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Current use of baseline medical treatment in chronic rhinosinusitis: Data from the National Chronic Rhinosinusitis Epidemiology Study (CRES)

Current use of baseline medical treatment in chronic rhinosinusitis: Data from the National Chronic Rhinosinusitis Epidemiology Study (CRES)
Current use of baseline medical treatment in chronic rhinosinusitis: Data from the National Chronic Rhinosinusitis Epidemiology Study (CRES)

Objectives: According to clinical and comissioning guidelines for chronic rhinosinusitis (CRS), patients being referred to secondary care should have failed primary medical treatment with nasal douching (ND) and intranasal corticosteroids (INCS). The study objectives were to identify the rate of specific medical therapy in CRS patients and establish any differences in medication use, for both CRS and associated medical conditions, between CRS phenotypes. Design and setting: Case–control study in a secondary care setting. Methods: Participant-reported study-specific questionnaire capturing free text data on current medication use at the time of study entry. Qualitative interviews with 21 participants also explored their experience of CRS and its management. Particpants: Patients both without (CRSsNPs) and with polyps (CRSwNPs). Main outcome measures: Reported use of CRS-related and non-related medications. Results: Within a total of 1243 CRS participants, current INCS usage was low (18% in CRSwNPs, 12% in CRSsNPs); ND was being performed by only 1% of all participants. Bronchodilators and inhaled corticosteroids use was significantly higher in CRSwNPs participants (P <.0001). Antidepressant use was significantly higher in CRSsNPs (14% vs 7%, P <.0002). There were no significant regional variations in rates of INCS use, nor any significant influence of social deprivation. Conclusions: The current use of baseline medical therapy in CRS appears to be very low, representing a combination of poor patient compliance, possible ineffectiveness of treatment and a lack of familiarity with current guidelines amongst general practitioners and some ENT specialists. Work is needed to disseminate guidelines to all practitioners involved and reduce unnecessary burden on existing healthcare resources for this common condition by ensuring timely referral and definitive management.

administration, intranasal, otolaryngology, patient compliance, sinusitis, therapeutic irrigation
1749-4478
509-524
Philpott, C.
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Erskine, S.
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Smith, R.
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Hopkins, C.
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Kara, N.
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Farboud, A.
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Salam, M.
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Robertson, A.
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Almeyda, R.
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Kumar, B.N.
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Anari, S.
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Ray, J.
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Cathcart, R.
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Carrie, S.
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Ahmed, S.
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Khalil, H.
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Clark, A.
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Thomas, M.
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Sunkaraneni, Vishnu
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Jervis, Paul
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Panesaar, Jaan
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Prinsley, Peter
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Mansell, Nicolas
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Hobson, Jonathan
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Woods, Jane
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Coombes, Emma
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the CRES group
Philpott, C.
3b9f988c-a61e-4736-9b69-6697fb2cdc5b
Erskine, S.
3e258d04-86b6-4b50-86b5-19bf38284493
Smith, R.
a4c1976d-8d6a-479d-b2a4-5e59369c6235
Hopkins, C.
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Kara, N.
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Farboud, A.
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Salam, M.
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Robertson, A.
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Almeyda, R.
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Kumar, B.N.
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Anari, S.
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Ray, J.
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Cathcart, R.
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Carrie, S.
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Ahmed, S.
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Khalil, H.
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Clark, A.
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Thomas, M.
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Sunkaraneni, Vishnu
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Jervis, Paul
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Panesaar, Jaan
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Prinsley, Peter
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Mansell, Nicolas
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Hobson, Jonathan
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Woods, Jane
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Coombes, Emma
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Philpott, C., Erskine, S., Smith, R., Hopkins, C., Kara, N., Farboud, A., Salam, M., Robertson, A., Almeyda, R., Kumar, B.N., Anari, S., Ray, J., Cathcart, R., Carrie, S., Ahmed, S., Khalil, H., Clark, A., Thomas, M., Sunkaraneni, Vishnu, Jervis, Paul, Panesaar, Jaan, Prinsley, Peter, Mansell, Nicolas, Hobson, Jonathan, Woods, Jane and Coombes, Emma , the CRES group (2018) Current use of baseline medical treatment in chronic rhinosinusitis: Data from the National Chronic Rhinosinusitis Epidemiology Study (CRES). Clinical Otolaryngology, 43 (2), 509-524. (doi:10.1111/coa.13012).

Record type: Article

Abstract

Objectives: According to clinical and comissioning guidelines for chronic rhinosinusitis (CRS), patients being referred to secondary care should have failed primary medical treatment with nasal douching (ND) and intranasal corticosteroids (INCS). The study objectives were to identify the rate of specific medical therapy in CRS patients and establish any differences in medication use, for both CRS and associated medical conditions, between CRS phenotypes. Design and setting: Case–control study in a secondary care setting. Methods: Participant-reported study-specific questionnaire capturing free text data on current medication use at the time of study entry. Qualitative interviews with 21 participants also explored their experience of CRS and its management. Particpants: Patients both without (CRSsNPs) and with polyps (CRSwNPs). Main outcome measures: Reported use of CRS-related and non-related medications. Results: Within a total of 1243 CRS participants, current INCS usage was low (18% in CRSwNPs, 12% in CRSsNPs); ND was being performed by only 1% of all participants. Bronchodilators and inhaled corticosteroids use was significantly higher in CRSwNPs participants (P <.0001). Antidepressant use was significantly higher in CRSsNPs (14% vs 7%, P <.0002). There were no significant regional variations in rates of INCS use, nor any significant influence of social deprivation. Conclusions: The current use of baseline medical therapy in CRS appears to be very low, representing a combination of poor patient compliance, possible ineffectiveness of treatment and a lack of familiarity with current guidelines amongst general practitioners and some ENT specialists. Work is needed to disseminate guidelines to all practitioners involved and reduce unnecessary burden on existing healthcare resources for this common condition by ensuring timely referral and definitive management.

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More information

Accepted/In Press date: 12 October 2017
e-pub ahead of print date: 11 December 2017
Published date: 1 April 2018
Keywords: administration, intranasal, otolaryngology, patient compliance, sinusitis, therapeutic irrigation

Identifiers

Local EPrints ID: 418961
URI: http://eprints.soton.ac.uk/id/eprint/418961
ISSN: 1749-4478
PURE UUID: 2747b45e-3e28-4673-abdb-7fa5ffcb8e2e

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Date deposited: 27 Mar 2018 16:30
Last modified: 13 Mar 2019 18:42

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Contributors

Author: C. Philpott
Author: S. Erskine
Author: R. Smith
Author: C. Hopkins
Author: N. Kara
Author: A. Farboud
Author: M. Salam
Author: A. Robertson
Author: R. Almeyda
Author: B.N. Kumar
Author: S. Anari
Author: J. Ray
Author: R. Cathcart
Author: S. Carrie
Author: S. Ahmed
Author: H. Khalil
Author: A. Clark
Author: M. Thomas
Author: Vishnu Sunkaraneni
Author: Paul Jervis
Author: Jaan Panesaar
Author: Peter Prinsley
Author: Nicolas Mansell
Author: Jonathan Hobson
Author: Jane Woods
Author: Emma Coombes

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