1
|
Takala J, Vähätalo I, Tuomisto LE, Niemelä O, Ilmarinen P, Kankaanranta H. Documentation of comorbidities, lifestyle factors, and asthma management during primary care scheduled asthma contacts. NPJ Prim Care Respir Med 2024; 34:2. [PMID: 38461294 PMCID: PMC10925028 DOI: 10.1038/s41533-024-00360-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/27/2024] [Indexed: 03/11/2024] Open
Abstract
Systematically assessing asthma during follow-up contacts is important to accomplish comprehensive treatment. No previous long-term studies exist on how comorbidities, lifestyle factors, and asthma management details are documented in scheduled asthma contacts in primary health care (PHC). We showed comorbidities and lifestyle factors were poorly documented in PHC in this real-life, 12-year, follow-up study. Documented information on rhinitis was found in 8.9% and BMI, overweight, or obesity in ≤1.5% of the 542 scheduled asthma contacts. Of the 145 patients with scheduled asthma contacts, 6.9% had undergone revision of their inhalation technique; 16.6% had documentation of their asthma action plan. Screening of respiratory symptoms was recorded in 79% but nasal symptoms in only 15.5% of contacts. Lifestyle guidance interventions were found in <1% of contacts. These results, based on documented patient data, indicate a need exists to further improve the assessment and guidance of asthma patients in PHC.
Collapse
Grants
- Tampere Tuberculosis Foundation (Tampere, Finland), the Finnish Anti-Tuberculosis Association Foundation (Helsinki, Finland), the Jarmari and Rauha Ahokas Foundation (Helsinki, Finland),the Ida Montini Foundation (Kerava, Finland), the Pihkahovi Foundation (Ylihärmä, Finland), the Finnish Allergy, Skin and Asthma Federation, the Järviseutu Foundation (Vimpeli, Finland), the General Practitioners in Finland (Helsinki, Finland), the Medical Research Fund of Seinäjoki Central Hospital (Seinäjoki, Finland)
- the Medical Research Fund of Seinäjoki Central Hospital (Seinäjoki, Finland) and the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital (VTR, Tampere, Finland). H Kankaanranta is an asthma and allergy research Professor funded by the Hermann Krefting Foundation and his work is supported by Swedish Heart- and Lung Foundation, Vetenskapsrådet (Sweden; 2022-01022) and ALF agreement (ALFGBG-966075; grant from the Swedish state under the agreement between the Swedish Government and the county councils).
Collapse
Affiliation(s)
- Jaana Takala
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland.
- Seinäjoki Health Care Centre, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland.
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Iida Vähätalo
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
- Tampere University, Tampere, Finland
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Krefting Research Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
2
|
Sarfraz Z, Sarfraz A, Cherrez-Ojeda I. Investigating Experimental Treatments for Rhinitis: A State-of-the-Art Systematic Review. EAR, NOSE & THROAT JOURNAL 2024:1455613231222363. [PMID: 38205635 DOI: 10.1177/01455613231222363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background: Rhinitis is a common inflammatory condition that affects the nasal passages, significantly impacting quality of life and placing a considerable burden on healthcare systems. While traditional treatments offer limited relief, there is a growing interest in novel therapies. This systematic review aims to analyze investigational new treatments for rhinitis. Methods: A search was conducted in ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and the European Union Clinical Trials Register, as well as PubMed, Web of Science, and the Cochrane Library. Both ongoing and completed clinical trials exploring innovative therapies for rhinitis, including immunotherapy, probiotics, and stem cell therapy, were included. Results: This systematic review compiled information from 74 clinical trials-51 completed and 23 ongoing-focused on new treatments for rhinitis. A significant portion of the completed studies (44) focused on various forms of immunotherapy, which showed potential for long-term effectiveness and had a high safety profile. Another seven completed trials investigated probiotics as a treatment method, yielding mixed results, though they did show promise in managing symptoms, particularly when combined with other treatments. The ongoing trials are primarily investigating immunotherapy, with a smaller number looking at probiotics and stem cell therapy. This shows a continued exploration of innovative and diverse therapies for managing rhinitis. Conclusion: This study highlights the potential of emerging rhinitis therapies to improve patient outcomes and enhance quality of life. Continued research is recommended for developing more effective, personalized, and targeted therapeutic strategies for rhinitis.
Collapse
Affiliation(s)
- Zouina Sarfraz
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Azza Sarfraz
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, SD, Pakistan
| | - Ivan Cherrez-Ojeda
- Department of Allergy and Pulmnology, Universidad Espíritu Santo, Samborondón, Guayas, Ecuador
| |
Collapse
|
3
|
Lugogo N, O'Connor M, George M, Merchant R, Bensch G, Portnoy J, Oppenheimer J, Castro M. Expert Consensus on SABA Use for Asthma Clinical Decision-Making: A Delphi Approach. Curr Allergy Asthma Rep 2023; 23:621-634. [PMID: 37991672 PMCID: PMC10716188 DOI: 10.1007/s11882-023-01111-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE OF REVIEW A modified Delphi process was undertaken to provide a US expert-led consensus to guide clinical action on short-acting beta2-agonist (SABA) use. This comprised an online survey (Phase 1), forum discussion and statement development (Phase 2), and statement adjudication (Phase 3). RECENT FINDINGS In Phase 1 (n = 100 clinicians), 12% routinely provided patients with ≥4 SABA prescriptions/year, 73% solicited SABA use frequency at every patient visit, and 21% did not consult asthma guidelines/expert reports. Phase 3 experts (n = 8) reached consensus (median Likert score, interquartile range) that use of ≥3 SABA canisters/year is associated with increased risk of exacerbation and asthma-related death (5, 4.75-5); SABA use history should be solicited at every patient visit (5, 4.75-5); usage patterns over time, not absolute thresholds, should guide response to SABA overuse (5, 4.5-5). Future asthma guidelines should include clear recommendations regarding SABA usage, using expert-led thresholds for action.
Collapse
Affiliation(s)
- Njira Lugogo
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Maeve O'Connor
- Allergy Asthma and Immunology Relief, Charlotte, NC, USA
| | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | - Rajan Merchant
- Woodland Clinic Medical Group, Allergy Department, Dignity Health, Woodland, CA, USA
| | - Greg Bensch
- Allergy Immunology and Asthma Medical Group, Stockton, CA, USA
| | - Jay Portnoy
- Section of Allergy, Asthma & Immunology, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - John Oppenheimer
- Department of Internal Medicine, New Jersey Medical School, Newark, NJ, USA
- Pulmonary and Allergy Associates, Morristown, NJ, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
4
|
Bosnic-Anticevich S, Fuhlbrigge AL. Getting Smart About Implementing SMART. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2778-2780. [PMID: 37481111 DOI: 10.1016/j.jaip.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Sinthia Bosnic-Anticevich
- Faculty of Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Anne L Fuhlbrigge
- Division of Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado School of Medicine, Aurora, Colo.
