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DOI 10.37219/2528-8253-2024-3-31

Gogunska I, Zabolotna D, Smagina T, Nesterchuk V
APPLICATIONS OF MOMETASONE FUROATE AND NASAL HYPERTONIC SALINE SOLUTION
WITH N-ACETYLCYSTEINE IN THE TREATMENT OF PATIENTS WITH POSTVIRAL RHINOSINUSITIS
Gogunska Inna V
State Institution “O.S. Kolomiychenko Institute of Otolaryngology of National Academy of Medical Science of Ukraine”; Kyiv, Ukraine
Center allergic diseases of the upper respiratory tract
Doctor of Medical Sciences, professor
Email: innagogunskaya@gmail.com
ORCID ID: https://orcid.org/0000-0001-6952-5057
Zabolotna Diana D
State Institution “O.S. Kolomiychenko Institute of Otolaryngology of National Academy of Medical Science of Ukraine”; Kyiv, Ukraine.
Head of Department of Rhinology and Allergology with a group of radiology
Doctor of Medical Sciences, Professor
E-mail: dianazab@ukr.net
ORCID ID: https://orcid.org/0000-0001-7807-8148
Smagina Tetyana V
State Institution “O.S. Kolomiychenko Institute of Otolaryngology of National Academy of Medical Science of Ukraine”
Department of Rhinology and Allergology with radiology group
Candidate of Medical Sciences
Email: smagin1@ukr.net
ORCID ID: https://orcid.org/0000-0002-8349-8275
Nesterchuk Vladislav I
State Institution “O.S. Kolomiychenko Institute of Otolaryngology of National Academy of Medical Science of Ukraine”; Kyiv, Ukraine
Department of Rhinology and Allergology with radiology group
Candidate of Medical Sciences
Email: smagin1@ukr.net
ORCID ID: https://orcid.org/0000-0003-4486-046X

Abstract

Relevance: It has been confirmed that the use of intranasal corticosteroids improves the quality of life in patients with PVRS. Buffered hypertonic solution physiologically stimulates the surface layer of the gel, increases the hydration of the sol layer, helps to increase the thickness of the mucus layer and reduce its viscosity, resulting in an improvement of mucociliary clearance. N-acetylcysteine ​​promotes the elimination of harmful contents from the nasal cavities and paranasal sinuses, has antibacterial properties and counteracts the formation of bacterial films, has an immunomodulatory and anti-inflammatory effect. Therefore, the complex use of mometasone furoate nasal spray and “FLU-ACIL Rhino” nasal spray (a medical product based on 3% hypertonic saline solution and 6% N-acetylcysteine) in the treatment of patients with PVRS can contribute to rapid relief of symptoms and improvement of patients’ quality of life.

Objective: to evaluate the efficacy and tolerability of nasal hypertonic saline solution with N-acetylcysteine ​​and mometasone furoate in the treatment of patients with post-viral rhinosinusitis.

Materials and methods: Patients with PVRS in the study were randomized into two groups of 30 people each. The standard treatment of patients in both groups included the use of intranasal corticosteroid mometasone furoate (“Nazonex”) in the form of a dosed nasal spray of 200 mcg 2 times a day. Patients of the first group also received endonasal spray “FLU-ACIL rhino” – 3 spray in each nostril 3 times a day, and patients in the second group – saline isotonic nasal spray 3 times a day. The evaluation of the effectiveness of treatment in the study groups was performed on the basis of the analysis of subjective and objective symptoms of PVRS, the rate of MCC (saccharin test, before treatment and on the 10th day of treatment), the assessment of the overall severity of symptoms of PVRS in points according to the VAS scale, the assessment of the patient’s condition according to scale of Clinical Global Impressions (CGI-I), patients’ assessment of tolerability of treatment.

Results and discussion: The study demonstrated a more pronounced and rapid regression of objective symptoms and subjective clinical manifestations of PVRS and the average VAS score in the group of patients treated with “FLU-ACIL rhino” spray. Due to mucolytic and anti-inflammatory action of the “FLU-ACIL rhino” nasal spray, the mucociliary clearence gradually improves, which is confirmed by the results of the saccharin test. The tolerability of the complex treatment when using the nasal spray “FLU-ACIL rhino” and isotonic saline solution did not differ significantly, the cases of side effects were predictable and corresponded to a mild degree of severity, which allows us to characterize the nasal spray “FLU-ACIL rhino” as having a favorable safety profile.

Conclusions: Taking into account the obtained data, the use of nasal spray “FLU-ACIL rhino” in the complex therapy of patients with PVRS can be considered as a rational choice that can contribute to a faster and more pronounced positive dynamics of PVRS symptoms and helps to improve the quality of patient’s life.

Key words: postviral rhinosinusitis, mometasone furoate, N-acetylcysteine, hypertonic sodium chloride solution.

