Effective Nasal Compounding for Polyps with the Help of Glucocorticoids
Ever had a line of patients waiting to buy cough syrup, fill their allergy scrips, or just get some relief from the flu? Their misery is obvious to everyone, but it’s tough for pharmacists to see patients suffering from headaches and stuffy noses, too– we want to offer a real cure instead of just managing symptoms. Well, it turns out that for some patients, irritable, blocked noses are curable. That’s because the congestion in their noses isn’t due to a cold but to polyps, and nasal compounding can save them from a lot of suffering.
What Are Nasal Polyps and How Do They Present?
While some patients learn about their own nasal polyps after a protracted cold or flu, polyps can be triggered by allergies or drugs, or sometimes by nothing at all.1 Nasal polyps are essentially growths in the wet mucosal layer inside a patient’s nose and sinuses that both protects the nasal passages and humidifies the air breathed in. The growths irritate already inflamed tissues, oftentimes where upper sinuses drain into the nose. Without nerve sensation in that area, the patient may not even know he has polyps, except for the congestion that doesn’t go away, even with the many over the counter remedies that ordinarily work well.
Researchers are not yet sure of what causes polyps, but they do know that polyps tend to affect young and middle-aged patients. Underlying conditions that may cause mucosal inflammation that can result in polyps include:
- Chronic irritation due to asthma or allergies
- Recurring infection
- Sensitivity to certain drug sensitivity
- Cystic fibrosis
- Immune disorders, such as Churg-Strauss syndrome
Nasal polyps and colds or allergies share many symptoms, but nasal polyps have some distinct symptoms that doctors and pharmacists, and patients themselves, should watch out for, including:2
- A blocked or runny nose, or post-nasal drip
- Nasal stuffiness or congestion
- Loss in taste or smell
- Breathing mostly through the mouth
- The feeling of pressure in the face or forehead
- Sleep apnea or snoring
- Itching around the eyes
- Pain in the face or teeth
- Prolonged or severe headaches
What’s important to realize that even though polyps may be unavoidable in these cases, nasal compounding can give patients a way to shrink or removal these polyps, and hopefully reduce the chance they’ll come back.
Why Is Nasal Compounding the Preferred Treatment?
In general, the treatments used for most colds, such as antihistamines and decongestants, work poorly for treating polyps.3Non-steroidal anti-inflammatory drugs (NSAIDs) or cromolyn sodium, another anti-inflammatory medication, also provide little benefit to the patient. Similarly, medications intended to treat bacterial infections (antibiotics) or allergic sinusitis (immunotherapy) can treat the underlying nasal condition, but won’t resolve the polyps.
Simply removing the polyps is not really an option either. As Dr. Satish Govindaraj, Vice Chairman of Clinical Affairs for Mount Sinai’s Department of Otolaryngology, puts it, “We don’t know the [polyp’s] underlying cause — what we do know is that it’s a hyperactive immune response. For this reason, removing the polyps alone doesn’t provide a cure. Once you remove the polyps, you still have to treat the lining to calm it down, or else it can start making polyps again.”4
Corticosteroids are currently the treatment of choice in nasal compounding, and can either be given as a topical solution or cream, or systemically via a pill or tablet. Direct injection into the polyps has been investigated but is not allowed by the FDA and further, is invasive and can be painful. Topical drugs most often used include5:
- Fluticasone propionate
- Beclomethasone dipropionate
- Betamethasone sodium phosphate
What Options Do Patients Have Outside of Nasal Compounding?
Although surgical removal of polyps doesn’t mean they won’t regrow, sometimes surgery is needed to manage serious cases where the polyps impede a patient’s ability to breathe. In these more severe cases, the physician may order CAT scan of the patient’s sinuses along with a culture of sinus mucus in order to diagnose and offer pre-surgical treatment to the patient. If these treatments do not resolve the problem, surgical removal of the polyps is done endoscopically.6
Nasal compounding may work to treat a particular episode of polyps but many patients want to know what they can do to avoid further medication, and surgery altogether. Some patients have found success through avoiding potential allergens, treating allergies, and sinus infections right away, using a nasal spray to shrink polyps before they grow larger, practicing breathing exercise through yoga or meditation, and following a diet that may prevent polyp formation.7 Foods that may prevent or shrink polyp growth are ones that have higher levels of omega-3 fatty acids, quercetin, vitamins A, C, E, and beta carotene, and selenium.8.
The American Pharmacists Association has recently put out new guidelines on how to treat sinusitis, in which they talk about delayed use of antibiotics as well as adjunctive saline irrigation of nasal passages alongside topical corticosteroid treatment.9 The new guidelines include a discussion on different treatment regimes to offer patients, and perhaps new nasal compounding options suitable for every individual case. Patients may not always be aware of the fact that polyps may be driving their nasal suffering, not a simple cold. Pharmacists who see patients coming in frequently for cold or allergy remedies should ask questions, offer natural over-the-counter remedies, and encourage them to see their physician to discuss unique treatment options and nasal compounding solutions.
It is often unclear when a patient suffers from a cold or allergy, and when she has nasal polyps. These polyps can cause chronic suffering as well as frustration in patients trying to live a healthy lifestyle. At Pharmaceutica North America, we are invested in keeping track of new guidelines to treat not just the polyps, but the underlying condition as well. We are proud to offer the best nasal compounding treatment made from safe and high-quality compounding materials. Contact us today to learn about our Bulk APIs and how we can support the care of your patients.
- “Nasal Polyps,” October 5, 2015, http://www.healthline.com/health/nasal-polyps#Causes2 ↩
- “Nasal polyps,” March 8, 2014, http://www.mayoclinic.org/diseases-conditions/nasal-polyps/basics/symptoms/con-20023206 ↩
- “Nasal Polyps Treatment & Management,” May 1, 2014, http://emedicine.medscape.com/article/994274-treatment ↩
- “Daily Checkup: What to do when that constant stuffiness isn’t just a cold or allergy flareup,” January 11, 2015, http://www.nydailynews.com/life-style/health/nasal-polyps-constant-stuffiness-article-1.2064204 ↩
- “Topical corticosteroids in nasal polyposis,” 2001, http://www.ncbi.nlm.nih.gov/pubmed/11368283 ↩
- “Endoscopic Nasal Surgery,” February 17, 2014,http://care.american-rhinologic.org/ess ↩
- “How to Prevent Nasal Polyps from Recurring?” June 2014, http://www.healthisright.com/2014/06/how-to-prevent-nasal-polyps-recurring.html ↩
- “Nasal Polyps & Diet: How to Eat to Prevent Nasal Polyps,” 2016, http://www.healwithfood.org/nasalpolyps/ ↩
- “New infectious disease guidelines on sinusitis, STDs,” January 13, 2016, http://www.pharmacist.com/new-infectious-disease-guidelines-sinusitis-stds ↩