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
James Paget University Hospital NHS Foundation Trust, Gorleston, UK.
Norwich Medical School, University of East Anglia, Norfolk, UK.
Clin Otolaryngol. 2018 Apr;43(2):509-524. doi: 10.1111/coa.13012. Epub 2017 Dec 11.
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.
Case-control study in a secondary care setting.
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.
Patients both without (CRSsNPs) and with polyps (CRSwNPs).
Reported use of CRS-related and non-related medications.
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.
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.
根据慢性鼻窦炎（CRS）的临床和诊疗指南，转诊至二级医疗机构的患者应是经鼻腔冲洗（ND）和鼻内使用皮质类固醇（INCS）进行的初始药物治疗失败的患者。本研究的目的是确定CRS患者特定药物治疗的比例，并确定CRS不同表型在CRS及相关疾病的药物使用方面是否存在差异。
在二级医疗机构进行的病例对照研究。
采用参与者报告的特定研究问卷，收集研究入组时当前用药情况的自由文本数据。对21名参与者进行的定性访谈还探讨了他们的CRS经历及其管理情况。
无息肉的CRS患者（CRSsNPs）和有息肉的CRS患者（CRSwNPs）。
报告的CRS相关和非相关药物的使用情况。
在总共1243名CRS参与者中，当前INCS的使用率较低（CRSwNPs中为18%，CRSsNPs中为12%）；所有参与者中仅1%的人进行鼻腔冲洗。CRSwNPs参与者使用支气管扩张剂和吸入性皮质类固醇的比例显著更高（P < .0001）。CRSsNPs中抗抑郁药的使用比例显著更高（14%对7%，P < .0002）。INCS使用比例不存在显著的地区差异，社会剥夺也没有显著影响。
CRS患者当前基线药物治疗的使用率似乎非常低，这表明患者依从性差、治疗可能无效以及全科医生和一些耳鼻喉科专家对当前指南缺乏了解。需要开展工作，向所有相关从业者传播指南，并通过确保及时转诊和明确管理，减轻现有医疗资源对这种常见疾病的不必要负担。
