Impact of Topical Steroid Nasal Irrigation Adherence on Chronic Rhinosinusitis and Allergic Rhinitis Patient Outcomes.

Abstract

Objective: High volume steroid nasal rinses are often prescribed for chronic rhinosinusitis and allergic rhinitis. Although the general importance of medication adherence is well established, the specific relationship between objectively measured adherence to topical steroid irrigation and patient-reported clinical outcomes has not been previously demonstrated. This study aims to investigate the effect of topical steroid nasal rinse adherence on patient outcomes.

Methods: This prospective longitudinal study recruited 97 patients with chronic rhinosinusitis or allergic rhinitis. All patients were prescribed twice-daily high-volume budesonide isotonic saline sinus rinses. Objective adherence data through quantified medication usage were collected over 8 weeks. Patient outcomes were assessed via the 22-item Sino-Nasal Outcome Test (SNOT-22), a sinus discomfort visual analog scale (VAS, 0-100), and patient-perceived surgery need. Generalized estimating equations were used to analyze the impact of adherence on symptom outcomes.

Results: Higher adherence was significantly associated with improvement in both VAS (β = -0.18, p < 0.001) and SNOT-22 (β = -0.10, p = 0.024) but was not associated with increased surgery desire. Median adherence was overall 47.5%, higher in patients with recent sinus surgery (< 3 months: 55.6%) and higher baseline symptom severity (SNOT-22 ≥ 20: 51.6%), with correspondingly larger improvements in clinical outcomes.

Conclusion: Objective adherence to budesonide sinus irrigation significantly associates with improved patient-reported outcomes, with the strongest benefit seen in patients with higher baseline symptoms and in the early postoperative period. Targeting adherence interventions may yield clinically meaningful improvements in sinonasal quality of life.

Level of evidence: 2.