What are Chronic Nasal Inflammatory Diseases (CNID)?
CNID: An Overview
CNID describes a set of bothersome, often debilitating conditions in which patients suffer from symptoms related to irritation deep in the nasal passages that lasts longer than two to three months. These conditions include chronic sinusitis (with or without nasal polyps) and various types of chronic rhinitis and perennial rhinitis. Symptoms commonly associated with CNID include congestion and blockage of the nose, facial pain and/or pressure, bothersome nasal drip or post-nasal drip, which may be thick or discolored, and reduction or loss of smell and taste.
Patients with more severe cases may have disturbed sleep, difficulty breathing, associated infections, cough (which may be worse at night), fatigue, bad breath, nausea, ear pain and worsening of asthma. People with CNID can experience a serious negative effect on the activities of their daily living, including in their ability to work, exercise and engage in typical social and leisure activities.
While CNID patients of all types may have exacerbations during allergy season, those with CNID tend to have significant nasal and sinus symptoms even after their allergy season has passed. The quality of life of people suffering from the more serious CNID has been reported to be lower than for patients suffering from asthma, angina and other chronic debilitating conditions.
Current treatments and their limitations
Many CNID patients try multiple treatments to try and obtain relief, from homeopathic remedies to over-the-counter and prescription medications, often without success.
Commonly used over-the-counter and prescription medications such as decongestants, anti-histamines, nasal steroid sprays and even oral steroids may effectively alleviate symptoms in some patients. Unfortunately, decongestants may not work very well, or may cause side effects or even worsening of congestion, especially when used frequently. Antihistamines may only help a little or may be completely ineffective for the non-allergic chronic inflammation, and oral steroids – while often effective – can only be used for short periods because of their side effects. Typical steroid nasal sprays help where they reach, but they are not very good at reaching the target areas high up and far back in the nasal cavity where most of the inflammation is located. Because the target areas are where the sinuses open into the nasal cavity, as well as where nasal polyps often originate, standard nasal sprays provide limited benefit.
Neti pots or nebulizers can help with some CNID symptoms by “rinsing” the nose, but for many people they are hard to learn to use correctly, time consuming and quite inconvenient. Together, the cost of these nasal rinses, multiple over-the-counter remedies and prescription medications that CNID sufferers use can really add up.
For patients with chronic rhinosinusitis (with or without nasal polyps), surgery may be an option and can be successful. However, it is not uncommon for people to fear surgery. In some cases, a single surgery is insufficient and repeat procedures may be necessary. One of the purposes of surgery is to open parts of the nose so that medication can penetrate more effectively, so even after surgery, it is very common for sufferers to continue to use various treatments to try and get relief.
OptiNose is currently conducting clinical studies for our candidate drug-device combination, OPN-375, to investigate the benefits of using a new type of device that gently propels steroid medication deeper into the nasal cavity in order to target more of the inflammation.
J.P.Morgan, August 18, 2014