The following article is a part of conference coverage from the American College of Allergy, Asthma & Immunology 2020 Annual Scientific Meeting, being held virtually from November 13-15, 2020. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the ACAAI 2020 Annual Scientific Meeting.

An exhalation delivery system appears to more effectively apply topical steroids to nasal polyps (NPs) located in the ostiomeatal complex, according to the results of a recent study presented at the American College of Allergy, Asthma &Immunology (ACAAI) Annual Scientific Meeting, held virtually from November 13 to 15.

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Nasal polyps that originate in the ostiomeatal complex may block normal sinus ventilation and contribute to symptoms in patients with chronic rhinosinusitis with NPs (CRSwNP). However, smaller NPs in the ostiomeatal complex may not be detected via nasal speculum examination because they are difficult to visualize without rhinoendoscopy. Therefore, researchers simulated topical steroid application to evaluate the efficacy of an exhalation delivery system compared to the intranasal spray. To accomplish this, grade 1 and 2 NPs were fashioned from moldable materials and placed into the ostiomeatal complex of an anatomically correct nasal silicone cast.

Fluorescein (2%) was delivered with 2 sprays (100 µL) per nostril from either the exhalation delivery system with fluticasone or conventional intranasal spray with mometasone. The nasal cast was exposed to ultraviolet light and photographed through a nasal speculum and a 2.7 mm Storz 0° rhinoscope. Results were compared between application methods.

The exhalation delivery system managed to deliver topical steroid treatment to the frontal sinuses and olfactory regions despite grade 1 and 2 polyps in the ostiomeatal complex. Additionally, all nasal polyps were coated in the treatment, compared to standard intranasal spray, which had minimal coating of nasal polyps.

“Although conventional [intranasal spray] delivery to the ostiomeatal complex is very limited, the exhalation delivery system device efficiently delivers medication to polyps high and deep in the [ostiomeatal complex], which is essential to shrink/eliminate polyps and restore sinus ventilation,” the researchers concluded.


Bosso J, Palmer J, Djupesland P, Guerrero G, Sacks H. Topical steroid delivery to grades 1/2 nasal polyps: exhalation delivery system and conventional intranasal spray. Presented at: the American College of Allergy, Asthma &Immunology (ACAAI) Annual Scientific Meeting (Virtual Experience); November 13-15, 2020. Abstract P404.

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