# Administration Technique of Intranasal Corticosteroid Sprays Among Nepali Pharmacists: Cross-Sectional Study

## TL;DR

Many Nepali pharmacists do not demonstrate correct techniques for using intranasal corticosteroid sprays, which could lead to reduced treatment effectiveness and more side effects.

## Contribution

This study is the first to assess the proficiency of Nepali pharmacists in demonstrating correct intranasal corticosteroid spray techniques and identify factors influencing their performance.

## Key findings

- Only 47.1% of pharmacists demonstrated adequate technique for using intranasal corticosteroid sprays.
- Pharmacists with bachelor’s degrees and those who use educational leaflets are more likely to provide correct counseling.
- Younger pharmacists and women were less likely to demonstrate proper spray techniques.

## Abstract

Allergic rhinitis is a common condition affecting up to 40% of people worldwide, with a notably high prevalence in South Asia. The primary treatment for moderate to severe allergic rhinitis is intranasal corticosteroid sprays (INCS), the use of which is typically demonstrated to patients by registered pharmacists. However, many patients do not use these sprays correctly.

This study evaluated the proficiency of pharmacists in demonstrating the correct technique for using INCS and the factors contributing to proper technique.

In a cross-sectional survey of 365 registered pharmacists in the Kathmandu Valley, Nepal, a trained observer used a standardized 12-step checklist to assess each pharmacist’s technique for using INCS. The 12-step checklist was created after studying international guidelines, studies conducted in Nepal, international research articles, and instructional pamphlets. Simple random sampling was done to collect the data from community pharmacies in Kathmandu district. Demographics, education, experience, previous training, and instructional materials use were recorded. A total of 12 marks were awarded for all 12 steps, with one mark given for each step. Proficiency was classified as “adequate” if more than 6 marks were obtained.

Out of 365 pharmacists, 239 (65.5%) were male and 126 (34.5%) were female. Overall, 216 pharmacists (59.2%) were aged 26 years or younger and 235 pharmacists (69.9%) held a diploma in pharmacy. We found that 193 (52.9%) pharmacists demonstrated inadequate technique, while only 172 (47.1%) showed adequate skill overall. However, only 22 pharmacists (6%) demonstrated all 5 critical steps. The likelihood of providing appropriate counseling on the use of INCS was significantly correlated with multiple independent factors. Those with a diploma in pharmacy had a 97% lower likelihood of providing appropriate counseling compared with those with a bachelor’s degree in pharmacy and above (P<.001). Pharmacists who perform counseling sessions 1‐4 times per week had 11-fold greater odds of doing so correctly compared with those who do not (P=.002). Pharmacists who do not use educational leaflets were 96% less likely to provide adequate counseling (P= .005) . Similarly, pharmacists under the age of 26 are 89% less likely than older pharmacists to provide adequate counseling (P=.001). It is interesting to note that men were found to have almost 2.3 times higher odds of providing appropriate counseling than women (P=.02).

More than half of the registered pharmacists in Nepal demonstrated inadequate technique when using INCS. The inadequate patient counseling on INCS use can significantly increase the risk of adverse drug reactions and reduce the efficacy of the therapy. Thus, there is a strong need for educational interventions and policy change for improved proficiency.