| |
Collapse
|
5
|
Alamyar S, Azzi E, Srour-Alphonse P, House R, Cvetkovski B, Kritikos V, Bosnic-Anticevich S. Uncovering the Burden of Rhinitis in Patients Purchasing Nonprescription Short-Acting β-Agonist (SABA) in the Community. PHARMACY 2023; 11:115. [PMID: 37489346 PMCID: PMC10366934 DOI: 10.3390/pharmacy11040115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/19/2023] [Accepted: 07/01/2023] [Indexed: 07/26/2023] Open
Abstract
Asthma and rhinitis are common comorbidities that amplify the burden of each disease. They are both characterized by poor symptom control, low adherence to clinical management guidelines, and high levels of patient self-management. Therefore, this study aims to investigate the prevalence of self-reported rhinitis symptoms in people with asthma purchasing Short-Acting Beta Agonist (SABA) reliever medication from a community pharmacy and compare the medication-related behavioral characteristics among those who self-report rhinitis symptoms and those who do not. Data were analyzed from 333 people with asthma who visited one of eighteen community pharmacies in New South Wales from 2017-2018 to purchase SABA and completed a self-administered questionnaire. Participants who reported rhinitis symptoms (71%), compared to those who did not, were significantly more likely to have coexisting gastroesophageal reflux disease (GERD), overuse SABA, and experience side effects. They may have been prescribed daily preventer medication but forget to take it, and worry about its side effects. They were also more likely to experience moderate-to-severe rhinitis (74.0%), inaccurately perceive their asthma as well-controlled (50.0% self-determined vs. 14.8% clinical-guideline defined), and unlikely to use rhinitis medications (26.2%) or daily preventer medication (26.7%). These findings enhance our understanding of this cohort and allow us to identify interventions to improve patient outcomes.
Collapse
Affiliation(s)
- Sara Alamyar
- Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Elizabeth Azzi
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
- GSK Australia, Pty., Ltd., Ermington, NSW 2115, Australia
| | - Pamela Srour-Alphonse
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Rachel House
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW 2006, Australia
- Sydney Local Health District, Sydney, NSW 2050, Australia
| |
Collapse
|
6
|
Belhassen M, Bérard M, Devouassoux G, Dalon F, Bousquet J, Van Ganse E. Treatment of Allergic Rhinitis and Asthma in Primary Care: Dispensations Do Not Align with Prescriptions. J Asthma Allergy 2022; 15:1721-1729. [DOI: 10.2147/jaa.s376786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022] Open
|
7
|
Lourenço O, Cvetkovski B, Kritikos V, House R, Scheire S, Costa EM, Fonseca JA, Menditto E, Bedbrook A, Bialek S, Briedis V, Boussery K, Canonica GW, Haahtela T, Kuna P, Mullol J, Orlando V, Samolinski B, Wallace D, Duggan C, Paulino E, Pinto GS, Söderlund L, Bousquet J, Bosnic‐Anticevich S. Management of allergic rhinitis symptoms in the pharmacy Pocket guide 2022. Clin Transl Allergy 2022; 12:e12183. [PMID: 36225265 PMCID: PMC9533218 DOI: 10.1002/clt2.12183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background Allergic rhinitis (AR) management requires a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Methods Allergic Rhinitis and its Impact on Asthma (ARIA) first published a reference document on the pharmacist's role in allergic rhinitis management in 2004. Several guidelines were developed over the past 20 years improving the care of allergic rhinitis patients through an evidence-based, integrated care approach. Results This ARIA/EAACI/FIP Position Paper is based on the latest ARIA in the Pharmacy guidelines and provides: (a) a structured approach to pharmacists identifying people with AR and/or allergic conjunctivitis as well as those at risk of poor disease control; (b) an evidence-based clinical decision support tool for optimising the management of allergic rhinitis in the community pharmacy; and (c) a framework of referral to the physician. Conclusion This document is not intended to be a mandatory standard of care but is provided as a basis for pharmacists and their staff to develop relevant local standards of care for their patients, within their local practice environment. Pharmacy care varies between countries, and the guide should be adapted to the local situation.
Collapse
Affiliation(s)
- Olga Lourenço
- Faculty of Health Sciences and CICS – UBIHealth Sciences Research CentreUniversity of Beira InteriorCovilhãPortugal
| | - Biljana Cvetkovski
- Woolcock Institute of Medical Research and University of SydneyGlebeNSWAustralia
| | - Vicky Kritikos
- Woolcock Institute of Medical Research and University of SydneyGlebeNSWAustralia
- Sydney Local Health DistrictSydneyNSWAustralia
| | - Rachel House
- Woolcock Institute of Medical Research and University of SydneyGlebeNSWAustralia
| | - Sophie Scheire
- Pharmaceutical Care UnitFaculty of Pharmaceutical SciencesGhent UniversityGhentBelgium
| | - Elisio M Costa
- UCIBIO, REQUINTEFaculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing)PortoPortugal
| | - João A. Fonseca
- MEDCIDS ‐ Department of Community MedicineInformation and Health Decision SciencesFaculty of MedicineCINTESIS – Center for Health Technology and Services ResearchRISE – Health Research NetworkUniversity of PortoPortoPortugal
| | - Enrica Menditto
- Department of PharmacyCIRFFCenter of Pharmacoeconomics and Drug Utilization ResearchUniversity of Naples Federico IINaplesItaly
| | | | - Slawomir Bialek
- Department of Biochemistry and Clinical ChemistryFaculty of PharmacyMedical University of WarsawWarsawPoland
| | - Vitalis Briedis
- Department of Clinical Pharmacy of Lithuanian University of Health SciencesKaunasLithuania
| | - Koen Boussery
- Pharmaceutical Care UnitFaculty of Pharmaceutical SciencesGhent UniversityGhentBelgium
| | - G. Walter Canonica
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele, Italy & Personalized Medicine, Asthma and AllergyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Tari Haahtela
- Skin and Allergy HospitalHelsinki University HospitalUniversity of HelsinkiHelsinkiFinland
| | - Piotr Kuna
- Division of Internal MedicineAsthma and AllergyBarlicki University HospitalMedical University of LodzLodzPoland
| | - Joaquim Mullol
- Rhinology Unit & Smell ClinicENT DepartmentHospital ClinicClinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERESUniversity of BarcelonaBarcelonaSpain
| | - Valentina Orlando
- Department of PharmacyCIRFFCenter of Pharmacoeconomics and Drug Utilization ResearchUniversity of Naples Federico IINaplesItaly
| | - Boleslaw Samolinski
- Department of Prevention of Environmental HazardsAllergology and ImmunologyMedical University of WarsawWarsawPoland
| | - Dana Wallace
- Nova Southeastern UniversityFort LauderdaleFloridaUSA
| | | | - Ema Paulino
- International Pharmaceutical FederationThe HagueThe Netherlands
- EzfyLisbonPortugal
| | | | | | - Jean Bousquet
- ARIAMontpellierFrance
- MASK‐airMontpellierFrance
- University Hospital of MontpellierMontpellierFrance
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
- Institute of AllergologyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Sinthia Bosnic‐Anticevich
- Sydney Local Health DistrictSydneyNSWAustralia
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of SydneySydneyNSWAustralia
| |
Collapse
|
8
|
Hancock KL, Bosnic-Anticevich S, Blakey JD, Hew M, Chung LP, Cvetkovski B, Claxton S, Del Fante P, Denton E, Doan J, Ranasinghe K, Morgan L, Sharma A, Smith PK, Stewart D, Thompson PJ, Wiseman R, Upham JW, Yan KY, Carter V, Dhillon K, Heraud F, Le T, Vella R, Price D. Characterisation of the Australian Adult Population Living with Asthma: Severe - Exacerbation Frequency, Long-Term OCS Use and Adverse Effects. Pragmat Obs Res 2022; 13:43-58. [PMID: 35818499 PMCID: PMC9270906 DOI: 10.2147/por.s360044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Asthma poses a significant burden for the Australian population. Understanding severe exacerbation rates, and steroid-related burden for adults diagnosed with asthma stands to offer insights into how this could be reduced. Methods Electronic medical records (EMR) and questionnaires from the Optimum Patient Care Research Database Australia (OPCRDA) were utilised retrospectively. OPCRDA is a real-world database with >800,000 medical records from Australian primary care practices. Outcomes were severe asthma exacerbations in Australian adults, over a 12-month period, stratified by Global Initiative for Asthma (GINA) treatment intensity steps, and steroid associated comorbidities. Results Of the 7868 adults treated for asthma, 19% experienced at least one severe exacerbation in the last 12-months. Severe exacerbation frequency increased with treatment intensity (≥1 severe exacerbation GINA 1 13%; GINA 4 23%; GINA 5a 33% and GINA 5b 28%). Questionnaire participants reported higher rates of severe exacerbations than suggested from their EMR (32% vs 23%) especially in steps 1, 4 and 5. Patients repeatedly exposed to steroids had an increased risk of osteoporosis (OR 1.95, 95% CI 1.43–2.66) and sleep apnoea (OR 1.78, 95% CI 1.30–2.46). Conclusion The Australian population living with GINA 1, 4, 5a and 5b asthma have high severe exacerbation rates and steroid-related burden, especially when compared to other first world countries, with these patients needing alternative strategies or possibly specialist assessment to better manage their condition.
