Use of Non steroidal Anti-inflammatory Drugs in Nasal Polyposis
Amany Reda Shosha;
Abstract
Nasal polyposis has been a source of suffering for patients and a vexing problem for doctors. Polyps are associated with so many different conditions-from aspirin intolerance to infections, so figuring out the body's processes that bring polyposis about has been a tall order. That complexity has also made treating the condition difficult.
Progress is being made in defining polyps' pathogenesis, but there might still be a long way to go. Polyps are probably just a common response to an inflammatory process and they, in all likelihood, have several different etiologies, for example, polyps associated with aspirin intolerance, polyps associated with asthma, polyps associated with infection, etc.
For many patients, NP should be regarded primarily as a medically managed condition in which surgery often plays a role. It could be argued that the surgery facilitates the instillation of nasal medication.
A range of medical treatments are available though the mainstay remains corticosteroids in various forms. However, there are a number of other approaches both new and old which may be considered. Randomised placebo-controlled trials are available for a relatively small number of preparations and more need to be conducted
NSAIDs are well established in the treatment of pain and inflammation.
COX exists as at least two isoenzymes: COX-1 and COX-2. COX-1 is constitutively expressed in most tissues and produces prostanoids involved in regulating physiological processes, such as haemodynamics, platelet aggregation and maintaining the integrity of the gastrointestinal (GI) mucosa
In contrast, COX-2 is an inducible enzyme, found abundantly at sites of inflammation, and produces prostanoids that primarily mediate fever, pain and inflammation. Celecoxib (Celebrex, Pfizer) was the first coxib to be introduced into clinical practice and was subsequently approved worldwide for a variety of indications involving pain and inflammation.
Meloxicam is a new enolic acid derivative developed for the treatment of some inflammatory diseases. Its selective inhibition of the COX-2 enzyme has been demonstrated in the microsomal assay. It can be used as a safe alternative for ASA-/NSAID-hypersensitive patients with asthma and/or NP.
Progress is being made in defining polyps' pathogenesis, but there might still be a long way to go. Polyps are probably just a common response to an inflammatory process and they, in all likelihood, have several different etiologies, for example, polyps associated with aspirin intolerance, polyps associated with asthma, polyps associated with infection, etc.
For many patients, NP should be regarded primarily as a medically managed condition in which surgery often plays a role. It could be argued that the surgery facilitates the instillation of nasal medication.
A range of medical treatments are available though the mainstay remains corticosteroids in various forms. However, there are a number of other approaches both new and old which may be considered. Randomised placebo-controlled trials are available for a relatively small number of preparations and more need to be conducted
NSAIDs are well established in the treatment of pain and inflammation.
COX exists as at least two isoenzymes: COX-1 and COX-2. COX-1 is constitutively expressed in most tissues and produces prostanoids involved in regulating physiological processes, such as haemodynamics, platelet aggregation and maintaining the integrity of the gastrointestinal (GI) mucosa
In contrast, COX-2 is an inducible enzyme, found abundantly at sites of inflammation, and produces prostanoids that primarily mediate fever, pain and inflammation. Celecoxib (Celebrex, Pfizer) was the first coxib to be introduced into clinical practice and was subsequently approved worldwide for a variety of indications involving pain and inflammation.
Meloxicam is a new enolic acid derivative developed for the treatment of some inflammatory diseases. Its selective inhibition of the COX-2 enzyme has been demonstrated in the microsomal assay. It can be used as a safe alternative for ASA-/NSAID-hypersensitive patients with asthma and/or NP.
Other data
| Title | Use of Non steroidal Anti-inflammatory Drugs in Nasal Polyposis | Other Titles | استخدام الأدوية الغير كورتيزونية المضادة للالتهاب في لحميات الأنف | Authors | Amany Reda Shosha | Issue Date | 2014 |
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