Loh C Y, Chao S S, Chan Y H, Wang D Y
Department of Otolaryngology, Head and Neck Surgery, National University Hospital, Singapore.
Allergy. 2004 Nov;59(11):1168-72. doi: 10.1111/j.1398-9995.2004.00554.x.
In the treatment of persistent rhinitis, the observed efficacy with intranasal steroids in clinical practice often falls short of that reported in clinical trials. We postulate that this could be due to patient non-compliance and thus designed this study to evaluate the impact of patient compliance on the efficacy of treatment in patients with persistent rhinitis.
Sixty-three consecutive adult patients with allergic and non-allergic rhinitis, treated with intranasal triamcinolone acetonate, were included in the study. Compliance was determined both by direct questioning and by measuring the weight of medication consumed (WMC) after 30 days of therapy. Nasal symptom scores were used to determine treatment efficacy.
Forty-nine patients (77.8%) reported a forgetfulness of using medication for a few times (1-5 times) during the treatment period. Less than 50% compliance was reported by one patient (1.6%) but detected in seven patients (11%) by WMC. There was a significant (P < 0.001) improvement in mean total symptom score before (7.45 +/- 1.99) and after (3.59 +/- 2.72) treatment in patients with WMC of at least 50%, but not when WMC was <50% (8.43 +/- 1.72 vs 6.29 +/- 2.43; P = 0.114). With >50% WMC, the positive predictive values for relief of each symptom were rhinorrhoea: 78%, nasal itch: 70%, nasal obstruction: 67% and sneezing: 65%.
Patients compliance has a significant impact on treatment efficacy with intranasal steroids. There is a discrepancy between reported and actual compliance. It is thus important to establish the actual compliance when evaluating patients who fail to respond to therapy.
在持续性鼻炎的治疗中，临床实践中观察到的鼻内用类固醇的疗效往往低于临床试验报告的疗效。我们推测这可能是由于患者依从性差，因此设计了本研究来评估患者依从性对持续性鼻炎患者治疗效果的影响。
连续纳入63例接受鼻内用醋酸曲安奈德治疗的成人过敏性和非过敏性鼻炎患者。通过直接询问和在治疗30天后测量药物消耗量（WMC）来确定依从性。使用鼻症状评分来确定治疗效果。
49例患者（77.8%）报告在治疗期间有几次（1 - 5次）忘记用药。1例患者（1.6%）报告依从性低于50%，但通过WMC检测到7例患者（11%）存在这种情况。WMC至少为50%的患者治疗前平均总症状评分（7.45±1.99）和治疗后（3.59±2.72）有显著改善（P<0.001），但WMC<50%时无显著改善（8.43±1.72 vs 6.29±2.43；P = 0.114）。WMC>50%时，每种症状缓解的阳性预测值分别为：流涕78%、鼻痒70%、鼻塞67%和打喷嚏65%。
患者依从性对鼻内用类固醇的治疗效果有显著影响。报告的依从性和实际依从性之间存在差异。因此，在评估对治疗无反应的患者时，确定实际依从性很重要。
