Chronic rhinosinusitis
Inflammation of the nasal and paranasal mucosa lasting over 12 weeks with mandatory symptoms of obstruction or discharge. Subtypes: with nasal polyps (CRSwNP) and without (CRSsNP). EPOS 2020 grounds treatment in intranasal corticosteroids and saline irrigation; with polyps, add a short course of systemic steroids during flares; severe eosinophilic forms call for biologics (dupilumab, omalizumab, mepolizumab). Surgery follows medical failure or anatomical obstruction.
Also known as: CRS, Chronic sinusitis, CRSwNP / CRSsNP
Drugs used for this condition
- AFluticasone furoate (nasal)First line · Intranasal corticosteroidFirst-line for chronic rhinosinusitis per EPOS 2020. Long-term use, usually several months.
- AMometasone furoate (nasal)First line · Intranasal corticosteroidFirst-line for chronic rhinosinusitis with or without nasal polyps under EPOS 2020. Reduces polyp size, nasal congestion, and restores olfaction. Polyp dose: 2 sprays per nostril twice daily. Long-term use is the rule – often many months.
- CBromelain (pineapple enzyme)Add-on therapy · Proteolytic enzyme from Ananas comosus pineapple stem and fruit. EU registered NexoBrid (concentrate of proteolytic enzymes enriched in bromelain, EMA 2012) for enzymatic deep burn excision topical. Oral – supplement. AEMPS registered NexoBrid for specialised burn centre useBromelain in acute and chronic rhinosinusitis has one of the most substantiated evidence bases among supplement indications. Büttner 2013 prospective multicentre cohort study in 116 acute rhinosinusitis patients showed clinically meaningful symptom duration reduction (pain, nasal congestion, mucosal oedema) with bromelain 500 mg three times daily × 7 days added to standard therapy. Guo 2006 systematic review (4 RCTs) and later papers documented moderate positive effects. EPOS 2020 (European Position Paper on Rhinosinusitis and Nasal Polyps) for acute postviral rhinosinusitis recommends saline nasal irrigation, intranasal corticosteroids (mometasone, fluticasone, budesonide); bromelain is mentioned as an option with limited evidence base. This is adjunct therapy, not standard treatment replacement. Note bleeding risk in patients on antiplatelets and anticoagulants. If bromelain is recommended for chronic rhinosinusitis with polyps instead of intranasal steroids and ENT evaluation, consider seeking a second opinion.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit