Q1. Region *   _____________
Q2. Province * _____________
Q3. Type of pharmacy * □Urban □Rural
Q4. Years since graduation * □<5 y □5–10 □11–20 □>20
Q5. Educational qualification * □Bachelor’s degree □II level master □Residency □Research doctorate
Q6. What are the most frequent age groups among the patients requiring intranasal decongestants? * Evaluation score: 1 = never; 2 = sometimes; 3 = usually; 4 = very often; 5 = always
0/17 Childhood/Adolescents	□1  □2  □3 □4 □5
18/35 Young adults	□1  □2  □3 □4 □5
36/60 Adults	□1  □2  □3 □4 □5
61/74 Late adults	□1  □2  □3 □4 □5
75/84 Elderly	□1  □2  □3 □4 □5
Over 85 Seniors	□1  □2  □3 □4 □5
Q7. How often do you dispense nasal sprays containing the following active principles on your own initiative? Evaluation score: 1 = 0 times a week; 2 = 1–10 times a week; 3 = 10 times a day; 4 = >10 times a day.
Alpha-agonists	□1  □2  □3 □4
Corticosteroids (over the counter)	□1  □2  □3 □4
Alpha-agonists combined with antihistamines	□1  □2  □3 □4
Saline solutions	□1  □2  □3 □4
Marine or hypertonic solutions	□1  □2  □3 □4
Q8. How often does the patient specifically request nasal sprays containing the following active principles? Evaluation score: 1 = 0 times a week; 2 = 1–10 times a week; 3 = 10 times a day; 4 = >10 times a day.
Alpha-agonists	□1  □2  □3 □4
Corticosteroids (over the counter)	□1  □2  □3 □4
Alpha-agonists combined with antihistamines	□1  □2  □3 □4
Saline solutions	□1  □2  □3 □4
Marine or hypertonic solutions	□1  □2  □3 □4
Q9. Based on your experience, how often do the patients require alpha-agonist decongestants in the following rhinology diseases? Evaluation score: 1 = 0 times a week; 2 = 1–10 times a week; 3 = 10 times a day; 4 = >10 times a day.
Viral rhinitis	□1  □2  □3 □4
Allergic rhinitis	□1  □2  □3 □4
Non-allergic vasomotor rhinitis	□1  □2  □3 □4
Rhinosinusitis without nasal polyps	□1  □2  □3 □4
Rhinosinusitis with nasal polyps	□1  □2  □3 □4
Q10. What is the average dosage used by your patients for alpha-agonist nasal sprays? □Below the therapeutic indications (<1–2 puff/nostril 2–3 times a day) □Equal to the therapeutic indications (1–2 puffs/nostril 2–3 times a day) □Superior to the therapeutic indications (>1–2 puffs/nostril 2–3 times a day)
Q11. On an average sample of ten patients, how many in your opinion use nasal sprays at a higher dosage than that reported in the technical data sheet?         ⓪    ①    ②    ③    ④    ⑤    ⑥    ⑦    ⑧    ⑨    ⑩
Q12. What is the average duration of alpha-agonist nasal-spray therapy in your patients? □Less than 5 days □Equal to 5 days □More than 5 days
Q13. On an average sample of 10 patients, how many buy nasal sprays recurrently (i.e., at least one pack every two weeks)?         ⓪    ①    ②    ③    ④    ⑤    ⑥    ⑦    ⑧    ⑨    ⑩