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2021 中国专家建议：经鼻糖皮质激素雾化吸入治疗慢性鼻窦炎（英

作者：中华医学网发布时间：2026-01-20 19:50浏览：次

Chinese Expert Recommendation on Transnasal Corticosteroid Nebulization for CRS 2021 (Structured English Summary)

This recommendation (published in Journal of Thoracic Disease, 2021;13(11):6217-6229, DOI: 10.21037/jtd-21-1142) was formulated by the Otorhinolaryngology & Ophthalmology Group of the Chinese Society of Allergy (CSA), focusing on standardizing the application of transnasal corticosteroid nebulization for chronic rhinosinusitis (CRS), balancing efficacy and safety, and addressing perioperative/postoperative management and special scenarios (e.g., COVID-19 pandemic). Below is a structured English summary.

1. Core Background & Scope

1.1 Definition & Rationale

Transnasal nebulization delivers corticosteroids as fine aerosols (1–5 μm) to nasal and sinus mucosa, achieving deeper penetration and higher local deposition than nasal sprays, with fewer systemic side effects than oral corticosteroids.
Target population: Adult and pediatric CRS patients (with/without nasal polyps [CRSwNP/CRSsNP]), especially those unresponsive to nasal sprays or intolerant to systemic steroids.

1.2 Key Objectives

Clarify indications, device selection, medication regimens, efficacy/safety, and perioperative/postoperative application.
Provide evidence-based guidance for clinical decision-making and patient education.

2. Device Selection & Technical Standards

Device Type	Working Principle	Recommended Scenarios	Key Parameters
Jet nebulizer	Compressed air generates aerosols	Routine CRS treatment (adults/children)	Particle size 1–5 μm, flow rate 6–8 L/min, residual volume <0.5 mL
Ultrasonic nebulizer	Ultrasonic vibration atomizes liquid	Patients with severe nasal congestion; caution in CRSwNP (avoid high temperature affecting steroid stability)	Particle size 2–8 μm, power 25–50 W
Pulsed oscillation nebulizer	Pulsed airflow enhances sinus deposition	Postoperative patients; refractory CRS with poor sinus ventilation	Oscillation frequency 10–15 Hz, targeted sinus delivery

2.1 Technical Requirements

Pre-treatment: Clean nasal cavity (saline irrigation) to remove secretions; ensure skin electrode impedance <5 kΩ if monitoring.
Operation: Patient in semi - Fowler’s position, nebulizer nozzle inserted 0.5–1 cm into nostril, alternate nostrils every 2.5 min; treatment duration 5–10 min per session (2–4 mL of liquid).
Post - treatment: Rinse nebulizer with distilled water; disinfect detachable parts weekly.

3. Pharmacological Regimens & Indications

3.1 Recommended Medications & Doses

CRS Subtype	Preferred Drug	Dose	Course	Evidence Level
CRSwNP (mild - moderate)	Budesonide suspension	1–2 mg (2–4 mL) per session, once daily	2–4 weeks (acute phase); 1–2 weeks (maintenance)	High (RCT - proven symptom improvement and polyp reduction)
CRSsNP (recurrent)	Fluticasone propionate solution	0.5–1 mg (2–4 mL) per session, once daily	2 weeks (acute); 1 week (maintenance)	Moderate (clinical trial data)
Postoperative CRS	Budesonide + sodium hyaluronate	1 mg budesonide + 2 mL sodium hyaluronate, once daily	3–7 days (perioperative); 2 weeks (postoperative)	High (reduces edema and infection risk)
Pediatric CRS (≥4 years)	Budesonide suspension	0.5–1 mg per session, once daily	1–2 weeks (max 4 weeks)	Moderate (safety confirmed in pediatric trials)

3.2 Indications & Contraindications

Strong Indications

CRSwNP/CRSsNP unresponsive to ≥2 weeks of nasal sprays.
Postoperative patients (within 1 month) to reduce mucosal edema and prevent recurrence.
CRS with comorbid asthma (improves both nasal and respiratory symptoms).
Patients intolerant to oral corticosteroids (e.g., diabetes, osteoporosis).

Contraindications

Severe hypersensitivity to corticosteroids.
Untreated nasal/sinus fungal infection.
Active tuberculosis or viral infection of the upper respiratory tract (acute phase).

4. Efficacy Evaluation & Safety Monitoring

4.1 Efficacy Metrics

Symptom scores: TNSS (Total Nasal Symptom Score), SNOT - 22 (Sinonasal Outcome Test - 22), VAS (Visual Analog Scale for headache/smell impairment).
Endoscopic findings: Polyp size, mucosal edema, secretion amount.
Imaging: CT/MRI for sinus opacification (reserved for refractory cases).

4.2 Safety Profile & Management

Adverse Event	Incidence	Management
Local irritation (nasal dryness, burning)	5%–10%	Reduce dose; add sodium hyaluronate; rinse nose post - treatment
Oropharyngeal candidiasis	<2%	Rinse mouth with water after treatment; avoid long - term high - dose use
Systemic effects (adrenal suppression, growth retardation in children)	<1%	Limit treatment course to <4 weeks; monitor cortisol levels in long - term use (children: 3 - monthly growth monitoring)

5. Perioperative & Special Scenario Management

5.1 Perioperative Application

Preoperative (3–7 days): Nebulization to reduce mucosal edema, facilitate surgical exposure.
Postoperative (1–3 months): Routine nebulization (1–2 mg budesonide daily) for 2–4 weeks; combine with saline irrigation to promote mucosal healing and prevent adhesion.

5.2 COVID - 19 Pandemic Considerations

Continue nebulization for stable CRS patients; avoid treatment in shared spaces to prevent virus transmission.
Use disposable nebulizer kits; disinfect equipment thoroughly after each use.

6. Core Recommendations (English Version)

Device Preference: Jet nebulizers are preferred for routine CRS treatment; select ultrasonic/pulsed devices based on patient condition.
Medication Choice: Budesonide suspension is the first - line agent for CRSwNP; adjust dose by age/severity.
Treatment Course: Acute phase (2–4 weeks); maintenance phase (1–2 weeks) to prevent recurrence.
Perioperative Use: Mandatory for postoperative CRS (within 1 month) to reduce complications.
Safety Priority: Avoid long - term high - dose use; monitor for local/systemic side effects; educate patients on proper device cleaning.