Effectiveness of the exhalation delivery system with fluticasone for treating chronic rhinosinusitis with nasal polyposis: a systematic review and meta-analysis
Abstract
Purpose: We evaluated the effects of two doses (186 µg and 372 µg) of exhalation delivery system with fluticasone (EDS-FLU) on chronic rhinosinusitis (CRS) with nasal polyp as a novel sinonasal delivery system.
Methods: We analyzed 5 studies retrieved from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to April 2024, focusing on subjective and objective scores, and adverse and beneficial effects (responder and complete responder rates, improvements in Patient Global Impression of Change [PGIC] scores, and surgical indication rates before and after EDS-FLU use.
Results: Over 3 months, EDS-FLU significantly reduced polyp (mean difference [MD] - 1.1605; 95% confidence interval [CI] [- 1.3277; -0.9934], I2 = 61.4%) and 22-item Sinonasal Outcome Test (MD - 20.7561; 95% CI [- 22.3473; -19.1648], I2 = 0.0%) scores compared to baseline. At 1 month, nasal congestion, facial pain, olfactory dysfunction, and rhinorrhea significantly improved compared to baseline. EDS-FLU significantly reduced the surgical indication rate (odds ratio 0.2594; 95% CI [0.1910; 0.3522], I2 = 0.0%) and improved patient satisfaction, with 63.34% of patients reporting significant improvement in PGIC scores after 3 months. However, adverse effects, including epistaxis, headache, nasal congestion, and nasopharyngitis, were reported, with incidence rates ranging from 4.46 to 8.99%. There were no significant differences in beneficial or adverse effects between high and low fluticasone doses, but…
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