Intranasal Corticosteroids: Patient Administration Angles and Impact of Education

Intranasal corticosteroids sprays (INCS) are first line treatment for allergic rhinitis and are frequently used for chronic rhinosinusitis. Improperly aiming INCS increases the risk of epistaxis and may decrease the efficacy of the medication. The goal of this study was to determine how patients position INCS for drug delivery and if verbal or written instructions improve their positioning.

Patients in rhinology clinics were photographed while administering a generic spray bottle. The angle of the spray bottle relative to the patients' head and a fixed background was determined.

A total of 46 participants were included. The average spray angle for the right naris was 10.1° towards the septum and 67.2° below the Frankfurt Horizontal plane. The average spray angle for the left naris was 4.5° towards the septum and 62.2° below the Frankfurt horizontal plane. The angle of the spray bottle ranged from 50° toward the septum to 43° away from the septum. Only 8 patients aimed away from the septum for both nares. Patients who recalled receiving verbal and written instructions aimed the INCS bottle at the lateral wall and inferior turbinate in contrast to patients who only received one form of instruction or no instructions.

Most patients (83%) incorrectly aim INCS when compared to current guidelines. There was statistically significant improvement in the positioning of patients who reported receiving both verbal and written instruction; however, this study highlights a greater need for patient education.