Introduction and aim Rhinosinus disease is common in asthma and causes nasal congestion, post nasal drip and pain. This can lead to altered breathing patterns, particularly mouth breathing which exposes patients airways to cold dehumidified air and may aggravate their asthma. Nasal irrigation is accepted as an appropriate early intervention for managing allergic rhinitis but may be under-utilised in severe asthma. This study aims to evaluate the effects of nasal irrigation in a severe asthma population.
Method Thirty patients (23 females, mean age 47), with a confirmed diagnosis of severe asthma (22/30 73% atopic) and rhinosinusitis took part in this study, none of the participants had previous nasal irrigation. Patients were taught to irrigate with the netti pot system (0.9%saline), initially 1–2 times each day and to titrate to individual needs. Symptoms were assessed with snott-22 questionnaires before and after three months of treatment, snott scores range from 0–110, a difference of 8.9 points is the minimal change thought to be clinically significant. Data was also collected on ACQ scores, usage, reported benefits and side effects.
Results 26 patients were using nasal irrigation at three month follow-up, mean initial snott scores were 63.2 ± 22.9 compared to 41.7 ± 26.8 post treatment (p = 0.0001). 69% (18/26) patients showed clinically significant decreased nasal symptoms, with a mean improvement of 33.7 points. 19% (5/26) showed no significant change and 12% (3/26) had a clinically significant increase in nasal symptoms. 88% (23/26) patients felt their nasal symptoms had improved, 62% (16/26) felt their chest symptoms had improved. Mean initial ACQ 3.42 ± 1.39 compared to 2.62 ± 1.58 post treatment (p = 0.01). Usage ranged from BD to 3–5 times per week. 17% (5/30) of patients reported side effects: headache (2) sneezing(1) Nose bleed(1) LBP(1) three patients stopped treatment due to the side effect.
Conclusion After three months of nasal irrigation 88% of patients reported improved nasal symptoms, 62% reported improved chest symptoms, there were statistically significant improvements in mean snott 22 and ACQ scores. Nasal irrigation is therefore an effective and inexpensive intervention, with few side effects, in the treatment of rhinosinus and related asthma symptoms and should be advocated in severe asthma clinics.