Medical management of chronic rhinosinusitis in cystic fibrosis: A systematic review

• Published in: The Laryngoscope 2014-06, Vol.124 (6), p.1308-1313
• Main Authors: Liang, Jonathan, Higgins, Thomas, Ishman, Stacey L., Boss, Emily F., Benke, James R., Lin, Sandra Y.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Administration, Topical; Adult; Anti-Bacterial Agents - therapeutic use; Child; Child, Preschool; Chronic Disease; Chronic rhinosinusitis; Clinical outcomes; Cystic fibrosis; Cystic Fibrosis - complications; Cystic Fibrosis - diagnosis; Cystic Fibrosis - drug therapy; Deoxyribonuclease I - therapeutic use; dornase alfa; Drug therapy; Drug Therapy, Combination; Female; Humans; Magnetic Resonance Imaging; medical; Prognosis; Randomized Controlled Trials as Topic; Recombinant Proteins - therapeutic use; Retrospective Studies; Rhinitis - complications; Rhinitis - diagnosis; Rhinitis - drug therapy; Risk Assessment; Severity of Illness Index; Sinusitis - complications; Sinusitis - diagnosis; Sinusitis - drug therapy; Steroids - therapeutic use; Studies; Tomography, X-Ray Computed; topical steroid; Treatment Outcome
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.24503

Objectives/Hypothesis To systematically review existing literature on the effectiveness of medical management of chronic rhinosinusitis (CRS) in cystic fibrosis (CF) patients. Study Design Systematic review. Methods We performed a literature search of PubMed, Embase, and Cochrane CENTRAL from 1987 to 2012. Inclusion criteria included English language as containing original data, with five or more subjects, measurable clinical outcomes, and readily available interventions. Data were systematically collected on study design, patient demographics, clinical characteristics and outcomes, and level of evidence. Two investigators independently reviewed all manuscripts and performed a comprehensive quality assessment. Results Of 415 s identified, 12 articles were included. These 12 studies reported on 701 adult and pediatric CF patients who underwent medical therapy. Medical treatment included antibiotics (4/12), topical steroids (4/12), dornase alfa (3/12), and ibuprofen (1/12). Outcome measures included symptom scores (7/12), endoscopic findings (7/12), radiographic findings (4/12), pulmonary function testing (4/12), and rhinomanometry (2/12). Most studies found improvement in at least one of the outcome measures. There was statistical significance in clinical outcomes with dornase alfa, beclomethasone, and betamethasone. Most studies were level 3 or 4 evidence (9/12), but three studies were level 1 or 2 evidence (two dornase alfa studies, one betamethasone study). Conclusions Dornase alfa and, to a lesser extent, topical steroids demonstrated significant benefits in the medical treatment CRS in CF. There was a lack of evidence to support antibiotic therapy in the outcomes assessed. Further high‐quality studies should be carried out to determine the efficacy of various medical therapies for CRS in CF. Level of Evidence NA Laryngoscope, 124:1308–1313, 2014