Collapse
Affiliation(s)
| | - Sinthia Bosnic-Anticevich
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Woolcock Institute of Medical Research, Glebe, MSW, 2037, Australia
- Sydney Local Health District, Camperdown, NSW, 2050, Australia
| | - John D Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, WA, 6009, Australia
- Curtin University Medical School, Bentley, Western Australia, 6102, Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, VIC, 3004, Australia
- Public Health and Preventive Medicine, Monash University, Victoria, 3800, Australia
| | - Li Ping Chung
- Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, WA, 6150, Australia
| | | | - Scott Claxton
- Genesis Care Sleep and Respiratory, Joondalup, WA, 6027, Australia
| | | | - Eve Denton
- Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, VIC, 3004, Australia
- Public Health and Preventive Medicine, Monash University, Victoria, 3800, Australia
| | - Joe Doan
- HealthPlus Medical Centre, Kogarah, NSW, 2217, Australia
| | - Kanchanamala Ranasinghe
- School of Medicine, Griffith University, Nathan, QLD, Australia
- Cannon Hill Family Doctors, Cannon Hill, QLD, 4170, Australia
| | - Lucy Morgan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Department of Thoracic Medicine, Concord Hospital, Sydney, NSW, Australia
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | - Anita Sharma
- Platinum Medical Centre, Chermside, QLD, 4032, Australia
| | | | - Deb Stewart
- Adjunct Lecturer, School of Medicine, University of Tasmania, Churchill Ave, Hobart, TAS, 7005, Australia
| | - Philip J Thompson
- The Lung Health Clinic, Hollywood Medical Centre, Nedlands, 6009, Australia
- The University of Western Australia, Perth, Western Australia, 6009, Australia
- Curtin University, Bentley, Western Australia, 6102, Australia
| | | | - John W Upham
- Diamantina Institute & PA-Southside Clinical Unit, the University of Queensland, Woolloongabba, QLD, 4102, Australia
| | - Kwok Y Yan
- Department of Respiratory Medicine, W, Camperdown, NSW, 2050, Australia
| | | | | | - Florian Heraud
- Optimum Patient Care Australia, Brisbane, QLD, 4000, Australia
| | - Thao Le
- Optimum Patient Care, Cambridgeshire, CB24 3BA, UK
| | - Rebecca Vella
- Optimum Patient Care Australia, Brisbane, QLD, 4000, Australia
| | - David Price
- Optimum Patient Care, Cambridgeshire, CB24 3BA, UK
- Optimum Patient Care Australia, Brisbane, QLD, 4000, Australia
- Observational and Pragmatic Research Institute, Midview City, 573969, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
- Correspondence: David Price, Optimum Patient Care Australia, 320 Adelaide St, Brisbane, QLD, 4000, Australia, Tel +4 05 764 842, Email
| | | |
Collapse
|
9
|
Cabrera M, Ryan D, Angier E, Losappio L, Flokstra ‐ de Blok BMJ, Gawlik R, Purushotam D, Bosnic‐Anticevich S. Current allergy educational needs in primary care. Results of the EAACI working group on primary care survey exploring the confidence to manage and the opportunity to refer patients with allergy. Allergy 2022; 77:378-387. [PMID: 34498282 DOI: 10.1111/all.15084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 03/12/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
The aim of this survey was to explore the specific educational needs of a cohort of European GPs with regards to allergy training so that future educational initiatives may better support the delivery of allergy services in primary care. METHOD This study took the form of a cross-sectional observational study in which a structured electronic questionnaire was distributed to primary care providers, in eight languages, across 8 European countries between September 2019 and November 2019. Data associated with demographic parameters, professional qualifications, type of employment, level of confidence regarding competencies for diagnosis and treatment of allergic diseases, referral of patients to allergist and preferred method of learning and assessment were collected. A 5-point Likert scale was used to assess level of confidence. Exploratory analysis was carried out. RESULTS A total of 687 responses were available for analysis, with 99.3% of responders working within Europe. 70.1% of participants were female; and 48.0% and 48.0% of participants respectively had received some undergraduate and/or postgraduate allergy education. Confidence in dealing with different aspect of allergy management differed between countries. The main reason for specialist referral was a perceived need for tertiary assessment (54.3%), and the main barrier for referral was the consideration that the patient's condition could be appropriately diagnosed and treated in a primary care facility. Up to 44.7% and 55.3% of participants reported that they preferred e-Learning over traditional learning. CONCLUSIONS This study identified the specific areas of skills training and educational needs of GPs in managing allergic conditions in primary care, and provided insights into possible strategies for more feasible and cost-effective approaches.
