Discrepancy between self-reported and actual topical steroid use in CRS-patients with nasal polyps
Abstract
The manuscipt is a letter to the editor, see DOI for full text.
Plain Language Summary
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition causing blocked and runny nose, loss of smell, and sinus pressure. Treatment relies heavily on daily nasal corticosteroid sprays, yet many patients do not use them as reliably as they tell their doctors. This is particularly important because in most countries, patients must demonstrate ongoing use of these sprays before they can be considered for newer biologic medicines. In this study, we examined the gap between what patients report and what they actually do. We included 136 adults referred for biologic screening, of whom 77% also had asthma — a combined condition called global airway disease (GAD). Almost all patients reported near-perfect adherence in questionnaires: 93–100% said they took their nasal spray as prescribed. Yet when we checked actual pharmacy prescription refills over 12 months, only 17% of patients with nasal polyps alone and 36% of those with combined asthma met the threshold for acceptable adherence. Our findings reveal a dramatic mismatch between self-reported and actual nasal spray use — consistent with what we and others have found for asthma inhalers. Patients with both nasal polyps and asthma had somewhat better objective adherence, possibly due to more regular clinical contact. These results have direct implications for biologic prescribing criteria and underscore the need for objective adherence monitoring.