Discussion:
Key findings and interpretation : To our best knowledge, this is the first patient-reported survey assessing each step of the nasal spray technique and identifying the common mistakes. Out of 99 patients, only 1 patient used the steroid nose spray with a completely correct spray technique. This survey also identified non-compliance in the use of steroid nose spray and using the wrong spray dosage. This is a major finding because we know that the spray technique and correct dosage are the two key factors for the success of medical treatment3,5. European position paper on chronic rhinosinusitis 2020 and British Society for Allergy and Clinical Immunology 2017 update on the management of Allergic and Non-Allergic rhinitis both emphasizes clinicians to check steroid nasal spray technique and patient compliance especially in cases of failed medical treatment 3,5.
This survey also identified that spray technique was only taught in only 40% of cases when it should have been taught to every patient3,5. To complicate things further some of the material available on the internet for the patients about the spray technique is not reliable and accurate 15,17. Some of the mistakes we found on reviewing this online material are mentioned below:
  1. No mention of using contralateral hand 15,17
  2. No mention of directing spray towards turbinates15,17.
  3. Breath in deeply as you squeeze the bottle. Remove the bottle and sniff once or twice 15.
Turbinate bones in the nose are covered with soft tissue. Directing spray towards the turbinates will allow the medication to work locally on this soft tissue and maximise benefit and at the same time, it will prevent any side effects i.e. nose bleed, irritation 6associated with the application of the spray on the nasal septum. Hard sniff while administering the spray in the nose can force the drug to go into the oropharynx instead of working locally in the nose.
Comparison with already published literature: Compliance issues identified in the study were associated with both wrong spray dosage and not using the spray regularly. Non-compliance in the use of the nasal spray is a known factor which has been highlighted in the previously published literature 6,18. Non- compliance rate found in our study was about 30%. Ganesh et al. reported non-compliance in the nasal spray use in about 29.1% of patients. Similarly, Nabi et al. investigated the use of steroid nose spray in the patients after sinus surgery and reported non-compliance in 57.4% of patients.
Asthma control and its correlation with inhaler technique and patient compliance is a well-known association and a plethora of published literature is available 19,20,21. Unfortunately, less literature is available about the nasal spray technique.