RT Journal Article
SR Electronic
T1 Adjunctive Saline Nasal Irrigation for Acute Rhinosinusitis: Results of a Randomized Pilot Study
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 6643
DO 10.1370/afm.22.s1.6643
VO 22
IS Supplement 1
A1 Rabago, David
A1 Zgierska, Aleksandra
A1 Turnquist, Alyssa
A1 Shara, Nawar
A1 Tong, Sebastian
A1 Fernandez, Stephen
A1 Henningfield, Mary
A1 Fencil, Charles
A1 Tarn, Derjung
A1 Krist, Alex
A1 Merenstein, Daniel
A1 Smith, Keisha Herbin
A1 Blaker, Joshua
A1 Sparenborg, Jessy
A1 Franko, Nicholas
A1 Barrett, Bruce
A1 Casey, Cameron
A1 Schramm, Danielle
A1 Tan, Tina
A1 Drose-Bigatel, Levelle
A1 Whitfield, Michael
A1 Stienecker, Sara
A1 Mete, Mihriye
A1 Sanghavi, Kavya
YR 2024
UL http://www.annfammed.org/content/22/Supplement_1/6643.abstract
AB CONTEXT Acute rhinosinusitis (ARS) affects 15% of the adult population annually, and accounts for 20% of adult outpatient antibiotic prescriptions. Evidence is needed to clarify effectiveness of standard treatment, which includes antibiotics and intra-nasal corticosteroids (INCS), and supportive care including saline nasal irrigation (SNI), which is reported safe and effective for limiting sino-nasal symptoms but is poorly studied in ARS.OBJECTIVE We assessed feasibility and patient-reported clinical outcomes of adjunctive use of SNI in ARS.STUDY DESIGN/INTERVENTION The PCORI-funded NOSES (Nasal Steroids, Nasal Irrigation, Oral Antibiotics and Subgroup Targeting for Effective Management of Sinusitis) study has completed a double-blind, 4-arm (antibiotics vs antibiotics+INCS vs INCS vs placebo antibiotics) feasibility RCT. Participants in six U.S. practice based research networks were followed in pre-randomized (days 0-9) and randomized (days 10-23) phases.INTERVENTION All participants were provided with SNI materials (neti pot, salt packets, and distilled water) and advised to use twice daily as part of supportive care.SETTING/POPULATION/OUTCOME MEASURES Outpatient, participants with ARS. Primary: days participants used SNI at least once assessed in daily diary. Secondary: average rate of SNI use, percentage of participants who used SNI at least 50% of study days; perceived effect on sino-nasal symptoms; association of SNI use with validated clinical outcomes instrument severity score.RESULTS: 140 participants in both phases of the study completed 1606 of 1727 possible diary entries (93%); 534 diary entries noted SNI use (33%). Pre-randomized participants reported using SNI 37.6% (SD=34.0) of the time independent of days in the study. Randomized participants used SNI 36.8% (SD=38.4) of days in the study. Among pre-randomized participants (n=110), 51 (46%) participants reported using SNI on a least 50% of study days; among randomized participants (n=87), 27 (31%) did so. SNI use varied by study site (P<.0001). 330 (81%) of diary entries noting SNI use reported it reduced nasal/sinus symptoms. SNI use and self-reported clinical outcomes scores were not associated in either study phase.CONCLUSIONS: Participants in this pilot study used SNI in both pre-randomized and randomized phases of the of the study, though adherence was low. Results suggest the need to enhance SNI adherence strategies.