A clinical survey on compliance in the treatment of rhinitis using nasal steroids


De-Yun Wang MD, PhD
Department of Otolaryngology
National University Hospital
5 Lower Kent Ridge Road
Singapore 119074


Background:  In the treatment of persistent rhinitis, the observed efficacy with intranasal steroids in clinical practice often falls short of that reported in clinical trials. We postulate that this could be due to patient non-compliance and thus designed this study to evaluate the impact of patient compliance on the efficacy of treatment in patients with persistent rhinitis.

Methods:  Sixty-three consecutive adult patients with allergic and non-allergic rhinitis, treated with intranasal triamcinolone acetonate, were included in the study. Compliance was determined both by direct questioning and by measuring the weight of medication consumed (WMC) after 30 days of therapy. Nasal symptom scores were used to determine treatment efficacy.

Results:  Forty-nine patients (77.8%) reported a forgetfulness of using medication for a few times (1–5 times) during the treatment period. Less than 50% compliance was reported by one patient (1.6%) but detected in seven patients (11%) by WMC. There was a significant (P < 0.001) improvement in mean total symptom score before (7.45 ± 1.99) and after (3.59 ± 2.72) treatment in patients with WMC of at least 50%, but not when WMC was <50% (8.43 ± 1.72 vs 6.29 ± 2.43; P = 0.114). With >50% WMC, the positive predictive values for relief of each symptom were rhinorrhoea: 78%, nasal itch: 70%, nasal obstruction: 67% and sneezing: 65%.

Conclusion:  Patients compliance has a significant impact on treatment efficacy with intranasal steroids. There is a discrepancy between reported and actual compliance. It is thus important to establish the actual compliance when evaluating patients who fail to respond to therapy.