The ideal nasal steroid should be:
- Easily administered or directed into the nose, most often in the form of a spray
- Physiologic or not harmful to the nasal mucous membrane
- Compatible with the normal nasal functions of regulation of humidification and cleansing air en route to the lungs
- Not absorbed into the general circulation to avoid the adverse effects of systemic steroids
- Relatively slow acting to permit once or twice daily usage in most patients, and
- Effective in minimizing inflammation within the nose.
Nasal steroid sprays have evolved from meeting few of the above requirements to now being both safe and effective in most patients. To meet these requirements, these sprays must be used daily and will often require weeks before their benefits are apparent to the patient. They should be sprayed towards the inner margin of the eye, which directs them towards the point of drainage of most of the sinuses. However, these drugs can cause nasal bleeding due to atrophy or erosion of the nasal mucous membrane, and require supervision by an ophthalmologist in those patients with glaucoma or cataracts.
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