Efficacy of the exhalation delivery system with fluticasone in patients with chronic rhinosinusitis with nasal polyps whose symptoms recur after sinus surgery

BACKGROUND: Sinus surgery removes inflamed tissue, restores airflow, and improves delivery of medication into surgically opened spaces. The exhalation delivery system with fluticasone (EDS‐FLU; XHANCE(®)) uses a novel delivery system to create closed‐palate, positive‐pressure, bidirectional mechanics that significantly alter the deposition of the topically acting anti‐inflammatory medication. We ask whether EDS‐FLU efficacy differs for patients with recurrent symptoms after sinus surgery versus patients without surgery. OBJECTIVE: We aimed to compare EDS‐FLU treatment responses in patients with recurrent symptoms after endoscopic sinus surgery (ESS) and patients who have never had sinus surgery. METHODS: Data were pooled from two large, controlled trials (NAVIGATE I and II) for exploratory analyses. Chronic rhinosinusitis symptoms, polyp grade, and quality‐of‐life measures were compared between patients with prior ESS and those without prior ESS. RESULTS: Patients with prior ESS (exhalation delivery system–placebo [n = 53], EDS‐FLU 186 μg [n = 52], and EDS‐FLU 372 μg [n = 49]) and unoperated patients (exhalation delivery system–placebo [n = 108], EDS‐FLU 186 μg [n = 108], and EDS‐FLU 372 μg [n = 111]) treated with EDS‐FLU reported similar and substantial benefits as measured by multiple symptom and quality‐of‐life/functioning outcomes (congestion score, 22‐Item Sinonasal Outcomes Test [SNOT‐22], Rhinosinusitis Disability Index [RSDI], Patient Global Impression of Change) and by nasal polyp grade. In previously operated patients, unlike surgery‐naive patients, multiple outcomes (SNOT‐22, RSDI, polyp grade) consistently showed numerically but not statistically greater responses to the higher dose. CONCLUSIONS: Patients with recurrent symptoms after sinus surgery who were treated with EDS‐FLU demonstrated significant symptom and quality‐of‐life improvement. Unlike unoperated patients, patients with prior ESS had a numerically but not statistically greater response to the higher dose of EDS‐FLU (two sprays per nostril twice a day).