Corticosteroid Exposure in Chronic Rhinosinusitis and Global Airway Disease: Adrenal and Bone Impact

Abstract

Objective: To investigate cumulative corticosteroid (CC) burden in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), with or without coexisting asthma (global airway disease, GAD), referred for biologic treatment, and to assess the prevalence of CC-related comorbidities, including secondary adrenal insufficiency, osteopenia and/or osteoporosis. Methods: Prospective cohort study of adults with chronic rhinosinusitis with nasal polyps and/or GAD referred to tertiary care for biologic treatment evaluation: Assessments included DXA scan, corticosteroid case history, Synacthen test, and analyses of cumulative CS exposure (systemic [SCS], inhaled [ICS], and nasal [NCS]) using prescription data. Results: Of 90 referred patients, 87 (97%) had complete data set and were included in the final cohort. The prevalence of Type 2 diabetes was significantly higher among patients with CRSwNP only compared with GAD (26% vs. 4%, p = 0.019), whereas subclinical adrenal suppression was detected only in the GAD group (6%, 4/70). Rates of osteopenia or osteoporosis were comparable (47% vs. 43%). Higher CC exposure was associated with lower bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip (all p < 0.02). Notably, these rates are considerably higher than those reported for the general Danish population aged ≥ 50 years, in which approximately 21.1% of women and 6.5% of men are estimated to have osteoporosis. Conclusion: Patients with CRSwNP and GAD had a substantial CC burden from combined systemic, inhaled, and nasal steroid use. This was associated with subclinical adrenal suppression and reduced BMD, while Type 2 diabetes was more prevalent in patients only with CRSwNP. Level of Evidence: 4.