Collapse
Affiliation(s)
- Martha Cabrera
- Allergy Department Hospital los Madroños Brunete, Madrid Spain
| | | | - Elisabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Laura Losappio
- Allergy and Immunology Unit ASST Grande Ospedale Metropolitano Niguarda Milan Italy
| | - Bertine M. J. Flokstra ‐ de Blok
- General Practitioners Research Institute Groningen the Netherlands
- GRIAC Research Institute University Medical Center Groningen University of Groningen Groningen The Netherlands
- Department of Pediatric Pulmonology and Pediatric Allergology University Medical Center Groningen Beatrix Children's Hospital University of Groningen Groningen The Netherlands
| | - Radoslaw Gawlik
- Department of Internal Medicine, Allergology and Clinical Immunology Silesian University of Medicine Katowice Poland
| | | | - Sinthia Bosnic‐Anticevich
- Quality Use of Respiratory Medicines Group Woolcock Institute of Medical Research University of Sydney NSW Australia
| |
Collapse
|
10
|
Wadhahi AA, Garvey L, Edward KL, Beasley C. The lived experience of adherence to asthma medication in young adults (18-34 years). J Asthma 2021; 59:2475-2490. [PMID: 34902272 DOI: 10.1080/02770903.2021.2018706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adherence to asthma medications is commonly poor and is the primary cause for anticipated worsening health outcomes for patients with asthma. Worldwide, qualitative investigations that examine the adherence of young adults (18-34 years) to their asthma medication are limited. METHOD This study used a phenomenological research approach to explicate the experience of asthma medication adherence as described by young adults. Data were collected using semi-structured in-depth video interviews conducted with participants aged between 18 and 34 years to elicit their lived experience with adherence to asthma medication. Data from the interviews were transcribed and analyzed using the Edward and Welch (1) extension of Colaizzi's approach to phenomenology. RESULTS Results yielded four main themes related to the phenomenon of adherence that emerged from the analysis. The themes were: Having a plan; Having knowledge about your medication and asthma triggers; Being responsible with asthma medication; and Health belief. CONCLUSION According to the findings, for young people adhering to asthma medication is a process that depends on four vital aspects: (A) plan, (B) knowledge, (C) responsibility, and (D) belief. If young adults with asthma received individualized written asthma plans and have adequate knowledge about this plan, developing the correct health belief is likely to result. Hence, this can lead to a greater responsibility to manage their asthma to the recommended adherence level.
Collapse
Affiliation(s)
- Amal Al Wadhahi
- Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia
| | - Loretta Garvey
- Department of Health Professions, Swinburne University of Technology, Melbourne, Australia
| | - Karen-Leigh Edward
- Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia.,Swinburne University of Technology, Melbourne, Australia.,School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Carolyn Beasley
- Department of Media and Communication, School of Social Sciences, Media, Film and Education, Swinburne University of Technology, Melbourne, Australia
| |
Collapse
|
11
|
Czira A, Turner M, Martin A, Hinds D, Birch H, Gardiner F, Zhang S. A systematic literature review of burden of illness in adults with uncontrolled moderate/severe asthma. Respir Med 2021; 191:106670. [PMID: 34883444 DOI: 10.1016/j.rmed.2021.106670] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/14/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are limited published data on the burden of moderate/severe uncontrolled asthma. METHODS We conducted a systematic literature review to better understand the impact of moderate-to-severe asthma in the US, the UK, Germany, France, Italy, Spain, Canada, Japan, and Australia in terms of prevalence, clinical measures, health-related quality of life (HRQoL) and economic burden, for patients whose asthma is uncontrolled despite inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) therapy. RESULTS The prevalence of uncontrolled asthma among patients with moderate/severe disease varied but was as high as 100% in some subgroups. Patients with uncontrolled asthma generally had poor lung function (mean/median pre-bronchodilator forced expiratory volume in 1 second [FEV1]: 1.69-2.45 L; mean/median pre-bronchodilator percent predicted FEV1: 57.2-79.7). There was also a substantial but variable exacerbation burden associated with uncontrolled asthma, with the annualised rate of exacerbations ranging from 1.30 to 7.30 when considering various patient subgroups. Furthermore, the annualised rate of severe exacerbations ranged from 1.66 to 3.60. The HRQoL burden measured using disease-specific and generic instruments consistently demonstrated substantial impairment of HRQoL for those with uncontrolled asthma; Asthma Quality of Life Questionnaire scores ranged from 3.00 to 5.20, whilst EurQol-5 Dimensions index scores ranged from 0.53 to 0.59. Direct, indirect and total costs together with consumption of other healthcare resources associated with managing uncontrolled asthma were also substantial in the population studied; no caregiver burden was identified. CONCLUSIONS Our findings suggest that significant unmet needs exist for patients with uncontrolled asthma despite the availability of ICS/LABA therapy. Novel treatments are needed to help reduce the burden to patients, healthcare systems and society.
Collapse
Affiliation(s)
| | - Monica Turner
- Evidera, Evidence Synthesis, Modeling & Communication, Waltham, MA, United States.
| | - Amber Martin
- Evidera, Evidence Synthesis, Modeling & Communication, Waltham, MA, United States.
| | - David Hinds
- GSK, R&D Global Medical, Collegeville, PA, United States.
| | - Helen Birch
- GSK, R&D Global Medical, Brentford, Middlesex, UK.
| | | | - Shiyuan Zhang
- GSK, R&D Global Medical, Collegeville, PA, United States.
| |
Collapse
|
12
|
Baron AJ, Flokstra-de Blok BMJ, Kerstjens HAM, Koopmans-Klein G, Price DB, Sellink AA, Tsiligianni I, Kocks JWH. High Use of SABAs is Associated with Higher Exacerbation Rate in Dutch Patients with Asthma. J Asthma Allergy 2021; 14:851-861. [PMID: 34285512 PMCID: PMC8285233 DOI: 10.2147/jaa.s292943] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Many patients with asthma still have insufficient disease control, despite the availability of effective treatment options. A substantial proportion of patients appear to rely more on short-acting beta2-agonist (SABA) rather than on anti-inflammatory maintenance treatment. The aim of this study was to describe differences in indicators of asthma symptoms and exacerbations among patients using more or less SABA than the guideline-recommended threshold of <3 times/week. PATIENTS AND METHODS Data from Dutch respondents in the European REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey were used in this post hoc analysis. The survey included asthma patients aged 18-50 years with at least two prescriptions for their asthma in the past two years. SABA use was categorized into two groups: <3 (low-SABA users) or ≥3 (high-SABA users) times in the last week. RESULTS Of the 736 asthma patients, 21% did not use SABA and 19% used SABA 1 to 2 times (all low SABA users) and 60% used SABA ≥3 times (high SABA users) in the last week. The majority of high and low SABA users also reported using an ICS-containing treatment. Significant differences were found for all indicators related to exacerbations (p<0.001): high SABA users more frequently used antibiotics and oral steroids, more frequently visited the emergency departments or needed an overnight hospital stay. Indicators of asthma symptoms were not significantly different between both groups. CONCLUSION The majority of a Dutch asthmatic population reported high SABA use and had frequent moderate/severe exacerbations. More effective interventions are needed to change healthcare providers' and patients' behaviours to improve care and reduce SABA (over)use.
