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Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care: a pragmatic randomized controlled trial

Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care: a pragmatic randomized controlled trial
Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care: a pragmatic randomized controlled trial
Background: Systematic reviews support saline nasal irrigation for chronic/recurrent sinus symptoms but the trials are small, and few in typical primary care settings. Steam inhalation is poorly evidence-based. Our aim was to estimate the impact of brief pragmatic interventions to use steam and nasal irrigation.

Methods: Adults with a history of recurrent/chronic sinusitis and reporting significant impact on quality-of-life from 72 UK general practices, were randomised to four advice strategies by a practice nurse, using numbered opaque sealed envelopes: 1) usual care 2) steam inhalation daily 3) saline nasal irrigation daily supported by a demonstration video 4) Irrigation and steam inhalation.

Results: 961 individuals consented. 871 returned baseline questionnaires (respectively n=210,n=219,n=232,n=210) and 671/871 (77%) participants self-reported Rhinosinusitis Disability Index (RSDI) scores at 3 months (the primary outcome). Multiple imputation avoided assuming data was missing completely at random. RSDI scores improved with both nasal irrigation and no irrigation (-7.4 and -5.2 respectively; adjusted estimate of the difference -2.51, 95% confidence intervals -4.65 to -0.37, p=0.021). By 6 months, significantly more patients maintained a 10 point clinically important improvement in the RSDI (44.1%, 36.6% respectively); fewer used over-the-counter (OTC) medications (59.4%, 68%) or intended to consult the doctor. Steam inhalation reduced headache but no other outcomes. There was no evidence of harms with either intervention.

Interpretation: Steam inhalation for chronic sinus symptoms in primary care is not effective. A brief pragmatic intervention to encourage nasal irrigation is less effective than prior evidence suggests, but provides some symptomatic benefit, and empowers self- management.
ISRCTN88204146
0820-3946
940-949
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
Thomas, Tammy
742fc3b2-61cb-4f87-8466-afa31b3c8d8e
Johnson, Sophie
9919c64a-b60b-4371-81bc-9540db19a56b
Leydon, Gerry
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Rabago, David
9fb58149-3df1-48cc-8ae1-497d2d490d8a
Richards-Hall, Samantha
dec677d7-b6a7-4e99-b10e-c1e22b3055cf
Williamson, Ian
12381296-edbf-4ac5-969b-dcb559c22f27
Yao, Lily
d777f84c-cf3d-4fad-bbc1-ea01dec01695
Raftery, James
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
Zhu, Shihua
13511f9c-151c-483c-9dfd-2da13421db5c
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
Thomas, Tammy
742fc3b2-61cb-4f87-8466-afa31b3c8d8e
Johnson, Sophie
9919c64a-b60b-4371-81bc-9540db19a56b
Leydon, Gerry
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Rabago, David
9fb58149-3df1-48cc-8ae1-497d2d490d8a
Richards-Hall, Samantha
dec677d7-b6a7-4e99-b10e-c1e22b3055cf
Williamson, Ian
12381296-edbf-4ac5-969b-dcb559c22f27
Yao, Lily
d777f84c-cf3d-4fad-bbc1-ea01dec01695
Raftery, James
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
Zhu, Shihua
13511f9c-151c-483c-9dfd-2da13421db5c
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99

Little, Paul, Stuart, Beth, Mullee, Mark, Thomas, Tammy, Johnson, Sophie, Leydon, Gerry, Rabago, David, Richards-Hall, Samantha, Williamson, Ian, Yao, Lily, Raftery, James, Zhu, Shihua and Moore, Michael (2016) Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care: a pragmatic randomized controlled trial. Canadian Medical Association Journal, 118 (13), 940-949. (doi:10.1503/cmaj.160362).

Record type: Article

Abstract

Background: Systematic reviews support saline nasal irrigation for chronic/recurrent sinus symptoms but the trials are small, and few in typical primary care settings. Steam inhalation is poorly evidence-based. Our aim was to estimate the impact of brief pragmatic interventions to use steam and nasal irrigation.

Methods: Adults with a history of recurrent/chronic sinusitis and reporting significant impact on quality-of-life from 72 UK general practices, were randomised to four advice strategies by a practice nurse, using numbered opaque sealed envelopes: 1) usual care 2) steam inhalation daily 3) saline nasal irrigation daily supported by a demonstration video 4) Irrigation and steam inhalation.

Results: 961 individuals consented. 871 returned baseline questionnaires (respectively n=210,n=219,n=232,n=210) and 671/871 (77%) participants self-reported Rhinosinusitis Disability Index (RSDI) scores at 3 months (the primary outcome). Multiple imputation avoided assuming data was missing completely at random. RSDI scores improved with both nasal irrigation and no irrigation (-7.4 and -5.2 respectively; adjusted estimate of the difference -2.51, 95% confidence intervals -4.65 to -0.37, p=0.021). By 6 months, significantly more patients maintained a 10 point clinically important improvement in the RSDI (44.1%, 36.6% respectively); fewer used over-the-counter (OTC) medications (59.4%, 68%) or intended to consult the doctor. Steam inhalation reduced headache but no other outcomes. There was no evidence of harms with either intervention.

Interpretation: Steam inhalation for chronic sinus symptoms in primary care is not effective. A brief pragmatic intervention to encourage nasal irrigation is less effective than prior evidence suggests, but provides some symptomatic benefit, and empowers self- management.
ISRCTN88204146

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A Primary Care RCT of Steam inhalation and nasal irrigation for recurrent or chronic sinus symptom (SNIFS) trial CMAJ May 2016.docx - Accepted Manuscript
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Accepted/In Press date: 13 May 2016
e-pub ahead of print date: 20 September 2016
Published date: 20 September 2016
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 394376
URI: https://eprints.soton.ac.uk/id/eprint/394376
ISSN: 0820-3946
PURE UUID: b33c1488-3d2a-4b09-8ea1-9b3a8391bb60
ORCID for Gerry Leydon: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 24 May 2016 08:11
Last modified: 12 Nov 2019 01:47

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Contributors

Author: Paul Little
Author: Beth Stuart
Author: Mark Mullee
Author: Tammy Thomas
Author: Sophie Johnson
Author: Gerry Leydon ORCID iD
Author: David Rabago
Author: Samantha Richards-Hall
Author: Ian Williamson
Author: Lily Yao
Author: James Raftery
Author: Shihua Zhu
Author: Michael Moore ORCID iD

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