Only 20% with chronic rhinosinusitis receive topical intranasal steroid therapy, Canadian study finds
Topical intranasal steroid spray was used by 1 in 5 patients for about 2 to 3 months on average, despite being a recommended treatment for adults with chronic rhinosinusitis.
Although topical intranasal steroid therapy is recommended for adults with chronic rhinosinusitis, it may be underutilized in primary care, a new study suggests.
Canadian researchers performed a retrospective review using a population-based administrative database to analyze the rate and quantity of topical intranasal steroid therapy among adults with chronic rhinosinusitis in Alberta (excluding those who had received endoscopic sinus surgery). Results were published online on Aug. 25 by JAMA Otolaryngology–Head & Neck Surgery.
Patients in the cohort (n=19,057) received a diagnosis of chronic rhinosinusitis between March 31, 2011, and March 31, 2014. Researchers evaluated the rate and quantity of steroid spray usage in the subsequent year by calculating the number of patients who used at least 1 U of spray (1 bottle; about a month of daily use) divided by the total number of patients in the cohort.
Overall, topical intranasal steroid spray was used by 1 in 5 patients (n=3,821), and the proportions of patients who used 1 U and 2 U of spray were 10.7% and 3.9%, respectively. Among those who used at least 1 U of spray, the crude and adjusted quantities were 2.4 U and 3.1 U per patient, respectively, suggesting that patients used the therapy for about 2 to 3 months on average. In a secondary analysis, researchers assessed geographic variations in usage across 64 geographic regions of Alberta. They found large geographic variation in the overall rate and quantity of utilization (P<0.001 for both).
The authors concluded that intranasal steroid spray, although a recommended treatment, is underused in patients with chronic rhinosinusitis. They noted limitations to the study, such as the potential inaccuracies contained within the administrative database and the restricted generalizability to different regions. They also noted that the outcomes are largely representative of patients with mild disease treated at the primary care level and that they did not investigate the factors leading to the underuse of topical intranasal steroid therapy. Future study of such factors is needed, they wrote.