclear why simple nebulizing solution has such an effect, which "was similar to what you would expect with a topical corticosteroid and certainly more than you'd expect with any of the other oral type agent," he said.

"We suspect that it's not just that the treatment hydrates the mucosa and improves mucosal flow — it probably affects inflammation somehow," he said.

Dr. Desrosiers speculated the treatment might decrease the load of bacteria that mediate the pathogenesis of rhinitis.

Soheil Chegini, MD, an allergist with the Allina Medical Clinic in Cokato, Minnesota, commented that nebulized saline alone is likely to be effective for respiratory problems. Dr. Chegini was not involved in the study.

"I use nasal lavage for my patients, and I am convinced that there is no difference between saline, albuterol, and racemic epinephrine, because it's the saline vehicle that loosens the mucus," he told Medscape.

However, Dr. Chegini pointed out that he is not convinced that the nebulizing spray works better than nasal lavage, although he conceded that "patients may prefer using nebulized saline to nasal lavage and therefore be more adherent to therapy," he said.

The study was funded by Respironics-Healthscan Inc.

AAAAI 60th Annual Meeting: Abstract 23. Presented March 8, 2003.

Reviewed by Gary D. Vogin, MD

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