Calgary, Canada—With ragweed and other fall allergens taking off in North America, pharmacists might be interested to know that, despite proven effectiveness, steroid nose spray often isn’t used correctly by patients.

A report published online by JAMA Otolaryngology-Head & Neck Surgery notes that topical intranasal steroid therapy tends to be underused for patients with chronic rhinosinusitis (CRS), even though practice guidelines widely recommend daily treatment.

Background information in the article points out that chronic rhinosinusitis is a common and expensive-to-treat disease, which is primarily managed with prolonged medical therapies. With topical intranasal steroid (INS) therapy proven to be highly effective at improving CRS-specific symptoms and quality of life, any deficiencies in utilization represent a gap in quality of care, according to the report.

Researchers from the University of Calgary and colleagues reviewed a Canadian population-based healthcare administrative database to evaluate utilization patterns of topical INS for chronic rhinosinusitis during the 2014-2015 fiscal year. The study group included 19,057 adult patients with CRS.

Results indicate that the overall rate of intranasal steroid spray utilization was 20 per 100 patients with CRS. In the 3,821 patients with CRS who used an intranasal steroid spray during 2014 to 2015, the average quantity of utilization was 2.4 U (1 U = 1 bottle per month) per patient.

In fact, researchers found that about 80% of CRS patients failed to use a single unit within the past year (2014-2015). The proportion of CRS patients who used 1 U and 2 U of INS spray within the past year was 10.7% and 3.9%, respectively, with even lower proportions using 3 U or more during that time period.

Adherence varied geographically in both the rate and quantity of intranasal steroid spray utilization, according to the study.

“Overall, the outcomes demonstrate that there is a significant under-use of INS spray for CRS patients; however, factors driving the underuse are currently unknown,” study authors conclude. “Given that CRS practice guidelines provide strong recommendations for daily use of topical INS therapy, improving utilization of this treatment strategy may represent an opportunity to improve the quality of care.”

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