Nasal Steroids for AERD (Samter's Triad)

Types of Nasal Steroids

Sprays

 

These are the most commonly prescribed nasal steroids. This is probably one of the first things you'll be prescribed when you're diagnosed with AERD (Samter's Triad). These include the popular brand names Rhinocort, Flonase, and Nasonex, but there are many others. There are also nose sprays which contain an antihistamine in addition to a steroid, such as Dymista. There is no single nose spray that works best.  

For most Aspirin Exacerbated Respiratory Disease (AERD, Samter's Triad) patients, traditional nasal spays are not enough to control the symptoms of nasal polyps. Many patients have significant sinus blockage, which prevents these medications from penetrating deeply into the sinuses. If you're not getting the relief you need from these sprays, you may want to consider the alternatives below.

Enhanced Nasal Sprays

Qnasl is a once-daily nasal spray that uses an aerosol propellant. The aerosol may allow the medication to penetrate deeper into the sinuses and prevents it from running down the throat or dripping out of the nose. 

XHANCE is a nasal spray that has a mouthpiece as well as a nosepiece. It is designed to use your breath to help deliver medicine high and deep into the nasal passages. XHANCE is approved by the FDA specifically for the treatment of nasal polyps.

Both of these medications are more expensive than traditional nasal sprays and only available by prescription. 

Using Budesonide (Slideshow)

On mobile, click slideshow to open with text.

Budesonide Respules (Pulmicort Respules)

Budesonide (Pulmicort) respules are capsules of steroid medication that be added to a sinus rinse bottle or used undiluted to soak the nasal polyps. Rinsing and/or soaking with budesonide respules has provided relief to many AERD (Samter's Triad) patients. This treatment is generally more effective than sprays at reducing the symptoms of nasal polyps, such as facial pain and nasal obstruction. A 2009 study found that rinsing with budesonide is an effective treatment for nasal polyps. Five of the 8 patients in this study had improvement, with several experiencing a complete regression of nasal polyps.

Budesonide respules come in several different strengths: 0.25mg, 0.5mg, and 1mg (per 2ml of solution). Respules can be added to a saline rinse, or used undiluted to soak the nasal polyps. The minimum effective dose should be used. Research has found that doses of up to 1mg per day produced no adverse effects after two months of use.

You will need to get a prescription for budesonide (Pulmicort) respules. Sinus rinses are typically only prescribed by ENTs. Keep in mind that sinus rinsing and/or soaking is an off-label use of budesonide (Pulmicort) respules, which are designed for use with an asthma nebulizer. This medication is not available in every country. In some countries, a similar medication called Flixonase Nasule Drops is available. Flixonase can be used in the same ways as budesonide - either adding it to a rinse bottle or soaking with it directly. Most often, budesonide respules are added to a sinus rinse, but they can also be administered using a nasal nebulizer such as a Nasoneb device. 

Budesonide Respules (Pulmicort)
Flixonase Nasule Drops

 

Using Budesonide Respules in a Rinse

1. Make your sinus rinse as you normally would. Visit our page on sinus irrigation for more information on proper irrigation techniques.

2. Add the budesonide respules. One or more respules may be used depending on the recommendation of your doctor. A standard dose is one 0.5mg respule per 250ml saline (standard rinse bottle).

3. Shake the solution and irrigate your sinuses as you normally would. 

Read Stanford University's Guide 

Using Budesonide Respules in a Soak

Your doctor may recommend that you use budesonide respules (or another steroid medication) to soak the nasal polyps. The best positions to do this in are shown below. These positions allow the medication to better penetrate every sinus cavity. This does take some getting used to and may require some trial and error on your part. However, many AERD patients report that a concentrated soak is effective at reducing nasal polyp symptoms and improving sense of smell. Below, you can read the instructions for this provided by Brigham & Women's AERD Center.

Print the sinus soaking guide from Brigham & Women's AERD Center.

Join the Facebook Samter's Society Support Group to talk to other patients about their experience using sinus rinses and soaks. Talking to others who've used these methods can be helpful.

Intrapolyp Injections

An ENT can inject steroid medications directly into the nasal polyps. Research has shown that this method of treatment is about as effective as a burst of oral steroids. Though it sounds unpleasant, these injections are generally well-tolerated. Nasal polyps do not have pain receptors, (which is perhaps the only good thing about them). Intrapolyp injections may improve symptoms for days to weeks, depending on the patient. This treatment may have fewer systemic side effects than a burst of oral steroids, since it is applied locally.