Adherence and effective treatment use
Adherence and effective treatment use
Much can be done to help people with AR to get the most out of their treatment. This could include explanations about how the different treatments work (see Tables 1 and 2) and demonstrations of how to use nasal sprays and drops correctly. In addition, it is important to emphasise and encourage regular, continuing treatment.
Intranasal steroids offer effective control of all symptoms of AR and it may be helpful to point out to customers that systemic absorption of mometasone and fluticasone salts is negligible, so they can be used long-term with confidence. In contrast, intranasal betamethasone is extensively absorbed and is regarded as a systemic steroid by some clinicians. The systemic absorption of budesonide, beclometasone, triamcinolone and flunisolide ranges from 33-50 per cent.2
Nasal drops and sprays are intended to deliver drug to the nasal mucosa, not just the nostrils, so their use calls for a different technique from using inhaled drugs that are delivered to the lungs. The following procedures can be recommended to patients:
Nasal sprays and drops
- Shake bottle well
- Look down
- Using right hand for left nostril put nozzle just inside nose aiming towards outside wall
- Squirt once or twice (two different directions)
- Change hands and repeat for other side
- Breathe in gently through the nose
- Do not sniff.
- To administer drops successfully the nose needs to be upside down.
- This is done by kneeling down with the head down or by lying on a bed with the head over the edge, either prone with head tipped down or on the back with the head tipped back over the edge.
- In any of these positions, drops administered can trickle back into the nasal cavity.
When to refer
Patients should be referred to their GP when the clinical picture does not fit with AR or if the condition is too severe to be treated with OTC products. Referral is essential for patients with unilateral symptoms, heavily blood-stained nasal discharge or pain.
Resources & references
- Bousquet J et al. ARIA (Allergic Rhinitis and its Impact on Asthma) 2008 Update. (in collaboration with the World Health Organization, GA(2)LEN and AllerGen).
- Scadding GK et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy. 2017; 47:856-889.
- Czarnowicki T et al. Novel concepts of prevention and treatment of atopic dermatitis through barrier and immune manipulations with implications for the atopic march. J Allergy Clin Immunol 2017; 139:1723-34.
- NICE Clinical Knowledge Summary: Allergic rhinitis (revised Sept 2018).
- Ã…Ìberg N et al. A nasally applied cellulose powder in seasonal allergic rhinitis in adults with grass pollen allergy: a double-blind, randomized, placebo-controlled, parallel-group study. Int Arch Allergy Immunol 2014; 163:313-318.