Journal Report

Kathrinna Feliz Alerta

Overview

 Title: Medical adherence to intranasal corticosteroids in

adult patients
 Date of publication: 2 May 2016
 Authors: Emre Ocak, Baran Acar, Deniz Kocaöz
 Journal of publication: Brazilian Journal of
Otorhinolaryngology
Allergic Rhinitis

 Classical symptoms
 Nasal itching, sneezing, rhinorrhea, nasal congestion
 Ocular symptoms
 Allergic rhino-conjunctivitis: itching and redness of the eyes
and tearing
 Other symptoms
 Itching of the palate postnasal drip and cough
Allergic Rhinitis

 Frequently associated with asthma

 15-38% of AR patients has asthma
 Risk factor for asthma
 Not associated with severe morbidity and mortality, but
burden and costs are substantial
Pathophysiology

 IgE-mediated hypersensitivity reaction

Pathophysiology

 Early reaction
 First 30 minutes
 Sneezing and rhinorrhea
 Response of mast cells (histamine, prostaglandins,
leukotrienes)
 Late reaction
 6 hours after exposure
 Nasal obstruction
 Eosinophil chemotaxis
Treatment Options

 Allergen avoidance
 Pharmacotherapy
 Immunotherapy
 Surgery
Operational Definition

 Adherence: the extent to which a person’s behavior—

taking medication, following a diet, and/or executing
lifestyle changes—corresponds with agreed
recommendations from a health care provider
Method

 Study Design: Prospective

 Patient population: adult patients in the outpatient clinic
of a tertiary hospital, diagnosed with moderate to severe
allergic rhinitis, who had not previously used any nasal
sprays
 Excluded: asthma, nasal septal deviation, history of nasal
spray use, acute/chronic sinusitis, history of sinonasal
surgery, history of sinonasal malignancy
Intervention

 Mometasone furoate nasal spray, 256 ug per day, two

sprays per nostril once daily in the morning for 30 days
Measurement

 11 item questionnaire on influences to adherence

 Age, gender, marital status, multidrug use, comorbidities,
daily working hours, children, side effects, benefit from the
drug, abroad days per month
 MMAS
Statistical Analysis

 Statistical Package for Social Sciences version 15

 Kruskal-Wallis test
Results
Results
Results

 Patients living with more than two dependent children,

who did not benefit from the medication, who
experienced side effects, or who traveled more than 5
days per month had higher scores for poor adherence
 2 factors significantly related to poor adherence
 Number of dependent children and benefit from the
medication
Discussion

 Suggest to schedule medication plan with respect to daily

activities
 Remind the patient to take the prescribed medication
properly
 Reexamine the patient at regular intervals, change
medicine if necessary
Limitations

 Number of participants
 Possibility of interaction between factors
 Follow-up period