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Since steroids generally take many hours before they begin to take effect, nasal steroids do not work well on an as-needed basis and need to be used routinely for best results. A steroid nasal spray or an aerosol has been marketed for treatment of sinusitis. The use of the steroid at bedtime is not recommended. Inhalation treatments for sinusitis include both oral and parenteral. There are two oral steroid inhalers available (the inhaler for nasal sprays and the nasal spray) and one nasal spray based on a formulation of steroid. Both are used on an as-needed basis (as needed due to the condition) and both reduce symptoms well. The inhalers have similar pharmacokinetic properties so their use can be combined with other treatments, such as steroids that prevent or delay the onset of symptoms. The nasal sprays have been shown to benefit a variety of diseases associated with sinusitis, such as chronic asthma, chronic obstructive pulmonary disease, and bronchitis. Pharmacokinetic When given at bedtime, inhaler steroid inhalers typically have a half-life of 2-4 hours, but some patients can be allergic to the steroids. Absorption Parenteral steroids are rapidly absorbed and there is little or no plasma phase change. As such, there is no significant increase in the rate of elimination. Pharmacodynamic Absorption is approximately half that seen with topical or oral drugs. At approximately 3-4 hours of the steroids' time of onset, their plasma levels increase 2-fold and 50% of serum steroids are cleared from the blood by this time, leaving approximately 30% in the urine and remaining half to be cleared by the liver, kidneys, and intestine. A few drugs are rapidly cleared from the body by the liver and intestine (eg, corticosteroids of the class prednisolone and prednisolone sulfate). Approximately 60% of the systemic steroids are cleared (but may remain in the circulatory system at least 1-2 days) and some drugs not cleared by the liver, intestines, or kidneys are rapidly re-esterified. This is why most steroids stay in the body for at least 1 more day (the time that passes from the time the drug is taken and its time of elimination to that time of re-esterification). Inhalation The onset of steroid oral (nasal) use is about 8 hours old, which is longer than the onset of oral (nasal) use for topical steroids. Nasal use is generally longer than for topical