Development of New Instruction for Intranasal Drug Administration

Abstract

Objective: To develop new instruction for intranasal spray administration. Method: A systematic review was conducted by retrieving related studies, clinical practice guidelines and clinical advices from PubMed, Medline, CENTRAL, Web of Science, Google Scholar, Open Gray, DART-Europe, ThaiLIS, ThaiJO and Thai Index Medicus. The main outcomes of data search were instructions for intranasal administration of decongestant or corticosteroids. Subsequently, the identified instructions were assessed through brainstorming among experts and developed into 5 best methods. They were preliminarily tested in laboratory setting for their efficacy in 10 healthy volunteers by using the modified NU_spiroBreathe (NUB). The outcome of interest was intranasal pressure measured from inhalation through the nose of volunteers during intranasal drug administration together with opinions from experts. One best method was selected and tested in laboratory setting in 20 healthy volunteers to confirm its efficacy. Results: Information gained from systematic review was used to develop 5 different instructions for intranasal drug administration. Experts reached the consensus on the best instruction, which was the one showing the best result in laboratory test. The chosen instruction was “tilt the head until one ear touches the fist placed on a table, then look straight along the arm”. The average intranasal pressures at inhalation measured at the left and right nostrils of healthy volunteers during intranasal drug administration were 34.55± 2.26 and 4.35± 2.86 cmH₂O, respectively, when not closing both nostrils and 11.26± 3.75, 10.16± 3.29 cmH₂O, respectively, when closing both nostrils. Conclusion: This study provided a new instruction for intranasal drug administration likely to be effective. Further study in patients is warrant.