Association between the correct use of intranasal aerosols and symptom improvement in allergic rhinitis

Main Article Content

Gabriela Galindo Rodríguez
Karen Patricia Chávez Jiménez
Sandra Nora González Díaz
Carlos Macouzet Sánchez
Cindy Elizabeth de Lira Quezada

Keywords

Aerosols, allergic rhinitis, education, follow-up, intranasal

Abstract

Objective: Allergic rhinitis (AR) is highly prevalent worldwide. Good patient adherence ensures successful treatment. This study aimed to identify the association between the intranasal aerosol technique and symptom improvement.


Methods: This is an analytical, prospective, and longitudinal study that included 36 patients diagnosed with AR. The Rhinitis Control Assessment Test (RCAT) questionnaire was administered to both an experimental population and a control group. The 11 steps of the intranasal aerosol technique were explained to the experimental group, and performance was graded using a pamphlet for patient follow-up in subsequent controls.


Results: Of the participants, 63.9% were women and 36.1% were men, with a median age of 30 years (IQR 24-42) and an age range from 18 to 69 years. An average RCAT percentage of 55.6% was observed in both groups during the first consultation. On the second visit, a difference in disease control was noted. In the experimental group, 83.3% had controlled symptoms, whereas only 61.1% of the control group did. At the third visit, 76.5% of the experimental group had controlled symptoms, compared to 58.8% of the control group. In the experimental group, 52.9% of patients demonstrated good technique, while only 5.9% in the control group did (p=0.004).


Conclusions: Patient education and training, compared to an untrained group, benefit the patient by aiding in the remission of symptoms and improving quality of life.

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References

1 Scadding GK, Durham SR, Mirakian R, et al. BSACI Guidelines for the treatment of allergic and non-allergic Rhinitis. Clin Exp Allergy. 2008; 38:19–42. 10.1111/j.1365-2222.2007.02888.x

2 Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, Van Weel C, Agache I. Allergic rhinitis and its impact on asthma (ARIA) 2008. Allergy. 2008 Apr;63:8–160. 10.1111/j.1398-9995.2008.01642.x

3 Aït-Khaled N, Pearce N, Anderson HR, Ellwood P, Montefort S, Shah J; ISAAC Phase Three Study Group. Global map of the prevalence of symptoms of rhinoconjunctivitis in children: The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Allergy. 2009;64(1):123–48. 10.1111/j.1398-9995.2008.01884.x

4 Bjorksten B, Clayton T, Ellwood P, et al. Worldwide Temporal Trends for Rhinitis and Conjunctivitis Symptoms: Phase III of the International Study of Asthma and Allergies in Childhood. Pediatric Allergy Immunol. 2008; 19:110–24. 10.1111/j.1399-3038.2007.00601.x

5 Keil T, Bockelbrink A, Reich A, et al. The Natural History of Allergy Rhinitis in Childhood. Pediatric Allergy Immunol. 2010; 21:962–69. 10.1111/j.1399-3038.2010.01046.x

6 Levin ME. Allergic rhinitis education. Curr Allergy Clin Immunol. 2014; 27(2), 101–106.

7 Corbett M, Garry S, Mc Gloughlin E, Hinchion K, Keogh, I. Treating rhinitis with topical nasal sprays: patient knowledge, use and satisfaction. Ir Med J. 2020; 113(8):154–57.

8 Meltzer EO, Blaiss MS, Naclerio RM, Stoloff SW, Derebery MJ, Nelson HS, Boyle JM, Wingertzahn MA. Burden of allergic rhinitis: allergies in America, Latin America, and Asia-Pacific adult surveys. Allergy Asthma Proc. 2012;33 Suppl 1: S113–41. 10.2500/aap.2012.33.3603

9 Roberts G, Mylonopoulou M, Hurley C, et al. Impaired quality of life is directly related to the level of allergen exposure and allergic airway inflammation. Clin Exp Allergy. 2005;35:1295–300. 10.1111/j.1365-2222.2005.02333.x

10 Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet. 2011; 378:2112–22. 10.1016/S0140-6736(11)60130-X

11 Takhar P, Smurthwaite L, Coker HA, et al. Allergen drives class switching to IgE in the nasal mucosa in allergic rhinitis. J Immunol. 2005; 174:5024–32. 10.4049/jimmunol.174.8.5024

12 Altıntoprak N, Kar M, Bayar Muluk N, Oktemer T, Ipci K, Birdane L, et al. Update on local allergic rhinitis. Int J Pediatr Otorhinolaryngol. 2016; 87:105–9. 10.1016/j.ijporl.2016.06.008

13 Gould HJ, Sutton BJ, Beavil AJ, Beavil RL, McCloskey N, Coker HA, et al. The biology of IGE and the basis of allergic disease. Ann Rev Immunol. 2003; 21:579–628. 10.1146/annurev.immunol.21.120601.141103

14 Gould HJ, Sutton BJ. IgE in allergy and asthma today. Nat Rev Immunol. 2008; 8:205–17. 10.1038/nri2273

15 Vazquez D, Onetti CI, Moreno P, et al. Treatment of allergic rhinitis in adults in Argentina. Update document. Archives of Allergy and Clinical Immunology. 2021, 52(Suppl 1), 7–36.

