Analyzing My Non-Adherence To Nasal Steroids

Last updated: March 2021

In a recent discussion with Dia and Kat, in which we were discussing washing the dust mite covers for our mattresses (which I finally got like 6+ years into having asthma because I was picky about not getting one that a) crinkled or b) cost $100), and I was like “Wait, you have to do that?” I was reminded of another way in which I am a Lazy Asthmatic, at least for anything “out of the ordinary”.

Look. I take my inhalers. I take my other meds. I even wash my spacer once or twice a year. (Note: They say clean weekly. You should do that. I should do that. But I’m an asthmatic with ADHD okay? My brain is chaos.) But this discussion of Things We Should Do reminded me of another thing I suck at doing, as I re-realized this morning...

I don’t just inhale steroids

People, I do not just inhale steroids on a twice-a-day basis, from two different inhalers, no less. I am supposed to snort those things too. (Yes, you’re not technically supposed to snort them. I don’t. You just sort of spray the junk into your nose and pretend like, you know, it’s the most elegant thing you have ever done.)
Last time I had a re-start on the nasal steroids? It lasted me like, four freaking days. And the kicker? I FELT BETTER IN JUST THOSE FEW DAYS? Why on earth would I just fail to continue adding them to my routine?! This is a mystery of life, because I’ve been thinking about that for the whole darned afternoon and I can’t for the life of me figure out, given I’m taking inhalers morning and night, why I can’t just get into the routine of the nasal steroids!

Analyzing my barriers to nasal steroids

In order to figure out why I am so sub-optimally (read: non-optimally, read: not at all) adherent to nasal steroids, here’s why I predict I don’t take them:

  • When it is bedtime, and I am taking 3 inhalers + 1-2 pills, I don’t want to add another step.
  • When it is morning, and I am taking 3 inhalers + 1 pill, and am still not very awake, I also don’t want to add another step.
  • Though constant, my rhinitis symptoms are not actually that bothersome to me, though I do feel better when I take the nasal steroids.
  • Taking the nasal steroids does NOT have an impact on my asthma (note: my asthma), and I had an ENT tell me this once.
  • Said ENT kind of said it was up to me if I kept taking them. (Dr. Smartypants disagrees and she prescribed me a fresh round last appointment.)

The Rebuttal: AKA Reasons I should take nasal steroids

Clearly I am not one of those people who will blindly take whatever is prescribed to me, we’ve figured that out long ago. So long there is sound science behind it, and I don’t feel worse, I’m happy  to comply. I mean, I’m reasonably adherent with my other meds. So what gives?!

  • In response to arguments 1 and 2 about adding a step: I should be waiting longer between puffs of inhalers anyways. This means I could be using this time to shoot steroids up my nose.
  • As above, when I take nasal steroids, my sinuses do feel better. And this happens fairly quickly, within a day or two. Which means, yes, I am benefitting from the nasal steroids.
  • Even if they do not have an impact on my asthma, clearly breathing through my nose easier is better for my asthma as the air gets more filtered before it hits my lungs. Which, in a small part, helps my asthma. (Typically sinus issues impact asthma by way of like, postnasal drip and inflammation that may affect the entire airway, nose/sinuses to lungs/bronchioles/alveoli).1
  • Dr. Smartypants thinks is a good idea, and she went to Harvard, and she is much smarter about me on these matters. The ENT (who I only saw once so he does not have a nickname, though he was also smart and wonderful) does not think my sinus issues have impact on my asthma.
  • Again, the ENT left it up to me. Which is probably the thing that stuck with me.
    Although a) I was noncompliant before then, and b) It’s not like anybody told me this before to trigger my noncompliance…

The reality is, beyond controlling my primarily non-troublesome symptoms, there’s just not a whole lot of concrete reason motivating me to go back on nasal steroids? Should I? Probably, if just for my sinus symptoms. But because there’s no guarantee—in my case—that they’re helping my asthma, it’s a bit harder to let that fact motivate me to adhere to my nasal steroids. Although, I guess another round (perhaps alongside some Quantified Asthma?) could be in order...

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