Comparison of the distribution of intranasal steroid spray using different application techniques

Tay, Sok Yan; Chao, Siew Shuen; Mark, Kim Thye Thong; Wang, De Yun

doi:10.1002/alr.21807

Cited by 17 publications

(18 citation statements)

References 15 publications

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“…Further, the head should be held in a neutral position to maximize administration into the nasal mucosa 14 . However, studies have demonstrated that many patients have suboptimal technique, preventing appropriate intranasal distribution of the medication 15,16 …”

mentioning

confidence: 99%

Understood? Evaluating the readability and understandability of intranasal corticosteroid delivery instructions

Lee

Brown

Gelpi

et al. 2020

Int Forum Allergy Rhinol

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Background Allergic rhinitis is a widespread disease that has significant quality‐of‐life ramifications. Symptoms include rhinorrhea, nasal obstruction, cough, and postnasal drip. Intranasal corticosteroids are a hallmark of treatment of allergic rhinitis. However, the benefits of treatment are dependent on correct nasal spray technique, of which many patients are not aware. Patient instructions are included with the purchase of these medications. The readability and understandability for these educational materials has been minimally assessed in the medical literature. The aim of this study was to evaluate the readability and understandability of commonly used intranasal steroids. Methods Three readability measures (Gunning Fog, Simple Measure of Gobbledygook [SMOG], and FORCAST) and an understandability assessment (Patient Education Materials Assessment Tool for Printable Materials [PEMAT‐P]) were used to evaluate the instructions for use of commonly prescribed intranasal steroids. Instructions with 6th grade readability level or lower were considered to meet health literacy experts’ recommendations. Higher understandability values correlate to easier understandability. Results Instructions for 10 intranasal corticosteroid brands were reviewed. Gunning Fog consistently estimated easiest readability, whereas FORCAST estimated most difficult readability. Twenty percent (20%) of analyzed instructions met National Institutes of Health and health literacy experts’ recommended reading levels. Understandability of instructions ranged from 33% to 90%, with an average of 66%. Conclusion The benefit of intranasal corticosteroids is contingent on correct use by patients. However, the prepackaged instructions provided are most often above recommended reading levels and are difficult to understand. Future development of intranasal steroid instructions should meet recommended readability levels and be understandable to maximize their utility.

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confidence: 99%

Understood? Evaluating the readability and understandability of intranasal corticosteroid delivery instructions

Lee

Brown

Gelpi

et al. 2020

Int Forum Allergy Rhinol

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“…There is a study that confirms this theory. 12 When administering the nasal spray, the nozzle should be directed away from the nasal septum to prevent nose bleeding and septum perforation. Furthermore, the lateral nasal wall has more cilia than the medial wall, so the distribution of the active substance is better.…”

Section: Discussionmentioning

confidence: 99%

“…This technique provides the best distribution of the medication. [10][11][12] In a recent study, we observed the method of administration among patients and found that most (94%) did not take their INCS as described in the patient information leaflets (PILs). 13 Moreover, the available PILs are currently incomplete and non-uniform.…”

Section: Introductionmentioning

confidence: 99%

Observational study of administering intranasal steroid sprays by healthcare workers

Boer

Rollema

Roon³

et al. 2020

BMJ Open

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ObjectivesPatients with allergic rhinitis receive their information about administering intranasal corticosteroid sprays (INCS) from healthcare workers. Since the majority of patients does not administer these sprays correctly, we investigated whether healthcare workers know how to administer INCS.SettingsWe studied participants at their working place: pharmacy, outpatient clinic or general practitioner centre for emergencies.ParticipantsPharmacist assistants, general practitioners, paediatricians and ear nose throat doctors.DesignObservational study. All the participants demonstrated the administration technique with a spray device filled with water.Primary outcomeNumber of steps of administration of INCS based on the established INCS protocol.Secondary outcomeNumber of five steps are labelled essential to obtain optimal distribution of the medication.ResultsAmong the 75 participants, none performed all the steps correctly. The median of correctly performed steps in the protocol was 14 out of 29. A significantly better result was found among the pharmacist assistants. The essential steps were performed by 27 out of the 75 participants (36%).ConclusionThe majority of healthcare workers does not know how to administer INCS correctly. Patients could, therefore, receive incorrect and non-uniform instructions. The education of healthcare workers on how to administer INCS correctly may be an option for improvement.

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“…Further to this, patients must be shown how to use their intranasal sprays correctly. Little is known about the proportion of patients who use their intranasal medication correctly; however, the way in which the patient uses their intranasal spray does impact on the way in which the spray distributes in the nasal cavity and the occurrence of local side effects . Therefore, as with asthma devices, it is recommended that pharmacists train the patient how to use their intranasal device with a placebo device.…”

Section: Management Of Allergic Rhinitis In the Pharmacy: Aria‐pharmamentioning

confidence: 99%

ARIA pharmacy 2018 “Allergic rhinitis care pathways for community pharmacy”

Bosnic‐Anticevich

Costa

Menditto

et al. 2019

Allergy

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Pharmacists are trusted health care professionals. Many patients use over‐the‐counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)‐pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA‐pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.

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Comparison of the distribution of intranasal steroid spray using different application techniques

Abstract: The presence of inspiratory airflow, using the gentle inspiration technique, improves the intranasal distribution of NS in patients with AR. The use of correct technique is more important than nasal decongestion in the distribution of nasal spray particles.

Cited by 17 publications

References 15 publications

Understood? Evaluating the readability and understandability of intranasal corticosteroid delivery instructions

Understood? Evaluating the readability and understandability of intranasal corticosteroid delivery instructions

Observational study of administering intranasal steroid sprays by healthcare workers

ARIA pharmacy 2018 “Allergic rhinitis care pathways for community pharmacy”

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