Rhinitis control in patients with persistent rhinitis is poor
Published: April 25, 2024
Rhinitis is a frequently encountered chronic condition, characterized by nasal congestion, sneezing, nasal itch, and a runny nose. The impact of rhinitis on patients’ quality of life is substantial, affecting sleep, physical and social functioning, and leading to decreased work/school performance and increased medical costs. The concept of rhinitis control has only recently emerged, and it represents the level to which patients’ symptoms are under control so they no longer interfere with daily life. In scientific literature, several factors have been identified that might influence rhinitis control, including factors that are related to patient behavior, such as nasal spray technique or adherence to therapy. However, little research has been done on rhinitis control in a real-world group of patients with persistent rhinitis.
In their study published in The Journal of Allergy and Clinical Immunology: In Practice, Scheire et al. investigated rhinitis control in a real-world sample of patients with persistent rhinitis. A total of 1,514 patients were recruited in 215 community pharmacies in Belgium. Patients completed multiple questionnaires that evaluated medical history, nasal symptoms, rhinitis medication use, adverse effects of treatment, etc. For current nasal spray users, nasal spray technique was observed and scored. Adherence to nasal corticosteroid sprays was calculated for patients that had been using this treatment for at least one year for the treatment of all-year round symptoms.
About 60% of study participants demonstrated suboptimal rhinitis control level, defined as having a Rhinitis Control Assessment Test score ≤ 21/30. Regarding rhinitis medication selection, Scheire et al. identified that the most frequently used treatment for persistent rhinitis was nasal corticosteroid sprays (55% of participants), followed by a high use of nasal decongestants (47% of participants). Nasal decongestants are sprays or drops used to treat nasal congestion. Guidelines advise using these only for short-term treatment (3-10 days) of nasal congestion, because long-term usage can lead to a vicious cycle where nasal congestion is temporarily relieved, but ultimately also caused by the treatment itself. Strikingly, 65% of patients in this study had been using the nasal decongestant daily for at least one year, which is cause for concern. Moreover, about a third of participants acknowledged ever having received systemic corticosteroids (either by mouth or by injection) for the treatment of nasal symptoms. Guidelines advise using this type of treatment only for patients with severe symptoms or symptoms unresponsive to other treatment due to the possibility of both short- and long-term adverse effects. About 11% of patients experienced adverse effects of their current treatment for rhinitis symptoms, with oral decongestants most frequently inflicted. Scheire et al. also found that, despite patients perceiving nasal spray technique as easy, their actual technique was poor. Only 10.3% of nasal spray users were able to administer the spray without making a single error. In patients for whom adherence to nasal corticosteroid sprays could be calculated, about 55% were considered non-adherent, defined as having a supply of sprays at home to cover less than 80% of the time. Lastly, the authors were also able to identify factors that were associated with lower rhinitis control. Knowledge of these factors could help direct future interventions to optimize rhinitis control for patients who would benefit the most.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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