Collapse
Affiliation(s)
- Anna Jetske Baron
- General Practitioners Research Institute, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, the Netherlands
| | - Bertine M J Flokstra-de Blok
- General Practitioners Research Institute, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, Groningen, the Netherlands
| | - Huib A M Kerstjens
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, the Netherlands
| | | | - David B Price
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, University of Crete, Crete, Greece
| | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
- Observational and Pragmatic Research Institute, Singapore
| |
Collapse
|
13
|
Simunovic M, Erbas B, Boyle J, Baker P, Davies JM. Characteristics of emergency patients admitted to hospital with asthma: A population-based cohort study in Queensland, Australia. Emerg Med Australas 2021; 33:1027-1035. [PMID: 33991056 DOI: 10.1111/1742-6723.13796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Patient characteristics with exacerbation of asthma accessing care in the ED who are at risk of hospital admission have not been determined in subtropical climates. The objective of the study was to investigate the spatiotemporal burden of asthma hospital admissions across Queensland (QLD) and model risk factors for asthma hospital admission following an ED visit. METHODS Six years of routinely collected data (2012-2017) from 28 QLD public hospitals were extracted from Queensland Health's Emergency Data Collection. The dataset contained individual, episode-level ED presentations having asthma-like diagnoses, and an indicator of hospital admission, including to short-stay unit (SSU). A generalised additive model was used to examine the risk of asthma hospital admission. RESULTS Asthma hospital admissions increased from a weekly median of 79 (interquartile range [IQR] 66-99) in 2012 to 104 (IQR 81-135) in 2017. A higher incidence of asthma hospital admission was observed among males (median age 9, IQR 5-32) in childhood and females in adulthood (median age 32, IQR 11-51). Compared to the state capital Brisbane, the odds of asthma hospital admission ranged from 0.48 (95% CI 0.42-0.54) to 1.34 (95%CI 1.21-1.48) in other regions of QLD. CONCLUSION Asthma hospital admissions appear to be increasing in QLD, largely driven by utilisation of the SSU admissions for asthma. With large variation in both incidence and proportion admitted across different regions, routinely collected data can in part be used to understand risk factors for asthma-related hospital admission following an ED presentation and further inform public health policy development.
Collapse
Affiliation(s)
- Marko Simunovic
- School of Biomedical Sciences, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bircan Erbas
- School of Public Health and Epidemiology, La Trobe University, Melbourne, Victoria, Australia
| | - Justin Boyle
- Australian E-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
| | - Philip Baker
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Janet M Davies
- School of Biomedical Sciences, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Office of Research, Metro North Hospital and Health Services, Brisbane, Queensland, Australia
| |
Collapse
|
14
|
De Jong HJI, Voorham J, Scadding GK, Bachert C, Canonica GW, Smith P, Wahn U, Ryan D, Castillo JA, Carter VA, Murray RB, Price DB. Evaluating the real-life effect of MP-AzeFlu on asthma outcomes in patients with allergic rhinitis and asthma in UK primary care. World Allergy Organ J 2020; 13:100490. [PMID: 33376573 PMCID: PMC7753940 DOI: 10.1016/j.waojou.2020.100490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
Background MP-AzeFlu (Dymista®; spray of azelastine/fluticasone propionate) is the most effective allergic rhinitis (AR) treatment available. Its effect on asthma outcomes in patients with AR and asthma is unknown. Methods This pre-post historical cohort study, using the Optimum Patient Care Research Database, included patients aged ≥12 years, from UK general practice with active asthma (defined as a recorded diagnosis, with ≥1 prescription for reliever or controller inhaler) in the year before or at the initiation date. The primary study outcome was change in number of acute respiratory events (i.e. exacerbation or antibiotic course for a respiratory event) between baseline and outcome years. The effect size of MP-AzeFlu was quantified as the difference in % of patients that improved and worsened. Results Of the 1,188 patients with AR and asthma included, many had a record of irreversible obstruction (67%), and uncontrolled asthma (70.4%), despite high mean daily doses of reliever/controller therapy and acute oral corticosteroid use, in the year pre-MP-AzeFlu initiation. MP-AzeFlu initiation was associated with fewer acute respiratory events (effect size (e) = 5.8%, p = 0.0129) and a reduction in daily use of short-acting β2-agonists, with fewer patients requiring >2 SABA puffs/week (e = 7.7% p < 0.0001). More patients had well-controlled asthma 1-year post-MP-AzeFlu initiation (e = 4.1%; p = 0.0037), despite a reduction in inhaled corticosteroids (e = 4.8%; p = 0.0078). Conclusions This study provides the first direct evidence of the beneficial effect of MP-AzeFlu on asthma outcomes in co-morbid patients in primary care in the United Kingdom. Trial registration EUPAS30940. Registered August 13, 2019.
Collapse
Key Words
- ADEPT, Anonymized data ethics & protocol transparency
- AR, Allergic rhinitis
- ATS, American Thoracic society
- BEC, Blood eosinophil count
- CRS, Chronic rhinosinusitis
- Control
- ERS, European respiratory society
- Exacerbations
- FEV1, forced expiratory volume in 1 s
- FVC, Forced vital capacity
- GERD, Gastroesophageal reflux disease
- GINA, Global initiative for asthma
- ICS, Inhaled corticosteroid
- INS, Intranasal corticosteroid
- NP, Nasal polyps
- OAC, Overall asthma control
- OAH, Oral anti-histamine
- OCS, Oral corticosteroid
- OPCRD, Optimum patient care research database
- OTC, Over the counter
- PEF, Peak expiratory flow rate
- RCT, Randomized controlled trial
- RDAC, Risk domain asthma control
- Rescue medication
- SABA, Short-acting β2-agonist
- SMD, Standardised mean difference
- UK, United Kingdom
Collapse
Affiliation(s)
| | - Jaco Voorham
- Observational and Pragmatic Research Institute, Singapore
| | - Glenis K Scadding
- Royal National Throat, Nose and Ear Hospital, University College London School of Medicine, London, UK
| | | | - Giorgio Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, SANI-Severe Asthma Network, Milan, Italy
| | - Peter Smith
- Griffith University, Southport, QLD, Australia
| | | | - Dermot Ryan
- Usher Institute, University of Edinburgh, Edinburgh, UK.,Optimum Patient Care, Cambridge, UK
| | | | | | | | - David B Price
- Observational and Pragmatic Research Institute, Singapore.,Optimum Patient Care, Cambridge, UK.,Academic Primary Care, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
15
|
Azzi E, Kritikos V, Peters M, Price D, Cvetkovski B, Alphonse PS, Bosnic-Anticevich S. Perceptions, attitudes, and behaviors of short-acting beta 2 agonist users: an Australian cross-sectional community pharmacy-based study. J Asthma 2020; 59:178-188. [PMID: 33086885 DOI: 10.1080/02770903.2020.1841223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND High use of short-acting beta-2-agonist (SABA) medication is a significant problem. Attitudes and perceptions toward asthma of over-the-counter (OTC) reliever users are unknown. The study aimed to describe the asthma attitudes, perceptions, medication knowledge and information gathering behavior of people with asthma with recent high SABA use (i.e. SABA use > twice a week in the last 4 weeks) and compare them to people with asthma with no recent high SABA use. METHOD A real-world cross-sectional observational study in Australian community pharmacies was conducted; surveying patients ages ≥ 16 years requesting SABA medication OTC. Data collected included; demographics, medication usage, asthma control, asthma-related perceptions and behaviors. Data were summarized by using descriptive analyses. RESULTS 375 participants completed the survey, 73.9% were high SABA users. Of the 375, 90.4% reported that their asthma symptoms were controlled or somewhat controlled and 56.0% felt that their asthma was not serious. However, only 17.6%, had controlled asthma according to GINA-defined criteria. High SABA users tended to be more anxious about their asthma and worried about its impact in the future (50.5% vs. 28.6%, p < 0.001). High SABA users were more likely to agree with the statements suggesting that asthma impacted on activities of daily living (46.6% vs. 16.3%, p < 0.001); were socially conscious about their asthma and more likely to feel embarrassed carrying (21.3% vs 9.2%, p = 0.007) and using (29.2% vs 18.4%, p = 0.036) their asthma inhaler. CONCLUSION This study revealed the extent of uncontrolled asthma and uncovered an anxious and socially conscious group of OTC SABA users. There is a need to better understand patient perceptions and their relationships to high-SABA use, to ensure targeted educational interventions are developed and implemented.
