Maintenance treatments

Nasal Rinsing

There are many ways to manage CRS. Maintenance treatments focus on reducing inflammation and irritation, clearing mucus, and improving breathing through the nose.

One of the key therapies for CRS is nasal rinsing with saline (salt water). This simple solution can:

  • Help clear out your nasal passages and sinuses
  • Help prevent secretions from dripping into your throat
  • Wash away allergens and irritants that might be making your symptoms worse

Using a rinse before applying other medications to your nose (like corticosteroid sprays) can also help those medicines work better by allowing them to reach the inside of your nose more effectively.

Nasal rinsing with saline has few side effects, except that you need to learn how to do it properly to avoid discomfort. Nasal rinsing should be done daily and preferably twice a day.

Saline solutions can be easily prepared at home by mixing clean, previously boiled, lukewarm water with unionized salt (9 grams of salt with 1 litre of water, or 3 grams in a nasal rinsing device) and pouring into a nasal rinsing device. These devices are available over-the-counter. Always prepare a fresh saline solution before use.

Nasal corticosteroids

An additional effective option is nasal corticosteroid sprays or drops. These sprays:

  • Help reduce inflammation inside your nose and sinuses
  • Reduce stuffiness over time

They work by calming down inflammation in your nasal passages and sinuses. Corticosteroid sprays are safe to use in the long term. Some people can experience side effects like irritation, nose bleeding or dryness. However, a correct spraying technique can prevent most of the discomfort. Some of these sprays are available over the counter, but in some countries, you might need a prescription to get them.

Your doctor might also advise you to dissolve this drug into your saline solution for nasal rinsing. This is sometimes referred to as corticosteroid irrigation. Keep the spray by your toothbrush so as not to forget.

If you suffer from allergies, your physician may also prescribe anti-allergic pills or sprays (also called antihistamines). These medications can typically be bought over the counter at your pharmacy.

Short-term relief therapies

Sometimes your doctor might recommend a treatment for short term use. These therapies are not recommended for a long period or for frequent use due to adverse effects.

 

  1. Decongestant sprays/drops: These nasal sprays/drops can quickly shrink swollen tissues inside your nose, making it easier to breathe. But if you use them for more than a few days in a row, they can backfire by making your nose feel even more stuffy when you stop using them. This is called rebound congestion, which means your nose becomes dependent on the spray to stay clear. To avoid this problem, you have to use these sprays only as directed and for a short time. If you are already relying on them to breathe, it is important to talk to a doctor, who can guide you on how to stop safely and explore other treatment options. If prescribed by your doctor, it is important to:
    • Use the spray only for the recommended time (no more than 7 days in a row).
    • Schedule a follow-up visit with your doctor to check progress.
    • Understand that it does not treat the inflammation that is causing your symptoms.
  • Decongestant pills: These pills contain pseudo-ephedrine, which is sometimes prescribed for short-term relief for a blocked nose. However, there is no recommendation for long term use due to adverse events (like cardiac risk).
  • Corticosteroid tablets or pills: These are sometimes used for a short time alongside nasal sprays to quickly reduce swelling. They work fast, are strong, and are affordable. However, their benefits do not last long, and long-term or repeated use can lead to several side effects. If it is prescribed for CRS, it should be done under specialist care.
  • Antibiotics: In some cases, the doctor might prescribe antibiotics for a short or longer period. Some antibiotics (like azithromycin) are given by a ENT specialist for a longer period because they can help reduce inflammation. The use of short-term antibiotics is usually not helpful in CRS and frequent short-term courses of antibiotics increase the risk of bacteria to become resistant making the drug less effective. Antibiotics may cause side effects like diarrhoea and fungal infections, along with other side effects, depending on the type of drug you get.

Additional options: Surgery

What is sinus surgery?

If symptoms don’t improve with nasal rinsing or corticosteroid sprays, there are additional options. One of the options your ENT specialist can consider is surgery.

The goals of sinus surgery are to:

  • Open up the sinuses to improve drainage of secretions and access to nasal irrigations with salt water and/or delivery of medications like nasal sprays.
  • Remove nasal polyps if they are present and improve nasal passage/breathing
  • May have positive effects on your lower airways

Surgery is typically recommended only after trying the combination of nasal rinsing and nasal corticosteroids.

What to expect from sinus surgery?:

  • Most nasal symptoms improve after surgery, but it doesn’t cure the condition, because CRS is caused by chronic inflammation of the nose and sinuses.
  • Recovery can take up to several months, though this varies from person to person and depends on the specific procedure done.

