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Using Budesonide Respules for AERD (Samter's Triad)

Updated: Oct 15, 2018

Nasal polyps make AERD patients miserable. One of the most helpful treatments (besides surgery or aspirin desensitization) is rinsing or soaking with budesonide respules. Many AERD (Samter's Triad) patients already use budesonide rinses, but if you're suffering with sinus symptoms and haven't given it a try yet - this guide is for you.



What are Budesonide (Pulmicort) Respules?

Budesonide respules are capsules of steroid medication that be added to a sinus rinse bottle. This is a different product than the budesonide sprays that are available over the counter. It is more concentrated and more effective. Unlike nasal sprays, a steroid sinus rinse can penetrate deep into the sinus cavities.


Several studies have found that rinsing with budesonide is an effective treatment for nasal polyps. Budesonide (Pulmicort) respules are only available by prescription. Sinus rinses are typically only prescribed by ENTs, so your primary care doctor or allergist may not provide this medication. Keep in mind that nasal administration is an off-label use of budesonide respules, which are designed for use with an asthma nebulizer.


Budesonide respules come in several different strengths: 0.25mg, 0.5mg, and 1mg (per 2ml of solution). The lowest effective dose should be used. Research has found that doses of up to 1mg intranasal budesonide per day produced no adverse effects after two months of use. Other research has found that budesonide irrigation did not cause significant side effects even with prolonged use.






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 respule to the rinse. One or more respules may be used depending on the recommendation of your doctor. A standard amount is one 0.5mg respule per 250ml sinus bottle.

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


Stanford University's Budesonide Irrigation Instructions


Here is an excellent video on proper sinus irrigation technique.





Using Budesonide Respules in a Soak

If you have severe nasal obstruction, your doctor may recommend that you use undiluted budesonide respules to do a sinus soak. This can take some getting used to and may involve some trial and error, but many AERD patients find these soaks effective at reducing polyp symptoms.


Print the budesonide soaking guide provided by Brigham & Women's AERD Center.





Is This Safe?


A number of studies have been done on the safety and effectiveness of using budesonide irrigations. It appears to be generally safe and well tolerated. As with any steroid medication, the lowest effective dose should be used.


Is Topical High Volume Budesonide Sinus Irrigation Safe? - 2017 Review


Safety of Long Term Budesonide Sinus Irrigation - 2016 Study


Budesonide Irrigations for Chronic Rhinosinusitis: An Update on Safety and Effectiveness - 2014 Review


Pilot Study of Budesonide Inhalant Suspension Irrigations - 2009 Study


Effect of Nasally Administered Budesonide Respules on Adrenal Cortex Function - 2009 Study



Summary


Rinsing or soaking with budesonide might seem like a complicated process, but it has provided relief to many AERD (Samter's Triad) patients suffering from the blockage and facial pain caused by nasal polyps. If you're using a nasal spray that doesn't seem to be doing anything for you, talk to your ENT about getting a prescription.



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