Treatment with intranasal furosemide – new clinical application of popular diuretic

Chronic rhinosinusitis with nasal polyps (CRSwNP) represents growing health problem in developed countries. Recent study reviled that topical furosemide is beneficial treatment for CRSwNP, reducing the recurrence of polyps after endoscopic sinus surgery. However, the optimal dosage and treatment duration has not been established and require further investigation. The article was published in JAMA Otolaryngology–Head & Neck Surgery.


Chronic rhinosinusitis (CRS) is defined as a group of multifactorial diseases characterized by inflammation of the mucosa of the nose and paranasal sinuses with a history of at least 12 weeks of persistent symptoms despite maximal medical therapy. CRSwNP, due to high recurrence rate of the disease, often requires combining multiple medications including topical nasal steroids and/or oral steroids or even surgical treatment in advanced cases. Functional endoscopic sinus surgery (FESS) is now a well-established strategy for the treatment of CRSwNP which has not responded to medical treatment.

Although beneficial, long-term topical steroid administration carries risk of potential side effects. Many current studies amid to find new, effective and safe pharmacological compounds which might be use in CRS treatment. The article published recently in JAMA Otolaryngology–Head & Neck Surgery has taken up this subject. It shoves the result of Iranian research study, which assess the effect of topical furosemide on recurrence rate of rhinosinusal polyposis after endoscopic sinus surgery.

Scientists conducted triple-blind randomized clinical trial enrolling 110 patients aged 18 to 60 years who undergo endoscopic sinus surgery due to CRSwNP. Patients were randomly assigned to receive postoperative nasal spray, 2 puffs twice a day for 2 months, either 300 µg of furosemide per day or placebo. Six months following FESS, the patients were examined in order to asses relapse of nasal polyposis using Meltzer endoscopic grading, computed tomographic (CT) scan of paranasal sinuses (PNS) scoring, Sino-Nasal Outcome Test (SNOT-22) scoring, and visual analog scale (VAS).

Among patients treated with topical furosemide the severity of polyposis was lower than in placebo group based on Meltzer scale and SNOT-22 scoring. Another reveal was that furosemide intranasal administration negatively correlated with pain accompanying CRSwPN measured with VAS. Moreover, no significant differences were observed based on CT scan of PNS scoring in the furosemide group vs the placebo group. The incidence of adverse effects (nasal irritation, headache, and constipation) occurred in both groups regardless of topical substance (furosemide or placebo).

According to authors, furosemide – widely known as hypotnensive drug, can substantially reduce the severity of polyposis after endoscopic sinus surgery in patients suffering from CRSwNP. Due to relatively low costs and clinical safety with no coexisting important adverse effects, when administered topically, furosemide is an interesting alternative for current intranasal treatment of CRSwNP. However, further studies are required in order to asses optimal dosage and duration of furosemide therapy.

Written by: Justyna Markowicz-Roman, Tomasz Roman, Katarzyna Hać

Source:
1. Hashemian F, Ghorbanian MA, Hashemian F, Mortazavi SA, Sheikhi M, Jahanshahi J, Poorolajal J. Effect of Topical Furosemide on Rhinosinusal Polyposis Relapse After Endoscopic Sinus Surgery: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2016 Jul 14.
2. http://magazynorl.pl/wp-content/uploads/2013/05/2013_04-06-magazynorl.pdf
3. Kalish L, Snidvongs K, Sivasubramaniam R, Cope D, Harvey RJ. Topical steroids for nasal polyps. Cochrane Database Syst Rev. 2012 Dec 12;12:CD006549.


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