Sinus surgery is a complex procedure, and complications can happen during surgery. Talk to your doctor to discuss the pros and cons that are relevant to you. If symptoms worsen again, your doctor may need to review your treatment plan and consider more medical or surgical options.

Additional options: Biologics

What are biologics and when are they used?

In cases where symptoms persist after surgery and impact your daily life greatly, biologics can be considered. Biologics are only added to your current treatment after your doctor has made a detailed evaluation of your condition and the type of inflammation you suffer from. This process of figuring out the specifics of your condition is something your specialist may refer to as “endotyping” or “phenotyping”. This is important because biologics are special medications given by injection that target specific parts of your immune system that cause this inflammation.

While effective, this treatment can be expensive and does not always replace other medications completely. So it is often considered when other options have not worked.

Different biologics target various molecules (substances that act as messengers in your body) that play a role in inflammation. Your doctor will decide together with you which would be the best option for you to modulate your immune system and reduce symptoms.

Sometimes a biologic given for asthma also reduces CRS symptoms and vice versa.

How do biologics help?

  • They can reduce the size of nasal polyps
  • Can improve smell and nasal congestion (stuffy nose)
  • Can improve the overall quality of life
  • Can decrease the need for corticosteroid pills or the need to have another surgery
  • Can have positive effects on your lower airways

The effects of biologics can vary from person to person because they are designed to treat specific types of inflammation.

Biologics are expensive and are not available everywhere, and access or reimbursement depends on local regulations. Talk to your doctor if you have specific questions about biologics therapy.

How to self-administer a biologic?

When starting treatment with biologics, your healthcare provider will train you how to give yourself a dose via injection. After practising a few times at the hospital, you will usually be able to do the injections by yourself at home (like insulin injections for diabetes). Since a proper technique is essential for the medicine to work and to ensure you get the full dose, we have created videos to assist you with the correct technique whenever you need it. There are two types of injections: (i) via prefilled pen or (ii) via prefilled syringe. Instructions depend on the device you use.

Keeping up with your treatment plan

Importance of adherence

To help manage CRS, it is very important to take your medicines just as your doctor prescribes. This means following the dose and using them day in day out. As a tip, you might find it helpful to rinse your nose and use your nasal corticosteroid spray at the same time each day, like when you brush your teeth.

When you stick to your treatment plan, you are more likely to feel better and may avoid needing stronger short-term medicines with potential severe side-effects. Even if you have had surgery, keeping up with your treatment is also important because chronic inflammation needs long-term treatment. Without proper care, nasal polyps (small growths in the nose) can return. Using your medicines as directed can help lower this risk.

Taking your medicines the right way is just as important as taking them regularly. For the treatment to work properly, it needs to reach the affected area in your body. Take your time to watch the videos in this module and review any materials your doctor has provided about using your medicines correctly.

What to do after visiting your doctor?

Some treatments, like corticosteroid sprays, need to be used regularly and may take 1 to 2 weeks to reach optimal effect. It is important to:

  • Stick to the treatment plan your doctor has prescribed.
  • Keep track of your symptoms between doctor visits.

Using corticosteroid sprays over a long time is safe, but if your symptoms do not improve, get worse, or if new symptoms appear, schedule another appointment with your doctor.

If your symptoms remain hard to control even after trying first-line treatments, you may need to see a GP and/or ear, nose, and throat (ENT) specialist.

If you also notice lower airway symptoms, like shortness of breath or high-pitch lung sounds (called wheezing), it might be a sign of asthma. In that case, consider seeing a GP and/or a lung specialist (pulmonologist).

What to do after surgery?

Recovery after sinus surgery can take up to several weeks to months. During this time:

  • You may need to rinse your nose with saline to remove secretions and blood.
  • Corticosteroid sprays are often used to reduce inflammation.
  • Follow-up visits with your surgeon are important to monitor healing, and the surgeon may clean your sinuses during these visits to help with recovery.

If you are on biologics, regular check-ups with your ENT specialist are needed to monitor your progress. If your symptoms get worse during this treatment, it is essential to see your specialist right away.

The information, including but not limited to, text, graphics, images, and other material contained on this website is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment and/or medical treatment of a qualified physician or healthcare provider. EUFOREA is not a medical organisation and cannot provide specific medical advice to patients via the Internet and/or E-mail. All patients are encouraged to direct their specific questions to their personal physicians. EUFOREA presents this information to patients so that patients can understand and participate in their own medical care. EUFOREA strongly emphasises that the information contained on this website is not a substitute for thorough evaluation and treatment by a qualified healthcare provider.

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