Are systemic effects from corticosteroid use greater with budesonide rinses compared to nasal sprays?

With the increased use of budesonide nasal rinses for chronic rhinosinusitis and nasal polyps, it seems appropriate to ask about the systemic effects of rinses versus nasal sprays. Two publications address this point, both of which are in the International Forum of Allergy and Rhinology. The first (Vol 6, page 228 2016) evaluated 35 patients on budesonide rinses for 36 months. An ACTH stimulation test showed a decrease in cortisol levels in 26 subjects. All were asymptomatic and continued the rinses. In the second paper (Vol 6 page 568 2016) 48 patients were evaluated after 22 months of budesonide rinse. 11 patients had lower cortisol levels after ACTH stimulation. All were asymptomatic and continued the rinses.

The authors raise the concer...