Intranasal corticosteroids and saline: Usage and adherence in chronic rhinosinusitis patients

Abstract

Objective Intranasal saline irrigations and intranasal corticosteroids are supported by level‐1 evidence for medical management of chronic rhinosinusitis (CRS). We sought to study adherence with these medications. Methods Prospective study of 174 patients with CRS. Patients reported their usage of intranasal saline irrigation and intranasal corticosteroid over the preceding 3 months, at presentation, and a subsequent follow‐up visit 3 to 12 months later. Adherence was defined as reported medication usage for ≥6 days per week. Results At the time of presentation, 44.3% of patients were using an intranasal corticosteroid spray or irrigation ≥6 days/week, whereas only 24.1% were using saline irrigation ≥6 days per week. At follow‐up, 60.3% of patients were using either an intranasal corticosteroid spray or irrigation ≥6 days per week, whereas 35.6% were using saline irrigation ≥6 days per week. Adherence with intranasal corticosteroids was associated with comorbid asthma (adjusted odds ratio [OR] = 2.68, 95% confidence interval [CI]: 1.10–6.50, P = 0.029), allergy (OR = 2.22, 95% CI: 1.05–4.71, P = 0.037), and change in 22‐item Sinonasal Outcome Test score (OR = 0.98, 95% CI: 0.96–0.99, P = 0.027). Use of intranasal corticosteroid sprays versus irrigations (OR = 2.56, 95% CI: 0.84–7.83, P = 0.099) was suggestive of association with improved adherence. Adherence with intranasal saline irrigation was associated with age (OR = 1.02, 95% CI: 1.01–1.05, P = 0.034). Conclusion Usage and adherence with intranasal steroids and saline may be low in CRS patients even with management in a tertiary level, subspecialty rhinology clinic. Adherence with medications represents a major opportunity for improving patient care and outcomes, specifically by targeting patients with lower disease burden and improving convenience of medications. Level of Evidence 2C Laryngoscope, 130:852–856, 2020

Antibiotic eluting sinus stents

“…[35][36][37][38] However, recent research has shown that patient adherence to saline irrigation and intranasal steroids are typically less than 25% and 50%, respectively. 39 Additionally, the duration of drugmucosa interaction of nasal sprays is typically less than a few hours secondary to ciliary clearance of the drug. 40 Low patient adherence combined with innately low mucosal-drug contact time dictates the need for alternative topical therapies that allow for prolonged therapeutic intervention without concern for patient nonadherence.…”

“…In addition, rinses can be done alone or in combination with topical steroid use, which has been shown to improve symptom burden 35‐38 . However, recent research has shown that patient adherence to saline irrigation and intranasal steroids are typically less than 25% and 50%, respectively 39 . Additionally, the duration of drug‐mucosa interaction of nasal sprays is typically less than a few hours secondary to ciliary clearance of the drug 40 .…”

Perceived Financial Insecurity Impacts Healthcare Decision‐Making Among Patients With Sinusitis

“…[13][14][15][16] Perceived financial insecurity may lead to decisions that disrupt optimal care including medication nonadherence and inability to maintain necessary follow-up or multidisciplinary care. 15,17 This may also compromise surgical outcomes if patients do not adhere to medication and follow-up recommendations. 16 Understanding personal financial concerns can help guide healthcare providers when making recommendations regarding treatment.…”

“…16 Understanding personal financial concerns can help guide healthcare providers when making recommendations regarding treatment. 11,[15][16][17][18] In addition, engaging patients in shared decision-making, accounting for their financial concerns, may lend toward improved patient compliance and ultimately improved outcomes. 16,[19][20][21] The purpose of this study was to describe and evaluate how individual perceived financial burden may associate with personal cost-saving healthcare decisions that can impact quality of life (QOL) and outcomes in patients with self-identified sinusitis.…”

Exploring Adherence to Treatment in Nasal Polyposis

“…As in other respiratory diseases [3][4], adherence to treatment has been previously explored in CRSwNP, finding low use of INCS and abandonment [5]. Rudmik [8].…”