A systematic review of medical management of chronic sinusitis in cystic fibrosis

   In a poster presented at Triological Society 2013, held April 2013 in Orlando, a group of researchers from Baltimore, Maryland, and Louisville, Kentucky, systematically reviewed the existing literature on the effectiveness of medical management of chronic sinusitis in cystic fibrosis (CF) patients.

   They performed a literature search encompassing the last 25 years of publications in PubMed, Embase, and Cochrane CENTRAL. Inclusion criteria included English language papers containing original data, 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. A rigorous quality assessment was performed. 

 

    The initial search yielded 415 abstracts, from which the researchers selected 12 articles. They encompassed 659 adult and pediatric CF patients who underwent medical therapy -- 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). 

   According to the investigators, 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 treatments. Most studies had level 3 to 4 evidence (9/12), but three studies had level 1 evidence (two dornase alfa studies, one betamethasone study).

 

   "In this systematic review, dornase alfa and topical steroids demonstrated significant benefits in the medical treatment of CF sinusitis," the researchers concluded. But "There was a lack of evidence to support antibiotic therapy in the outcomes assessed."