Factors affecting correct technique and compliance of intranasal corticosteroid spray usage in patients with allergic rhinitis

Abstract

Objective: To identify factors affecting correct technique and compliance of intranasal corticosteroid (INCS) spray usage in patients with allergic rhinitis. Methods: It was a cross-sectional study conducted in the Dept of ENT-Head and Neck surgery, Tribhuvan University Teaching Hospital from April to September 2023. Patients aged 18 or more with allergic rhinitis on INCS or used INCS in the past three months were assessed for INCS administration technique based on EPOS 2020 protocol and their compliance asked. Factors that could hinder the correct techniques and compliance were assessed. Results: A total of 138 patients, 71 males and 67 females, aged 18 to 72 years were included. Most of them (60/138; 43.5%) had completed secondary level education. 97.1% (134/138) had been prescribed INCS spray by an ENT doctor and 89.13% (124/ 138) patients had received verbal instructions mostly by ENT doctor (91.1%). 7.2% (10/138) patients completed all the steps of INCS administration technique as per EPOS 2020 protocol whilst 25/138 (18.1%) completed five essential steps. The correctness of the INCS administration technique however did not differ with age, gender, academic qualification, prescriber or whether instructions were given or not. Compliance was seen in 119/138 (86.2%). Amongst the 19 (13.7%) non-compliant patients, improvement in nasal symptoms in 13, no symptom improvement in two, cost factor in two and side effects like nasal irritation in two were observed. These factors were statistically different between compliant and non-compliant patients. The correctness of the technique did not affect the compliance. Conclusion. INCS spray was scarcely administered in the correct technique however the compliance was good. There were no identifiable factors associated with correctness of the INCS spray technique however, the compliance depended on the cost, side effect to INCS. As for symptoms, both improvement or no improvement could deter compliance. Keywords: Intranasal corticosteroid, allergic rhinitis, compliance, spray technique