Factors Influencing Public Knowledge and Usage Patterns of Nasal Decongestants

Introduction: This study sought to identify factors associated with public knowledge and usage of nasal decongestants.

Methods: A cross-sectional survey was administered to US adults via ResearchMatch. Questions included a demographic section, validated sinonasal questionnaires, and subjective ratings of knowledge and confidence in decongestant relief (5-point Likert scale). Multivariable ordinal and logistic regressions were performed to understand factors associated with knowledge of nasal decongestants as well as trends in usage.

Results: The cohort (n=686) was primarily female (70.5%), White (84.4%), and college educated (39.3%); 35.7% endorsed a history of chronic rhinosinusitis (CRS). Respondents reported greatest knowledge (4 or 5 on Likert scale) of Pseudoephedrine (73.5%) and Phenylephrine (55.8%). Factors associated with knowledge of any nasal decongestant included age [OR 0.99; 95% CI (0.98-0.99)], literacy score [OR 0.83; 95% CI (0.77-0.91)], CRS diagnosis [OR 1.38; 95% CI (1.01-1.89)], and SNOT-22 score (p < 0.05), by ordinal regression. Against recommended guidelines, 45.2% of Oxymetazoline (Afrin) users (n=243) reported use for more than 3 days and 34.2% reported use more than 2 times per day. Factors associated with Oxymetazoline overuse despite self-reported high knowledge of Oxymetazoline included residence in the US South, West, or Midwest (p < 0.05), married status [OR 2.05; 95% CI (1.03-4.04)], CRS diagnosis [OR 2.15; 95% CI (1.28-3.61)], and higher NOSE score (p < 0.05), per logistic regression. Of Phenylephrine users (n=265), perceived confidence in relief was markedly inflated compared to actual relief (t=5.70, p< 0.0001). Phenylephrine offered worse relief as compared to Pseudoephedrine (t=7.21, p< 0.0001) and Oxymetazoline (t=6.45, p< 0.0001).

Conclusions: Married status, residence outside of the US Northeast, CRS diagnosis, and greater NOSE score are associated with Oxymetazoline overuse despite high reported knowledge. In addition, overconfidence in Phenylephrine use and its reported substandard relief may support recent calls to eliminate this medication from the market.