Adherence Issues

The information below was compiled from a group of referenced allergic rhinitis studies.

Initial diagnosis of allergic rhinitis
A good history is important in diagnosing allergic rhinitis. Symptoms include sneezing, congestion, runny nose, nasal itch, and ocular itch.⁶ Ask patients about the length of symptoms and the medications they have taken in the past to relieve symptoms.⁶ In particular, information about the length of time allergy medications were used, whether they were effective, and any adverse events that they caused, is useful for developing an ongoing therapeutic plan.⁶ This condition-specific history should be followed by a thorough general history and a full physical examination.

Once a diagnosis of allergic rhinitis has been established, a therapeutic plan can be created. This may involve both allergy medications and lifestyle changes.

How are we doing with current therapeutic strategies?
Allergic rhinitis affects approximately 20% of the population and the incidence is increasing.¹⁰ Inhaled nasal steroids, which are the most effective medication class for controlling symptoms of allergic rhinitis⁶, are prescribed for only 21% of patients.⁸ Nonsedating antihistamines are prescribed for 72% of these patients, and combination therapy for 8%.⁸

How well do these therapeutic regimens work?
Mild allergic rhinitis is experienced by 36% of patients seeking treatment; one quarter of whom say that their allergy medicine keeps symptoms in check.⁴ One fifth of the 46% of patients with moderate disease obtain good symptom suppression.⁴

Some patients with allergic rhinitis are not getting relief from their allergy medicines. However, these low success rates are in part due to patient nonadherence.⁵

Why don't patients adhere to their prescribed therapeutic regimen?
Patients may not adhere to their prescribed regimen for allergic rhinitis for a number of reasons. Patients believe that they can “build up an immunity” to their medicine so that it no longer is effective.⁵ Some patients do not understand the need to take their medicine daily to prevent symptoms; instead they wait to see if they have symptoms on any given day and then use their medication.⁹

Patients forget to take their allergy medication.

When symptoms worsen during seasonal changes, patients perceive this as the medicine not working.^{7, 10} Sometimes, patients feel that the side effects of prescribed medications outweigh the benefits.^{7, 10}

Antihistamines, currently the most prescribed treatment, reduce runny nose, sneezing, and itching, but have little effect on nasal congestion.⁶ Antihistamines, even second-generation ones, can cause drowsiness.⁷ The effectiveness and the side effects associated with different antihistamines can be varied.⁷

Decongestants are recommended for reducing nasal congestion.⁶ They do not relieve itching, runny nose, or sneezing, so they are often prescribed in combination with antihistamines.⁶ This requires the patient to take two medications to control all their symptoms. Decongestants can cause insomnia, loss of appetite, excessive nervousness, and increased blood pressure.⁶ When nasal decongestant sprays are used for more than 3 to 4 days at a time, they can cause rebound congestion.⁶

Inhaled nasal steroids are the most effective medication class for controlling symptoms of allergic rhinitis.⁶ Some patients don't like the idea of spraying something into their nose, or they don't like the sensation they get from the spray.⁵ Some have concerns about using a steroid continuously.⁹ Finally, inhaled nasal steroids do have side effects, including nasal irritation and nosebleeds, which deter some patients from using them.⁶

How can we improve patient adherence?
One of the best ways to improve medication adherence is to educate patients. When patients understand how their medications work, they have more realistic expectations of therapeutic outcomes. Instructions on how to take medications should emphasize the need to take them on schedule and continuously to achieve full effect. This important aspect of INS therapy needs to be reinforced at each visit. Patients also need an explanation of seasonal variations in allergens and reassurance that worsening of symptoms does not necessarily mean that their medication is not working. It could mean that lifestyle and perhaps dosing changes are needed.

Encourage Your Patients to Join the RHINOSE Network

Another way to improve adherence is to involve the patient in their treatment plan. The RHINOSE Network will provide them the information and encouragement they need to manage their nasal allergies with RHINCORT AQUA. There is no charge to participate and the program is personalized just for them. Click here to find out more information about RHINOCORT AQUA.

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