Canadian Guidelines for Rhinosinusitis

7/30/2019 Canadian Guidelines for Rhinosinusitis

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CANADIAN GUIDELINES FOR

RHINOSINUSITIS:Practical Tools for the Busy Clinician


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Acute bacterial rhinosinusitis (ABRS) andchronic rhinosinusitis (CRS)frequently present

in clinical practice.

Guidelines for management of theseconditions - published extensively in the past.

Presented guidelines are applicable

internationally - single algorithms for diagnosis

and management of ABRS and CRS


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INTRODUCTION

Current Canadian guidelines mark the first

time that comprehensive guidelines covering

both ABRS and CRS appear.

Rhinosinusitis - Denotes inflammation of the

sinus and nasal passages

often occur simultaneously due to their close

location and shared respiratory epithelium


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Rhinosinusitis is common and increasing in

prevalence worldwide

Rhinosinusitis continues to affect more

individuals - impact on patient lives and total

costs continue to rise.


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DISCUSSION

ABRS and CRS have different pathologies and

thus management strategies.

Critical that clinicians understand these

differences so appropriate treatment can bestarted.

Canadian guidelines - Easy-to-read

practical recommendations to assist clinicians facingpatients with rhinosinusitis symptoms in everydaypractice.


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ABRS Diagnosis

requires the duration of appropriatesymptoms be greater than 7 days.

P Pain/Pressure/fullness

O

Nasal Obstruction

D Nasal Discharge

S Smell disorder (hyposmia/anosmia)

2 symptoms, one of which must be O or D,

for > 7 days without improvement.


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ABRS treatment

guidelines base severity by the degree to

which symptoms impair the patient.

low severity - easily tolerated symptoms,

moderate severity - steady symptoms that are

tolerable,

severe severity - symptoms are difficult totolerate or interfere with sleep or daily

activities.


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Mild to moderate intensity INCS (1st step)

antibiotics are reserved for patients failing to

respond to INCS after 3 days & symptoms

continue for more than 7 days.

Severeillness- INCS and antibiotics

recommended in combination as a first step in

treatment.


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CRS diagnosis

C Facial Congestion

P Facial Pain

O Nasal Obstruction

D

Nasal DischargeS Smell dysfunction (hyposmia/anosmia)

At least two symptoms present for 8 to 12 weeks,

Documented inflammation of the nasal mucosa or

paranasal sinuses.

Duration of symptoms for diagnosis - 12 weeks.

Minimum duration according to guidelines8 weeks


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presence or absence of nasal polyps is used to

further categorize disease.

Bilateral polyps in the middle meatus

characterizes CRS with nasal polyps (CRSwNP)

Lack of polyps constitutes CRS without nasal

polyps (CRSsNP).


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CRS treatment

CRS - primarily inflammatory disease with

unknown contributions from bacteria,

cytokines, leukocytes, and tissue remodeling,

treatment based uponuse ofINCS asmonotherapy or as adjunct therapy with

antibiotics.


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Before treatment - predisposing and

contributing conditions identified and treated.

Conditions contributing to CRS:

allergic rhinitis

asthma

Ciliary dysfunction

immune dysfunction

lost ostia patency

aspirin-exacerbated respiratory disease

Cystic fibrosis.


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Nasal or oral corticosteroids are used with or

without antibiotics for initial treatment ofCRSsNP.

Antibiotics should be a second-line agent with

broad-spectrum coverage. duration of therapy should be longer than for

ABRS.


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CRSwNP - Course of topical INCS and short

courses of oral steroids used.

Antibiotics are not recommended for CRSwNPunless there are symptoms suggesting

infection.


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Role of antibiotics

guidelines discuss concerns of increasing rates ofantibiotic resistance

Antibiotic resistance rates increased between

1988 and 2005 some rates have stabilized in the 5-year period

between 2000 and 2005 (ciprofloxacin, penicillin,and TMP/SMX resistance)

Because of trends in resistance rates, guidelinesadvise judicious use of antibiotic therapy andawareness of related issues


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Ancillary therapy, testing, and

prevention

Saline irrigation

Use of saline irrigation as adjunct therapyprimarily based on reported symptomatic

improvement allergy testing in cases of recurrent episodes

of ABRS or for CRS potential contributing

condition Prevention of illness- hand washing & health

education.


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Guideline rationale and method

designed to be valuable tool for first-line

clinicians.

Evidence based, make specific

recommendations, and comprehensively

address both ABRS and CRS

Guidelines were constructed using an

evidence based strategy and present an

evidence strength rating


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Conclusion

The knowledge base of ABRS and CRS

pathology and management continues to

grow and evolve

provide a solid foundation for future

developments

User-friendly tool - quickly grasp appropriate

methods of diagnosis and management of

ABRS and CRS

Documents

Canadian Guidelines for Rhinosinusitis