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

Review question

We reviewed the evidence for the effect of medical interventions for chronic rhinosinusitis in people with cystic fibrosis.

Background

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: 22 May 2019.

Study characteristics

We found 47 trials in our search, but none of them met our inclusion criteria and they were not included 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 to organize well-designed trials assessing relevant treatment options to show which treatment is best for managing chronic rhinosinusitis, preventing lower airway disease and improving quality of life in people with cystic fibrosis and chronic rhinosinusitis.

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...
Background: 

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.

Objectives: 

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: 22 May 2019.

We also searched ongoing trials databases, other medical databases and the reference lists of relevant articles and reviews. Date of latest additional searches: 20 May 2019.

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 searches identified 47 trials, none of which were eligible for inclusion in the current version of this review.

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