A Novel Device to Improve the Tolerability of Intranasal Corticosteroid Sprays for Allergic Rhinitis and Postoperative Chronic Rhinosinusitis: A Crossover Trial

BACKGROUND: Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are commonly treated with intranasal corticosteroid sprays. Despite their efficacy, unpleasant sensations associated with their application, including post-nasal drip and nasal irritation, are often cited as reasons for poor compliance. Optimising the intranasal application experience is key to improving long-term adherence. We developed a nasal adaptor for metered-dose inhalers (MDIs) to reduce the unpleasantness of nasal administration, potentially improving patient compliance. METHODS: Two crossover trials were conducted in AR and postoperative CRS participants (n = 16 per group). Participants used a standard fluticasone nasal spray (50 μg) and a fluticasone MDI (125 μg) with the adaptor for 3 weeks each, separated by a 1-week washout period. Device order was alternated, and doses were adjusted to ensure an approximately equal fluticasone dose. Device preference was determined using an adjusted Clinical Trial Patient Preference Questionnaire, and symptom improvement was assessed using Total Nasal Symptom Score and Sino-nasal Outcome Test-22 questionnaires. RESULTS: Symptom improvement was comparable between the devices. However, in both groups, 11/16 (69%) participants preferred the MDI with the adaptor over the standard nasal spray, citing fewer unpleasant sensations. Satisfaction score improvement was significantly greater with the novel device in the CRS cohort. Participants reported a higher likelihood of compliance with the novel device, suggesting improved adherence. CONCLUSIONS: An MDI with the adaptor was preferred over a standard nasal spray among AR and postoperative CRS participants. The enhanced tolerability may promote improved compliance, and consequently, more effective long-term symptom control.