Collapse
Affiliation(s)
- Elizabeth Azzi
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia.,School of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia
| | - Matthew Peters
- Respiratory Medicine, Concord Repatriation General Hospital, Concord, Australia.,Emphysema Centre, Woolcock Institute of Medical Research, Glebe, Australia
| | - David Price
- Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom of Great Britain and Northern Ireland
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia
| | - Pamela Srour Alphonse
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, Australia
| |
Collapse
|
16
|
Serhal S, Saini B, Bosnic-Anticevich S, Krass I, Wilson F, Armour C. Medication Adherence in a Community Population with Uncontrolled Asthma. PHARMACY 2020; 8:pharmacy8040183. [PMID: 33036454 PMCID: PMC7711630 DOI: 10.3390/pharmacy8040183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022] Open
Abstract
It is well documented that the use of medications in asthma and allergic rhinitis is often suboptimal, and consequently, patients remain symptomatic. This study aimed to determine the extent and type of medication-related issues contributing to poor asthma control by profiling medication management in those most at risk—a population with clinically uncontrolled asthma. Participants (n = 363) were recruited from Australian community pharmacies, and a dispensed medication history report for the previous 12 months was collected to examine medication adherence and factors affecting adherence. Information was also collected regarding participant asthma control and asthma/allergic rhinitis (if applicable) management. The participants’ mean asthma control score was 2.49 (± 0.89 SD, IQR = 1.20) (score ≥ 1.5 indicative of poorly controlled asthma), and 72% were either non-adherent or yet to initiate preventer therapy. Almost half had been prescribed high doses of inhaled corticosteroid and 24% reported use of oral corticosteroids. Only 22% of participants with concomitant allergic rhinitis were using first line treatment. A logistic regression model highlighted that participant health care concession status and hospital admissions were associated with better adherence. Suboptimal medication management is evident in this at-risk population.
Collapse
Affiliation(s)
- Sarah Serhal
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2031, Australia; (B.S.); (S.B.-A.); (F.W.); (C.A.)
- Correspondence: ; Tel.: +61-4-1495-9883
| | - Bandana Saini
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2031, Australia; (B.S.); (S.B.-A.); (F.W.); (C.A.)
- School of Pharmacy, The University of Sydney, A15, Science Rd, Camperdown, NSW 2006, Australia;
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2031, Australia; (B.S.); (S.B.-A.); (F.W.); (C.A.)
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Ines Krass
- School of Pharmacy, The University of Sydney, A15, Science Rd, Camperdown, NSW 2006, Australia;
| | - Frances Wilson
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2031, Australia; (B.S.); (S.B.-A.); (F.W.); (C.A.)
| | - Carol Armour
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2031, Australia; (B.S.); (S.B.-A.); (F.W.); (C.A.)
| |
Collapse
|
17
|
Kritikos V, Price D, Papi A, Infantino A, Ställberg B, Ryan D, Lavorini F, Chrystyn H, Haughney J, Lisspers K, Gruffydd-Jones K, Román Rodríguez M, Høegh Henrichsen S, van der Molen T, Carter V, Bosnic-Anticevich S. The Burden of Self-Reported Rhinitis and Associated Risk for Exacerbations with Moderate-Severe Asthma in Primary Care Patients. J Asthma Allergy 2020; 13:415-428. [PMID: 33116650 PMCID: PMC7547767 DOI: 10.2147/jaa.s266204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose There is a dearth of research regarding the prevalence and nature of patient-reported rhinitis and its relationship with risk of asthma exacerbations. The aim of this study was to (i) determine the prevalence, severity and treatment of self-reported rhinitis symptoms among adults aged ≥18 years with asthma treated at Global Initiative for Asthma (GINA) Step 3 and above and (ii) compare the demographics, clinical characteristics, medication use, side-effects and healthcare practitioner review between patients who report rhinitis symptoms and those who do not and (iii) determine whether patient-reported rhinitis is associated with risk of asthma exacerbations in the total patient sample. Patients and Methods This analysis used data from the iHARP (Initiative Helping Asthma in Real-life Patients) asthma review service – a cross-sectional observational study (2011 and 2014) in seven countries that captured data on patient demographics, rhinitis symptoms, asthma symptoms, indicators of exacerbations, medication use, oropharyngeal effects and side-effects, using practitioner- and patient-reported questionnaires. Comparisons between patients with and without rhinitis were tested. Univariate logistic regression was used to identify variables associated with risk of exacerbations for entry into multivariable logistic regression. Results This report contains data from 4274 patients: 67.4% (2881/4274) reported rhinitis symptoms and of which 65.7% (1894/2881) had not received a doctor diagnosis; 36.5% (1052/2881) had moderate-severe rhinitis, 12.4% (358/2881) had used intranasal corticosteroids and 19.8% (569/2881) oral antihistamines. Patients with coexisting moderate-severe rhinitis were more likely to have GINA-defined uncontrolled asthma than those with mild rhinitis or no rhinitis. Moderate-severe rhinitis was associated with 40% increased risk of asthma exacerbations (OR=1.40, 95% CI: 1.02–1.90). Conclusion This study identified a major gap in the diagnosis and management of rhinitis in a cohort of people with asthma treated at GINA Step 3 and above who are managed in general practice. It highlights the need for practitioners to identify, evaluate and optimally treat rhinitis in adults with asthma, which is a significant factor associated with exacerbation risk.
