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EDS FLU for CRS Treatment
Advancing CRS Care: EDS-FLU and the Future of Treatment Options

Released: December 09, 2024

Expiration: December 08, 2025

Edward El Rassi
Edward El Rassi, MD
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Key Takeaways
  • Chronic rhinosinusitis (CRS) is classified into CRS without nasal polyps and CRS with nasal polyps . While the 4 cardinal symptoms of CRS are the same for both CRSsNP and CRSwNP, the underlying causes differ.
  • Initial CRS management includes saline irrigations and intranasal corticosteroids. While intranasal corticosteroid sprays are affordable and accessible, a newer exhalational delivery system with fluticasone (EDS-FLU) has demonstrated better efficacy for symptom management.
  • EDS-FLU, which is supported by 2 pivotal clinical trials, ReOpen1 and ReOpen2, is approved by the FDA and provides an effective, nonsurgical treatment option for CRS patients who are unresponsive to standard therapies.

Chronic rhinosinusitis (CRS) affects approximately 30 million Americans, significantly affecting quality of life. The 4 cardinal symptoms of CRS are nasal obstruction or congestion, thick and discolored nasal drainage, facial pain or pressure, and reduced or lost sense of smell. Beyond these rhinologic symptoms, CRS imposes a significant burden on patients, often leading to fatigue, poor sleep quality, and decreased productivity.

CRS Classifications
CRS is classified into 2 primary phenotypes: CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP). CRSsNP represents the majority of cases, approximately 90% of patients, and is characterized by symptoms such as pressure, fullness, nasal discharge, and frequent bacterial infections. On the other hand, CRSwNP is primarily a chronic inflammatory condition with fewer infections and is less common, affecting approximately only 10% of patients.

CRS Treatment
First-line treatment for patients with CRS typically includes saline nasal irrigations and intranasal corticosteroid sprays. While intranasal sprays are affordable and accessible, their evidence for efficacy is limited. For patients with ongoing symptoms despite first-line treatment, a newer option, the exhalational delivery system with fluticasone (EDS-FLU) for intranasal corticosteroids, has demonstrated improved efficacy. For infectious or more severe symptoms, a course of oral antibiotics and/or oral corticosteroids should be considered. Refractory symptoms or the need for recurrent courses of oral antibiotics or oral corticosteroids should warrant referral to an otolaryngologist for advanced evaluation and consideration for functional endoscopic sinus surgery (FESS).

Exhalational Delivery Systems With Fluticasone
Introduced in 2021, the exhalational delivery system with fluticasone (EDS-FLU) has provided a novel approach for CRS treatment. It is a breath-powered, bidirectional delivery system that consists of a nasal nozzle, an oral nozzle, and a pressurized chamber. This unique delivery mechanism allows for broader and more effective distribution of the medication into the nasal cavity compared with standard intranasal sprays.

EDS-FLU is the first FDA-approved drug-device combination approved for treating CRSsNP. It offers a nonsurgical treatment option that can be used as a first-line therapy for CRS or for patients with persistent CRS symptoms despite the use of over-the-counter intranasal corticosteroid sprays and before escalation to surgery or systemic therapy.

The efficacy of EDS-FLU has been demonstrated in 2 randomized, placebo-controlled trials, ReOpen 1 and ReOpen 2, which assessed its use in patients with CRS. Patients treated with EDS-FLU showed greater improvement in nasal congestion and discharge, facial pain, and sense of smell compared with patients receiving placebo. Notably, patients who had not responded to the previous use of standard intranasal corticosteroid sprays also experienced symptom reduction from baseline with EDS-FLU, highlighting its role as effective secondary treatment. This advancement provides an effective and innovative option and broadens the therapeutic options in the management of patients with CRS.

Your Thoughts? 
What factors influence your decision to recommend EDS-FLU for patients with CRSsNP? Join the discussion by posting a comment below.

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In your clinical practice, how often do you recommend EDS-FLU for patients with CRSsNP who have failed other treatments?

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