Management of Sinusitis in the Cystic Fibrosis Patient
Chronic rhinosinusitis (CRS) is present in up to 100% of patients with cystic fibrosis (CF). CF-associated CRS is particularly recalcitrant, and sinus disease can have important implications in the health of the lower airways and overall quality of life in these patients. Both medical and surgical management play important roles in treating CF-associated CRS, but guidelines are lacking. This review summarizes the current literature on both medical and surgical management of this disease to provide an up-to-date analysis and recommendations on the treatment of CF-associated CRS.
ConclusionSex, CF ‐related diabetes, sinonasal infection status, allergic rhinitis, and nasal steroid use may all modulate severity of CF‐CRS in adults. Sinusitis exacerbation may be a precursor to pulmonary exacerbation.
CONCLUSIONS: ESS represents the best option to improve clinical QoL of CF patients who do not response to conventional medical therapy. PMID: 30931587 [PubMed - as supplied by publisher]
ConclusionTopical intranasal dornase appears to improve sinonasal symptoms in CF patients to a greater degree than saline alone. The impact on other outcomes is less clear. Larger studies are needed to fully elucidate the true efficacy of dornase alfa in the treatment of CRS in CF patients.
The objective of this study was to evaluate whether co‐treatment with ivacaftor and l‐methionine can reduce the formation of Pseudomonas aeruginosa biofilms. MethodsP aeruginosa (PAO‐1 strain) biofilms were studied in the presence of l‐methionine and/or ivacaftor. For static biofilm assays, PAO‐1 was cultured in a 48‐well plate for 72 hours with stepwise combinations of these agents. Relative biofilm inhibitions were measured according to optical density of crystal violet stain at 590 nm. Live/dead assays (BacTiter‐Glo™ assay, Promega) were imaged with laser scanning confocal microscopy. An agar diffusi...
ConclusionThis study provides direct evidence of aspiration of sinonasal secretions into the lungs of patients with CF and healthy adults in the recumbent position. The fact that both patients and controls aspirated secretions suggests that aspiration alone does not account for the pathogenesis of lung disease in CF patients.
ConclusionThere was a high correlation between pretransplant sinus cultures and posttransplant BAL cultures for PsA, MRSA, and Burkholderia sp. This suggests that the paranasal sinuses may act as a reservoir for allograft colonization in patients with cystic fibrosis. Further studies are needed to determine whether treatment of sinusitis affects allograft colonization and transplant outcomes.
BackgroundThe clinical association between cystic fibrosis (CF) and chronic rhinosinusitis (CRS) is well known. Studies have identified several non‐CF transmembrane conductance regulator single nucleotide polymorphisms (SNPs) associated with disease severity in CF patients. We hypothesized that prevalence of these SNPs would be different between CRS patients and age/gender‐matched non‐CRS controls. MethodsThis is a targeted SNP study of 1231 CRS patients identified through a large university hospital database who were compared with 8796 age‐ and gender‐matched controls without a history of rhinitis, sinusitis, al...
Chronic rhinosinusitis with nasal polyposis (CRSwNP) represents a subset of chronic sinusitis with various causes. Some forms of the disease are driven by allergy, often in association with asthma. Refractory CRSwNP can be associated with cystic fibrosis and other clinical syndromes. More recent literature is presented regarding roles of innate immunity and superantigens. Effective treatment of CRSwNP requires careful endoscopic sinus surgery followed by an individualized treatment plan that often includes oral and topical steroids. Recidivism of polyps is common, and patients require long-term follow-up.
Authors: Shah A, Panjabi C Abstract In susceptible individuals, inhalation of Aspergillus spores can affect the respiratory tract in many ways. These spores get trapped in the viscid sputum of asthmatic subjects which triggers a cascade of inflammatory reactions that can result in Aspergillus-induced asthma, allergic bronchopulmonary aspergillosis (ABPA), and allergic Aspergillus sinusitis (AAS). An immunologically mediated disease, ABPA, occurs predominantly in patients with asthma and cystic fibrosis (CF). A set of criteria, which is still evolving, is required for diagnosis. Imaging plays a compelling role in th...
CONCLUSIONS: The SN-5 tool provides a quick, safe, and reliable qualitative metric for monitoring sinonasal symptoms in young children with CF. PMID: 26358346 [PubMed - in process]