Collapse
Affiliation(s)
- Vicky Kritikos
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - David Price
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Antonio Infantino
- Special Interest Respiratory Area, Italian Interdisciplinary Society for Primary Care, Bari, Italy
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Dermot Ryan
- Optimum Patient Care, Cambridge, UK.,Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Federico Lavorini
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | | | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | | | - Miguel Román Rodríguez
- Primary Care Respiratory Research Unit Instituto De Investigación Sanitaria De Baleares (IdISBa), Palma, Spain
| | - Svein Høegh Henrichsen
- Department of Primary Health Care Services, Norwegian Directorate of Health, Oslo, Norway
| | - Thys van der Molen
- Department of Primary Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Victoria Carter
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Central Sydney Local Area Health District, Sydney, NSW, Australia
| |
Collapse
|
18
|
Qazi A, Armour C, Saini B. Perspectives of general practitioners about a collaborative asthma care model in primary care. J Asthma 2020; 58:1648-1660. [PMID: 32921189 DOI: 10.1080/02770903.2020.1823408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Asthma affects 2.7 million people in Australia and is predominantly managed by general practitioners (GPs) within primary care. Despite national focus on this condition, asthma control in the population is suboptimal, with many preventable hospitalizations. In the light of robust evidence supporting the role of pharmacists in the management of chronic diseases including asthma, the Australian Medical Association (AMA) proposed a General Practice Pharmacist (GPP) model in 2015. In this proposal, a non-dispensing pharmacist, co-located within the primary care setting and collaborating with GPs and allied health professionals, can make a positive impact on patients' health and minimize costs due to medication misadventure. The aim of this study was to obtain the views of GPs regarding the GPP model for better management of asthma in a qualitative study. METHODS Semi-structured interviews were conducted with 23 GPs, audio-recorded, transcribed verbatim, and later analyzed for emergent themes. The GPs support the idea of a GPP as time and task pressures restrict them in adhering to asthma management guidelines. RESULTS Support from another health professional in such a pressured environment can positively impact patient's health. Funding, clear role delineation within general practice, training of pharmacists working as GPPs, and effective communication systems were described as the potential catalysts for the success of the model. CONCLUSION Sustainable funding and the willingness of practice owners/managers were described as the barriers. The GPs agreed that pharmacists can make a positive difference in patient's asthma management once the barriers were effectively addressed.
Collapse
Affiliation(s)
- Anila Qazi
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Carol Armour
- The Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Bandana Saini
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,The Woolcock Institute of Medical Research, Glebe, NSW, Australia
| |
Collapse
|
19
|
Managing Allergic Rhinitis in the Pharmacy: An ARIA Guide for Implementation in Practice. PHARMACY 2020; 8:pharmacy8020085. [PMID: 32429362 PMCID: PMC7355936 DOI: 10.3390/pharmacy8020085] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 01/30/2023] Open
Abstract
The paradigm of how we manage allergic rhinitis is shifting with a growing understanding that it is a complex process, requiring a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Community pharmacists are the most accessible healthcare professionals to the public and allergic rhinitis is one of the most common diseases managed by pharmacists. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed over the past 20 years have improved the care of allergic rhinitis patients through an evidence-based, integrated care approach. In this paper, we propose an integrated approach to allergic rhinitis management in community pharmacy following the 2019 ARIA in the pharmacy guidelines.
Collapse
|
20
|
Bertilsson E, Serhal S, Emmerton L, Bosnic-Anticevich S, Krass I, Bereznicki B, Bereznicki L, Armour C, Saini B. Pharmacists experience of and perspectives about recruiting patients into a community pharmacy asthma service trial. Res Social Adm Pharm 2020; 17:595-605. [PMID: 32448767 DOI: 10.1016/j.sapharm.2020.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/03/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Research trials testing the impact of community pharmacy services require adequate and appropriate recruitment of patients by participating pharmacists, however, this step presents an ongoing challenge. OBJECTIVE To identify factors affecting recruitment of patients in community pharmacies participating in a multi-center trial of a pharmacy asthma service in Australia (Pharmacy Trial Program - Asthma and Rhinitis Control (PTP-ARC). METHODS The PTP-ARC protocol required identification and recruitment of seven eligible asthma patients per pharmacy. Pharmacists responsible for sites that failed to recruit or retain any patients into the PTP-ARC trial participated in a semi-structured telephone interview about their experiences with these elements of the trial. The interviews were recorded, transcribed and coded using QSR International's NVivo 11 software. The analysis was conducted with reference to the COM-B framework (Capability, Opportunity, Motivation). RESULTS Pharmacists from 47 of 50 eligible pharmacies were interviewed. Seventeen factors were isolated and mapped to the COM-B framework. Psychological capability (recruitment hesitancy, research literacy and health literacy), physical capability (technological barriers, staffing issues and pharmacy busyness), physical opportunity (patient busyness, trial timing, study protocol, support and location), social opportunity (health literacy and supportive milieu), reflective motivation (incentive for participation, simplification) and automatic motivation (patient attitudes and pharmacist-felt experience) were factors affecting pharmacists' participation. Challenges identified included: issues with the software, unfamiliarity with research procedures generally (and specifically with the PTP-ARC protocols), the patients' lack of interest and pharmacists' lack of time. CONCLUSIONS To the best of our knowledge, this is the first study to focus on issues affecting patient recruitment into a pharmacy health services (asthma) trial in real time. To propel evidence-based trials towards practice implementation, user-friendly software, pharmacists' training on research and patient-engagement and adequate remuneration to address pharmacist time issues need to be key foci for health services design and implementation research.
Collapse
Affiliation(s)
| | - Sarah Serhal
- Woolcock Institute of Medical Research - 431 Glebe Point Road, Glebe, NSW, 2031, Australia.
| | - Lynne Emmerton
- Curtin University - School of Pharmacy and Biomedical Sciences, Building 306, Brand Drive, Curtin University Bentley Campus, Perth, WA, 6845, Australia.
| | | | - Ines Krass
- The University of Sydney -The University of Sydney, A15, Science Rd, Camperdown, NSW, 2006, Australia
| | - Bonnie Bereznicki
- University of Tasmania - Tasmanian School of Medicine, University of Tasmania, Private Bag 34, Hobart, Tasmania, 7001, Australia.
| | - Luke Bereznicki
- University of Tasmania - School of Pharmacy and Pharmacology, University of Tasmania, Private Bag 26, Hobart, Tasmania, 7001, Australia.
| | - Carol Armour
- Woolcock Institute of Medical Research - 431 Glebe Point Road, Glebe, NSW, 2031, Australia
| | - Bandana Saini
- The University of Sydney -The University of Sydney, A15, Science Rd, Camperdown, NSW, 2006, Australia.
| |
Collapse
|
21
|
Yorgancıoğlu AA, Gemicioğlu B, Cingi C, Kalaycı Ö, Kalyoncu AF, Bachert C, Hellings P, Pfaar O, Schünemann HJ, Wallace D, Bedbrook A, Czarlewski W, Bousquet J. ARIA 2019, Allerjik Rinite Tedavi Yaklaşımı-Türkiye. Turk Thorac J 2020; 21:122-133. [PMID: 32203003 DOI: 10.5152/turkthoracj.2019.19084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/06/2019] [Indexed: 11/22/2022]
Abstract
Gerçek yaşamda, çevresel maruziyetlerin de etkilediği rinit ve astım mültimorbidite durumlarında, dijitalleşmiş ve kişiye odaklanan tedaviler için bütünleştirilmiş tedavi yollarının değerlendirilmesi önerilmektedir. Gerçek yaşamdaki bu durum mültisipliner bir yaklaşımla basamaklandırılıp, rehberilerinde ülkelerdeki gereksinimlere göre değiştilmesini gerektirebilir. Allerjik rinitte hem farmakoterapi hem immünoterapi açısından acil yeni yaklaşımlara ihtiyaç olduğu görülmüştür. 3. Aralık 2018'de Paris'te bir toplantı yapılmış ve iki ayrı belge hazırlanmıştır. Bu yayında bunlara ait bir özet sunulup, ülkeye ve sağlık sistemine uygun kullanımın çerçevesi oluşturulmak istenmiştir.