16 Vance G, Lloyd K, Scadding G, et al. The “unified airway”: the RCPCH care pathway for children with Asthma and/or Rhinitis. Acordis Child. 2011;96 (Suppl 2): i10–14. 10.1136/adc.2011.213462

17 Benninger MS, Ahmad N, Marple BF. The Safety of intranasal steroids. Otolaryngol Head Neck Surg. 2003;129(6):739–50. 10.1016/j.otohns.2003.10.001

18 Erskine SE, Verkerk MM, Notley C, Williamson IG, Philpott CM. Chronic rhinosinusitis: experiences of primary and secondary care patients: a qualitative study. Clin Otolaryngol. 2016; 41:8–14. 10.1111/coa.12462

19 Kublik H, Vidgren MT. Nasal delivery systems and their effect on deposition and absorption. Adv Drug Delivery Rev. 1998; 29:157–177. 10.1016/S0169-409X(97)00067-7

20 Del Cuvillo A. Adaptation to Spanish and validation of the Rhinitis Control Assessment test questionnaire. J Investig Allergol Clin Immunol. 2020; 30(3):175–181 10.18176/jiaci.0420

21 Nathan RA. The rhinitis control evaluation test: implications for the present and future. Curr Opin Allergy Clin Immunol. 2014;14:13–9. 10.1097/ACI.0000000000000020

22 Demoly P, Calderón MA, Casale T, Scadding G, Annesi-Maesano I, Brown J, et al. Evaluation of disease control in allergic rhinitis. Clin Transl Allergy. 2013; 3:7. 10.1186/2045-7022-3-7

23 Hellings PW, Fokkens WJ, Akdis C, Bachert C, Cingi C, Dietz de Loos D, et al. Uncontrolled allergic rhinitis and chronic rhinosinusitis: where are we? this day? Allergy. 2013; 68:1–7. 10.1111/all.12040

24 Nathan RA, Dalal AA, Stanford RH, Meltzer E, Schatz M, Derebery J, et al. Qualitative development of the Rhinitis Control Assessment Test (RCAT), an instrument to assess the control of rhinitis symptoms. Patient 2010; 3:91–9. 10.2165/11318410-000000000-00000

25 Ganesh V, Banigo A, McMurran AEL, Shakeel M, Ram B. Does the intranasal steroid spray technique effect side effects and compliance? Results of a patient survey. J Laryngol Otol. 2017; 131:991–96. 10.1017/S0022215117002080

26 Rollema C, van Roon EM, Schilder AGM, et. to the. Evaluation of instructions in patient information leaflets for the use of intranasal corticosteroid aerosols: an observational study. BMJ Open. 2019; 9:e026710. 10.1136/bmjopen-2018-026710

27 Binita, KC, Khan, GM and Shrestha, N. Nasal spray technique among patients attending the outpatient department of a tertiary care hospital, Gandaki province, Nepal. Integrated Pharmacy Research and Practice. 2020; 9:155. 10.2147/IPRP.S266191

28 Rattanawong, S., Wongwattana, P., & Kantukiti, S. Evaluation of the techniques and steps of the administration of intranasal corticosteroid aerosols. Asia Pacific Allergy. 2022; 12(1). 10.5415/apallergy.2022.12.e7

29 Pathak, RK. Educating Patient regarding the use of INCS technique for allergic rhinitis: an intervention study. Int J Pharm Clin Res. 2021;13(1):26–35

30 Rollema, C., van Roon, EN, de Vries, TW Inadequate quality of administration of intranasal corticosteroid sprays. J Asthma Allergy. 2019; 91–94. 10.2147/JAA.S189523

31 de Boer, M., Rollema, C., van Roon, E., & de Vries, T. Observational study of administering intranasal steroid sprays by healthcare workers. BMJ Open. 2020; 10(8):e037660. 10.1136/bmjopen-2020-037660

32 Kc B, Khan GM, Shrestha N. Nasal spray use technique among patients attending the out-patient department of a tertiary Care Hospital, Gandaki Province, Nepal. Integrated Pharmacy Research and Practice. 2020; 155–60. 10.2147/IPRP.S266191