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Rhinitis Patients Report Symptomatic Medication Use

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Patients with rhinitis treat their condition when symptoms appear, rather than following guidelines for managing their disease, suggests a longitudinal study that corroborates cross-sectional analyses.

Investigators collected data from patients in 25 countries through a mobile application called MASK-air. According to senior author Jean Bousquet, MD, professor at the Institute of Allergology at Charité – Universität für Medizin Berlin, the app provides real-world data on patients’ experiences with their allergic rhinitis and how they use – or don’t use – their medication, and corporate member of Freie Universität Berlin and the Humboldt University of Berlin, Germany.

“People take their medication when they’re not feeling well,” he said in an interview. “If they’re fine, they don’t take any medication.”

The results were published in Allergy, the European Journal of Allergy and Clinical Immunology.

Medication intake and medication changes

The MASK-air app assesses the daily control of allergic rhinitis and asthma through visual analogue scales. The study evaluated data from 2,590 patients from specific weeks when they responded to a daily rhinitis questionnaire in the app, all 7 days of the week. The ages ranged from 16 to 90 years with a mean age of 39.1 years. Just over half of the patients (54.1%) were female. From May 2015 to December 2020, the app generated 16,177 weeks of data for the study.

Researchers identified 10 clusters based on weeks of medication and six clusters based on weeks of no medication. Visual analog scales were used to assess allergic rhinitis control, which was subdivided into good rhinitis control, moderate control, poor control, and variable control.

The researchers found that the percentage of days without medication varied from 11.8% in one cluster to 39.4% days in another cluster. Changes in their rhinitis medication self-treatment regimen within the same week varied from 15.9% in one cluster to 45% in another cluster.

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Bousquet and his co-authors from around the world concluded that the results indicate a knowledge gap among patients on how to manage their allergic rhinitis.

The results “suggest that patients are uncertain about how to adjust their medication according to their symptoms and use trial-and-error strategies rather than following guidelines,” the authors write. “Specifying how to gradually increase and decrease medication depending on symptoms and expected pollen exposure could be a relevant future step. To that end, MASK-air can play a crucial role as it could alert users according to pollen levels, making the data easily accessible (with patients’ consent) to their doctors.”

“We need shared decision-making with our patients,” Bousquet said, noting that common guidelines recommend the use of intranasal steroids and intranasal antihistamines.

Data for shared decision-making with patients

The data is helpful for physicians treating patients with rhinitis who are unable to control their disease, and the data also show that patients with rhinitis do not know what next steps to take if they are not responding to medication, Andy noted Nish, MD, Northeast Georgia Physicians Group, Allergy and Asthma, Gainesville, Georgia.

“It was remarkable that when they had symptoms, they didn’t necessarily know how to change their medicine to improve it,” Nish said. “We as doctors need to make sure they have a plan if they are not doing well with their medication. The data from the app can be made available to their doctors who can help them [patients] decide what to do with their symptoms.

“The results of this study are consistent with previous studies that were cross-sectional,” he said. “This is a longitudinal study over time and is consistent with studies that have looked at a period of time. This study helps to support previous studies.”

One limitation of the research is that it required the app to be used, Nish said. “Some people aren’t ready to use technology,” Nish said. “The use of technology is geared towards the younger and more affluent.”

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Additionally, investigators did not consider people’s access to healthcare as a factor in why they did or did not change their medications. “We assume they switched medications based on their symptoms, but maybe they didn’t have them [healthcare and economic] Access to make changes,” he said.

Evidence from the real world

Sunil K. Saini, MD, a practicing allergist and immunologist in Mission Viejo, Calif., and a volunteer associate clinical professor at the University of California Irvine, described the study as exploratory and offering insights into patient behavior.

“What I like about it is that it’s a real-world study,” Saini said, noting that the app serves as a data collection tool where previous patients would otherwise keep paper journals to record their symptoms. “The study tells us that some people may need to take their medication every day and other times they may not need to take their medication. she [study investigators] trying to find out: How do people behave? This is a qualitative study.”

Saini agreed that there might be a selection bias in the patients included in the study.

“It may be that people with milder symptoms are not as interested [in using the app]but people who have more severe symptoms may be more interested in doing this,” Saini said. “So maybe you choose [patients] that may be a bit more serious, and you may select patients who are more comfortable using cell phones.

Bousquet reports personal fees from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, sanofi-aventis, Takeda, Teva and Uriach. Bousquet has interests in Kyomed Innov and MASK-air. Nish and Saini disclose no relevant financial relationships.

Allergy. Published online November 3, 2022. Full text

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