DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20210155

Patient education on nasal spray technique for allergic rhinitis

Fauziah B. Nasir, Balwinder S. Mann

Abstract


Background: Allergic rhinitis (AR) is a common condition worldwide. Intranasal corticosteroid spray (INCS) is the mainstream and effective first line monotherapy treatment of AR. However, the efficacy of INCS may be dependent on factors such as the patient’s compliance and delivery technique of the nasal spray. The correct delivery technique of INCS depends on the adequacy of patient education. Hence, our study was conducted to assess the benefit of the different methods of patient education and the best method of patient education on INCS usage technique. Objectives of the study were to determine if proper education in the usage of ICNS affected the treatment of AR and to determine the best teaching method of nasal spray technique using both subjective and objective methods of assessment.

Methods: This is a prospective study that was performed over 2 years duration from the year 2017 until 2019. A total of 96 patients were recruited based on our inclusion and exclusion criteria. The effectiveness of the different methods of teaching were determined both subjectively by total nasal symptom score (TNSS) and objectively using Rhinomanometry test. The teachings method became increasingly more comprehensive as compared to the previous visit. Assessment was done every six weeklies for 4 times after each teaching methods of nasal spray usage on each visit. All Rhinometry test and patients follow up of was done by the same surgeon.

Results: There was statistically significant improvement (p<0.05) in patients symptoms based on the nasal resistance and TNSS with more comprehensive method of teaching nasal spray.

Conclusions: Our study showed the importance of educating patient regarding the use of INCS. Both objective and subjective assessment of improvement after each method of patient education showed statistically significant outcome.


Keywords


Allergic rhinitis, Teaching method, Intranasal corticosteroids, Rhinomanometry, Total nasal symptom score

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References


Anolik R. Clinical benefits of combination treatment with mometasone furoate nasal spray and loratadine vs monotherapy with mometasone furoate in the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 2008;100(3):264-71.

Axtell S, Haines S, Fairclough J. Effectiveness of Various Methods of Teaching Proper Inhaler Technique: The Importance of Pharmacist Counsellin. J Pharm Pract. 2017;30(2):195-201.

Loh CY, Chao SS, Chan YH, Wang DY. A clinical survey on compliance in the treatment of rhinitis using nasal steroids. Allergy. 2004;59(11):1168-72.

Asha’ari ZA, Yusof S, Ismail R, Che CM, Path M. Clinical Features of Allergic Rhinitis and Skin Prick Test Analysis Based on the ARIA classification: a preliminary study in Malaysia. Ann Academy Med Singapore. 2010;39(8):7.

Ganesh V, Banigo A, McMurran AEL, Shakeel M, Ram B. Does intranasal steroid spray technique affect side effects and compliance? Results of a patient survey. J Laryngol Otol. 2017;131(11):991-6.

Price D, Bond C, Bouchard J, Costa R, Keenan J, Levy ML et al. International Primary Care Respiratory Group (IPCRG) Guidelines: Management of allergic rhinitis. Prim Care Respir J. 2006;15(1):58-70.

Clement FG. Standardisation Committee on Objective Assessment of the Nasal Airway, IRS, and ERS. Consensus report on acoustic rhinometry and rhinomanometry. Rhinol. 2005;43:169-79.

Bousquet J, Van Cauwenberge P, Khaltaev N, Aria Workshop Group, World Health Organization. Allergic Rhinitis and Its Impact on Asthma. J Allergy Clin Immunol. 108(5):S147-334.

Chong LY, Head K, Hopkins C, Philpott C, Schilder AG, Burton MJ. Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis. Cochrane ENT Group, editor. Cochrane Database Syst Rev. 2016;4:CD011996

Merkus P, Ebbens FA, Muller B, Fokkens WJ. The ‘best method ‘of topical nasal drug delivery: comparison of seven techniques. Rhinol. 2006;44(2):102-7.

Rollema C, Van Roon EN, De Vries TW. Inadequate quality of administration of intranasal corticosteroid sprays. J Asthma Allergy. 2019;12:91-4.

Benninger MS, Hadley JA, Osguthorpe JD, Marple BF, Leopold DA, Derebery M.J et al. Techniques of Intranasal Steroid Use. Otolaryngol Neck Surg. 2004;130(1):5-24.

Basheti IA, Reddel HK, Armour CL, Bosnic-Anticevich SZ. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol. 2007;119(6):1537-8.

McElnay JC, Scott MG, Armstrong AP, Stanford CF. Audiovisual Demonstration for Patient Counselling in The Use of Pressurised Aerosol Bronchodilator Inhalers. J Clin Pharm Ther. 1989;14(2):135-44.

Bousquet J, Schunemann HJ, Togias A, Bachert C, Erhola M, Hellings PW et al. Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol. 2019;145(1):70-80.e3.