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References

  1. Fokkens W, Lund V, Hopkins HP, Kern R, Reitsma S, Toppila-Salmi S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020 Feb 20;58(Suppl S29):1-464. doi: 10.4193/Rhin20.600.
  2. Ryan ET, Solomon T, Endy TP, Hill DR, Aronson NE, editors. Hunter’s Tropical Medicine and Emerging Infectious Diseases. 10th ed. Elsevier; 2020. van Doorn HR, Yu H. Chapter 33, Viral Respiratory Infections; p. 284-288.
  3. [Rhinosinusitis. Evidence-based clinical practice]. Ministry of Health of Ukraine. 2023. Available from: https://www.dec.gov.ua/wp-content/uploads/2023/10/2023_kn_rynosynusyty.pdf. [In Ukrainian].
  4. [Unified clinical protocol of primary and specialized medical care. Acute rhinosinusitis]. Ministry of Health of Ukraine. 2023. Available from: https://moz.gov.ua/uploads/10/50495-dn_1793_13102023_dod_1.pdf. [In Ukrainian].
  5. Jaume F, Valls-Mateus M, Mullol J. Common Cold and Acute Rhinosinusitis: Up-to-Date Management in 2020. Curr Allergy Asthma Rep. 2020 Jun 3;20(7):28. doi: 10.1007/s11882-020-00917-5.
  6. Passali D, Spinosi MC, Crisanti A, Belussi LM. Mometasone furoate nasal spray: a systematic review. Multidiscip Respir Med. 2016 May 2:11:18. doi: 10.1186/s40248-016-0054-3.
  7. Zalmanovici Trestioreanu A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev. 2013 Dec 2;2013(12):CD005149. doi: 10.1002/14651858.CD005149.pub4.
  8. Talbot AR, Herr TM, Parsons DS. Mucociliary clearance and buffered hypertonic saline solution. Laryngoscope. 1997 Apr;107(4):500-3. doi: 10. 1097/00005537-199704000-00013.
  9. Lansley АВ, Sanderson MJ, Dirksen ER. Control of the beat cycle of respiratory tract cilia by Ca2+ and cAMP. Am J Physiol. 1992 Aug;263(2 Pt 1): L232-42. doi: 10.1152/ajplung.1992.263.2.L232.
  10. Keojampa BK, Nguyen MH, Ryan MW. Effects of buffered saline solution on nasal mucociliary clearance and nasal airway patency. Otolaryngol Head Neck Surg. 2004 Nov;131(5):679-82. doi: 10.1016/j.otohns.2004.05.026.
  11. Ural A, Oktemer TK, Kizil Y, Ileri F, Uslu S. Impact of isotonic and hypertonic saline solutions on mucociliary activity in various nasal pathologies: clinical study. J Laryngol Otol. 2009 May; 123(5):517-21. doi: 10.1017/S0022215108003964.
  12. Hauptman G, Ryan MW. The effect of saline solutions on nasal patency and mucociliary clearance in rhinosinusitis patients. Otolaryngol Head Neck Surg. 2007 Nov;137(5):815-21. doi: 10.1016/j. otohns.2007.07.034.
  13. Liu L, Pan M, Li Y, Tan G, Yang Y. Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis. Braz J Otorhinolaryngol. 2020 Sep-Oct; 86(5):639-646. doi: 10.1016/j.bjorl.2020.03.008.
  14. Murugesan S, Sai V, Nithya. The Effects of N-Acetyl Cysteine on Nasal Mucociliary Clearance in Healthy Volunteers. J. Pharm. Sci. & Res. 2015; 7(10):885-887. https://www.jpsr.pharmainfo.in/Documents/Volumes/vol7Issue10/jpsr07101521.pdf.
  15. Dinicola S, De Grazia S, Carlomagno G, Pintucci JP. N-acetylcysteine as powerful molecule to destroy bacterial biofilms. A systematic review. Eur Rev Med Pharmacol Sci. 2014 Oct;18(19):2942-8. 
  16. Lane CJ, Redding D, Gonzalez KA, Cardenas V, Boldogh I, Sur S. Topical N-acetyl cysteine (NAC) reduces late phase nasal symptoms following ragweed challenge. J Allergy Clin Immunol. 2009 Feb;123(2);S53. doi: 10.1016/j.jaci.2008.12.170. 
  17. Dieeva J. [The effect of “FLU-ACIL RINO” nasal spray on the course of the inflammatory process and recovery of patients after FESS]. Otorhinolaryngology. 2021;6(4):43-50. doi 10.37219/2528-8253-2021-4-43. [Article in Ukrainian].
  18. Zanetti L, Valetti L, Bettoni L, Agostini S. Efficacy of a nasal spray containing N-acetylcysteine in hypertonic saline solution in the treatment of chronic rhinosinusitis, with early recurrence after Functional Endoscopic Sinus Surgery. Farmaci 2019;18(3). https://www.medizioni.it/wp-content/uploads/2020/ 09/FEst-3_2019-Viscoflu_eng.pdf.
  19. Maffezzoni E, Notargiacomo M, Agostini S, Gelardi M. Efficacy of a nasal spray containing N-acetylcysteine in hypertonic solution in the treatment of nonallergic chronic rhinitis with goblet cell metaplasia. J Biol Regul Homeost Agents. 2020 Nov-Dec;34(6):2345-2352. doi: 10.23812/ 20-411-L.
  20. Andersen I, Proctor DF. Measurement of nasal mucociliary clearance. Eur J Respir Dis Suppl. 1983:127:37-40.
  21. Borum P, Holten A, Loekkegaard N. Depression of nasal mucociliary transport by an aerosol hair-spray. Scand J Respir Dis. 1979 Oct;60(5):253-9.
  22. Berk M, Ng F, Dodd S, Callaly T, Campbell S, Bernardo M, Trauer T. The validity of the CGI severity and improvement scales as measures of clinical effectiveness suitable for routine clinical use. J Eval Clin Pract. 2008 Dec;14(6):979-83. doi: 10.1111/j.1365-2753.2007.00921.x.