{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T21:41:00Z","timestamp":1787866860196,"version":"build-2784847793"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2014,1,21]],"date-time":"2014-01-21T00:00:00Z","timestamp":1390262400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Budesonide is a potent corticosteroid commonly prescribed for management of inflammation in chronic rhinosinusitis (CRS). The standard for prescribing budesonide is via impregnated nasal saline irrigation (INSI), although recently the mucosal atomization device (MAD) has emerged as a theoretically superior method of distributing medication into the sinuses. The MAD atomizes medication into small droplets and this is thought to enhance absorption and improve bioavailability. However, no studies have shown whether enhanced absorption and improved bioavailability of budesonide via MAD causes adrenal suppression. The objective of this study is to determine whether budesonide via MAD affects the hypothalamic\u2010pituitary\u2010adrenal (HPA) axis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty CRS patients were recruited from a tertiary rhinology clinic and randomized to take budesonide (1\u00a0mg) via MAD or via INSI twice a day for 60\u00a0days. The adrenocorticotropic hormone (ACTH) stimulation test and 22\u2010item Sinonasal Outcomes Test (SNOT\u201022) questionnaire were administered on days\u00a01, 30, and 60 of the study. Plasma budesonide and cortisol levels were simultaneously quantified using a high\u2010performance liquid chromatography\u2013tandem mass spectrometry technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was no indication of adrenal suppression in either group (n = 20) based on ACTH stimulation test results nor was there significant plasma budesonide levels detected in either group. Quality of life, as indicated by SNOT\u201022, did not differ between groups at 60\u00a0days (<jats:italic>p<\/jats:italic> = 0.404; 95% confidence interval [CI], \u221237.2 to 15.9), but SNOT\u201022 scores for patients using MAD did show statistically significant improvement at 60\u00a0days compared to baseline (<jats:italic>p<\/jats:italic> = 0.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The MAD is likely a safe and effective method of delivering budesonide to the sinuses in the short term.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.21280","type":"journal-article","created":{"date-parts":[[2014,1,21]],"date-time":"2014-01-21T14:58:55Z","timestamp":1390316335000},"page":"397-402","source":"Crossref","is-referenced-by-count":39,"title":["The safety and efficacy of short\u2010term budesonide delivered via mucosal atomization device for chronic rhinosinusitis without nasal 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