(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Polyps

Nasal polyposis accounts for 40% of chronic nasal disease. The part played by surgery seems to be steadily growing if the number of publications dedicated to this approach is any yardstick. The medical treatment remains however the undisputed therapeutic mainstay but trials dedicated to the assessment of its overall efficacy are rather scarce. The aim of this study is focused on the evaluation of a dual modality, topical and systemic, over a follow-up period of three years. A total of 100 subjects were treated according to a standardized therapeutic protocol combining a short-term oral administration of a corticosteroid (prednisolone) and a daily intranasal spray of an other steroid (beclomethasone). Over the follow-up period of three years, this dual modality proved to be successful in 85% of the subjects; only 15% had to undergo surgery after its failure. The average symptom reduction reached an improvement rate varying from 58 to 80%, according to the symptom type. The daily dosage of prednisolone and beclomethasone was progressively decreased while the gain in nasal comfort was being preserved. Management of nasal polyps should be primarily medical. Resorting to surgical procedures should not be envisaged before a trial of dual steroid therapy under strict compliance to treatment. The single character of this long follow-up and the importance of the series of patients included in the protocol make all the originality of this work which shows for the first time the long-term improvement after medical treatment.

Topics: Administration, Intranasal; Administration, Oral; Adult; Beclomethasone; Cohort Studies; Combined Modality Therapy; Drug Evaluation; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasal Polyps; Paranasal Sinus Neoplasms; Polyps; Prednisolone; Treatment Outcome

In a 50 year old man who complained of cough and sputum, a small endobronchial tumour was found in the left main bronchus and was biopsied via bronchoscopy. The histological diagnosis was inflammatory polyp with marked infiltration of eosinophils. Six years later, the patient developed asthma. At the same time, another polyp was found in the posterior basal bronchus of the right lower lobe. The appearance of the first polyp was unchanged endoscopically and histologically. Inhalation of beclomethasone dipropionate, 200 micrograms b.i.d., was started and symptoms of asthma soon subsided. In addition, the two polyps regressed and eventually disappeared after one year of treatment. Inhaled corticosteroids, being noninvasive and relatively safe, appear to be a possible therapeutic option in inflammatory bronchial polyps, especially in cases where the patient has asthma as an underlying condition, or the polyps are small and their management is not urgent.

Topics: Administration, Inhalation; Administration, Topical; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Beclomethasone; Bronchi; Bronchial Neoplasms; Glucocorticoids; Humans; Male; Middle Aged; Polyps; Time Factors

A case of an inflammatory endobronchial polyp associated with chronic smoke injury is reported. Unlike previously reported cases, this was not associated with acute, severe thermal injury, was solitary in occurrence, and responded rapidly to a short course of intrabronchial steroids.

Topics: Beclomethasone; Bronchial Neoplasms; Bronchoscopy; Humans; Male; Middle Aged; Polyps; Smoking