Medical interventions for chronic inflammation of the nose and sinuses in cystic fibrosis

Review question

What are the effects of medical interventions for chronic rhinosinusitis on people with cystic fibrosis?


Chronic rhinosinusitis is long-term infection and inflammation of the nasal cavity and air-filled spaces around the eyes and nose. Cystic fibrosis is a genetic condition that makes secretions in the body thick, and hence stagnant. When this occurs in and around the nose, it causes chronic rhinosinusitis. Better care of people with cystic fibrosis has led to them living longer, increasing the chance of developing chronic rhinosinusitis. Early and effective interventions with antibiotics, steroids, drugs that thin the mucus (e.g. dornase alfa) and drugs to improve how the cell membrane channel functions (CFTR modulators) can help to improve quality of life and prevent the development of lower airway disease. Currently, there are no guidelines based on trials to know how best to treat chronic rhinosinusitis in people with cystic fibrosis.

Search date

The evidence is current to: 09 September 2021.

Study characteristics

We found no trials in our search that met our inclusion criteria. We have listed 12 trials as excluded and one trial as ongoing in the current review.

Key results

Although chronic rhinosinusitis is common in people with cystic fibrosis, there is not enough evidence available on its management. This review highlights the need for well-designed trials assessing which treatment is best for managing chronic rhinosinusitis, preventing lower airway disease and improving quality of life in people with cystic fibrosis.

Authors' conclusions: 

We identified no eligible trials assessing the medical interventions in people with cystic fibrosis and chronic rhinosinusitis. High-quality trials are needed which should assess the efficacy of different treatment options detailed above for managing chronic rhinosinusitis, preventing pulmonary exacerbations and improving quality of life in people with cystic fibrosis.

Read the full abstract...

Chronic rhinosinusitis frequently occurs in people with cystic fibrosis. Several medical interventions are available for treating chronic rhinosinusitis in people with cystic fibrosis; for example, different concentrations of nasal saline irrigations, topical or oral corticosteroids, antibiotics - including nebulized antibiotics - dornase alfa and modulators of the cystic fibrosis transmembrane conductance regulator (CFTR) (such as lumacaftor, ivacaftor or tezacaftor). However, the efficacy of these interventions is unclear.

This is an update of a previously published review.


The objective of this review is to compare the effects of different medical interventions in people diagnosed with cystic fibrosis and chronic rhinosinusitis.

Search strategy: 

We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and hand searching of journals and conference abstract books. Date of last search of trials register: 09 September 2021.

We also searched ongoing trials databases, other medical databases and the reference lists of relevant articles and reviews. Date of latest additional searches: 22 November 2021.

Selection criteria: 

Randomized and quasi-randomized trials of different medical interventions compared to each other or to no intervention or to placebo.

Data collection and analysis: 

Two review authors independently assessed trials identified for potential inclusion in the review. We planned to conduct data collection and analysis in accordance with Cochrane methods and to independently rate the quality of the evidence for each outcome using the GRADE guidelines.

Main results: 

We identified no trials that met the pre-defined inclusion criteria. The most recent searches identified 44 new references, none of which were eligible for inclusion in the current version of this review; 12 studies are listed as excluded and one as ongoing.