Treatment of Nasal Polyps

[Dr. Patricia Loftus]
Yeah. Like you said, we always try medical management first, and for CRS with nasal polyps, this is a disease where prednisone is actually recommended. We have guidelines that give us different options. However, patients with polyps, which are eosinophilia-driven, tend to do well with prednisone because they respond well to steroids. So, this is something that's recommended if the patient doesn't have any contraindications to it. In a patient who is treatment-naive and can take prednisone, I will do a steroid taper.

There's no specific taper that you should do. What I like to do is 40 milligrams for four days, 30 for four days, 20 for four days, 10 for four days. So, it's 40 pills over a 16 day taper. I would say that most rhinologists tend to not go higher than 40. From what I read, someone looked into it like about the dosage that you hit that kind of had side effects and might've created lawsuits, or something along that line. They kind of found that 40 was okay to go up to. That's what most of us do. Also, I will definitely tell them, do saltwater rinses. We know there's a recommendation for that and we know there's a recommendation for intranasal corticosteroids. Intranasal corticosteroids that are FDA approved are Flonase or the sprays. But as you guys know, we do tend to add our steroids to rinses. I use budesonide for that. It is off-label technically. There's not robust data and I think mostly because it is off-label, but we know that it does work. What's nice about adding the budesonide is that with the rinse, it's higher volume, can kind of get into the nose and sinus cavities a little bit better.