Patients with rhinitis treat their condition as symptoms arise, rather than by guidelines on how to keep their disease under control, suggests a longitudinal study that confirms cross-sectional analyses.
Investigators captured data from patients in 25 countries via a mobile application called MASK-air. The app provides real-world data on patient experiences with their allergic rhinitis and how they use — or do not use — their medications, according to senior author Jean Bousquet, MD, a professor at the Institute of Allergology, Charité – Berlin University of Medicine, and corporate member of Free University of Berlin and Humboldt University of Berlin, Germany.
“People use their medication when they are not well,” he said in an interview. “When they are well, they don’t use medications.”
The findings were published in Allergy, the European Journal of Allergy and Clinical Immunology.
Medication Use and Medication Changes
The MASK-air app assesses the daily control of allergic rhinitis and asthma through visual analogue scales. The study assessed data from 2590 patients from specific weeks when they responded to a rhinitis daily questionnaire on the app on all 7 days of the week. Ages ranged from 16-90 years, with a mean age of 39.1. Slightly more than half of patients (54.1%) were female. From May 2015 to December 2020, the app generated 16,177 weeks of data for the study.
The researchers identified 10 clusters based on weeks with medication use and six clusters based on weeks where there was no medication use. Visual analogue scales were employed to capture control of allergic rhinitis, which was divided into good rhinitis control, intermediate control, poor control, and variable control.
Investigators found the percentage of days without medication varied between 11.8% in one cluster to 39.4% of the days in another cluster. Changes in their self-treatment regimen in rhinitis medication within the same week varied from 15.9% in one cluster to 45% in another cluster.
Bousquet and his co-authors from around the globe concluded that the findings point to a knowledge gap on the part of patients about how to gain control of their allergic rhinitis.
The results “suggest that patients are uncertain on how to amend their medication according to their symptoms and use trial-and-error strategies rather than follow guidelines,” the authors write. “Indication on how to step-up and step-down medication depending on symptoms and on expected pollen exposure may be a relevant future step. For this purpose, MASK-air may play a decisive role, as it could provide alerts to users according to pollen levels, making data easily available (with the patients’ consent) to their doctors.”
“We need to have shared decision-making with our patients,” said Bousquet, noting general guidelines advise use of intranasal steroids and intranasal antihistamines.
Data for Shared Decision-making With Patients
The data are helpful to physicians treating patients with rhinitis who do not have their disease under control, and the data also reveal patients with rhinitis do not know what next steps to take if they’re not responding to medication, noted Andy Nish, MD, Northeast Georgia Physicians Group, Allergy and Asthma, Gainesville, Georgia.
“It was noteworthy that when they were having symptoms, they didn’t necessarily know how to change their medicine to make it better,” said Nish. “It is incumbent on us as doctors to be sure they have a plan if they are not doing well on their medications. The data from the app can be provided to their physicians, who can help [patients] decide what to do about their symptoms.
“This study’s findings are consistent with previous studies that were cross-sectional studies,” he said. “This is a longitudinal study over time and agrees with studies that looked at a slice in time. This study helps to reinforce previous studies.”
A limitation of the research is that it required use of the app, said Nish. “Some people are not willing to use technology,” said Nish. “The use of technology is slanted towards the younger and the more affluent.”
In addition, investigators did not look at people’s access to healthcare as a factor in terms of why they did or did not change their medications. “We assume they changed medicines based on their symptoms, but perhaps they did not have the [healthcare and economic] access to make changes,” he said.
Sunil K. Saini, MD, practicing allergist-immunologist in Mission Viejo, California, and volunteer associate clinical professor at University of California Irvine, described the study as exploratory and offering insights into patient behavior.
“What I like about it is that it’s a real-world study,” Saini said, noting the app serves as a data collection tool where erstwhile patients otherwise would keep paper diaries to record their symptoms. “The study tells us some people may need to take their medication every day, and then at other times, they may not need to take medications. They [study investigators] are trying to figure out: How do people behave. This is a qualitative study.”
Saini agreed that there may be a selection bias in the patients who were included in the study.
“It may be people with milder symptoms aren’t as interested [in using the app], but people who have more severe symptoms might be more interested in doing this,” said Saini. “So, you may be selecting [patients] who may be a little more severe, and you may be selecting patients that are more comfortable using cell phones.”
Bousquet reports personal fees from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, sanofi-aventis, Takeda, Teva, and Uriach. Bousquet has shares in Kyomed Innov and MASK-air. Nish and Saini report no relevant financial relationships.
Allergy. Published online November 3, 2022. Full text