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Intranasal corticosteroids and saline: Usage and adherence in chronic rhinosinusitis patients
Author(s) -
Phillips Katie M.,
Hoehle Lloyd P.,
Caradonna David S.,
Gray Stacey T.,
Sedaghat Ahmad R.
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28152
Subject(s) - medicine , nasal administration , saline , corticosteroid , nasal lavage , chronic rhinosinusitis , odds ratio , nasal spray , asthma , prospective cohort study , anesthesia , surgery , nose , immunology
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