Collapse
Affiliation(s)
| | - Bilun Gemicioğlu
- Department of Chest Diseases, İstanbul University-Cerrahpaşa, Cerrahpasa School of Medicine, İstanbul, Turkey
| | - Cemal Cingi
- Department of Ear Nose Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Ömer Kalaycı
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Dept, Ghent University Hospital, Ghent, Belgium
| | - Peter Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, Belgium, and Academic Medical Center, University of Amsterdam, The Netherlands and Euforea, Brussels, Belgium
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Phillipps-Universität Marburg, Germany
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Anna Bedbrook
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| | | | - Jean Bousquet
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, France
| |
Collapse
|
22
|
ARIA guideline 2019: treatment of allergic rhinitis in the German health system. Allergol Select 2019; 3:22-50. [PMID: 32176226 PMCID: PMC7066682 DOI: 10.5414/alx02120e] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background: The number of patients affected by allergies is increasing worldwide. The resulting allergic diseases are leading to significant costs for health care and social systems. Integrated care pathways are needed to enable comprehensive care within the national health systems. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative develops internationally applicable guidelines for allergic respiratory diseases. Methods: ARIA serves to improve the care of patients with allergies and chronic respiratory diseases. In collaboration with other international initiatives, national associations and patient organizations in the field of allergies and respiratory diseases, real-life integrated care pathways have been developed for a digitally assisted, integrative, individualized treatment of allergic rhinitis (AR) with comorbid asthma. In the present work, these integrated care pathways have been adapted to the German situation and health system. Results: The present ICP (integrated care pathway) guideline covers key areas of the care of AR patients with and without asthma. It includes the views of patients and other healthcare providers. Discussion: A comprehensive ICP guideline can reflect real-life care better than traditional guideline models.
Collapse
|
23
|
Kritikos V, Price D, Papi A, Infantino A, Ställberg B, Ryan D, Lavorini F, Chrystyn H, Haughney J, Lisspers K, Gruffydd-Jones K, Román Rodríguez M, Høegh Henrichsen S, van der Molen T, Carter V, Bosnic-Anticevich S. A multinational observational study identifying primary care patients at risk of overestimation of asthma control. NPJ Prim Care Respir Med 2019; 29:43. [PMID: 31804501 PMCID: PMC6895161 DOI: 10.1038/s41533-019-0156-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/08/2019] [Indexed: 11/11/2022] Open
Abstract
Factors related to the discrepancy between patient-perceived and actual disease control remain unclear. Identifying patients at risk of overestimation of asthma control remains elusive. This study aimed to (i) investigate the relationship between patient-reported and actual level of asthma control (ii), compare the characteristics between patients who believe their asthma is well controlled that accurately report ‘well-controlled’ asthma with those that do not, and (iii) identify factors associated with inaccurately reported ‘well-controlled’ asthma. A historical, multinational, cross-sectional study using data from the iHARP (initiative Helping Asthma in Real-life Patients) review service for adults with asthma prescribed fixed-dose combination therapy. Data from 4274 patients were analysed. A major discrepancy between patient-reported and Global Initiative for Asthma defined asthma control was detected; 71.1% of patients who reported ‘well-controlled’ asthma were inaccurate in their perception despite receiving regular maintenance therapy. Significant differences were noted in age, gender, body mass index, education level, medication use, side effects, attitudes to preventer inhaler use, inhaler technique review and respiratory specialist review between patients who accurately reported ‘well-controlled’ asthma and those who did not. Independent risk factors associated with inaccurately reported ‘well-controlled’ asthma were: having taken a maximum of 5–12 puffs or more of reliever inhaler on at least one day within the previous 4 weeks; being female; having seen a respiratory specialist more than a year ago (rather than in the previous year); and having required oral corticosteroids for worsening asthma in the previous year. The study highlighted the significant hidden burden associated with under-recognition of poor asthma control, on the part of the patient and the need for targeted interventions designed to address the continuing discrepancy between perceived and actual disease control.
Collapse
Affiliation(s)
- Vicky Kritikos
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia. .,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - David Price
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Southbank, Singapore.,Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Antonio Infantino
- Special Interest Respiratory Area, Italian Interdisciplinary Society for Primary Care, Bari, Italy
| | - Bjorn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Dermot Ryan
- Optimum Patient Care, Cambridge, UK.,Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Federico Lavorini
- Department Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | | | | | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | | | - Miguel Román Rodríguez
- Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Spain
| | - Svein Høegh Henrichsen
- Department of Primary Health Care Services, Norwegian Directorate of Health, Oslo, Norway
| | - Thys van der Molen
- Department of Primary Care, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Victoria Carter
- Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute, Southbank, Singapore
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Central Sydney Local Area Health District, Sydney, NSW, Australia
| |
Collapse
|
24
|
Difficulties With Inhaled Therapy: A Complex Simple Technique. Arch Bronconeumol 2019; 56:416-417. [PMID: 31813588 DOI: 10.1016/j.arbres.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/29/2019] [Accepted: 08/29/2019] [Indexed: 11/20/2022]
|
25
|
The Explosion of OTC Management of Allergic Rhinitis: Costs and Risks. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-00222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
26
|
Bousquet J, Pfaar O, Togias A, Schünemann HJ, Ansotegui I, Papadopoulos NG, Tsiligianni I, Agache I, Anto JM, Bachert C, Bedbrook A, Bergmann K, Bosnic‐Anticevich S, Bosse I, Brozek J, Calderon MA, Canonica GW, Caraballo L, Cardona V, Casale T, Cecchi L, Chu D, Costa E, Cruz AA, Czarlewski W, Durham SR, Du Toit G, Dykewicz M, Ebisawa M, Fauquert JL, Fernandez‐Rivas M, Fokkens WJ, Fonseca J, Fontaine J, Gerth van Wijk R, Haahtela T, Halken S, Hellings PW, Ierodiakonou D, Iinuma T, Ivancevich JC, Jacobsen L, Jutel M, Kaidashev I, Khaitov M, Kalayci O, Kleine Tebbe J, Klimek L, Kowalski ML, Kuna P, Kvedariene V, La Grutta S, Larenas‐Linemann D, Lau S, Laune D, Le L, Lodrup Carlsen K, Lourenço O, Malling H, Marien G, Menditto E, Mercier G, Mullol J, Muraro A, O’Hehir R, Okamoto Y, Pajno GB, Park H, Panzner P, Passalacqua G, Pham‐Thi N, Roberts G, Pawankar R, Rolland C, Rosario N, Ryan D, Samolinski B, Sanchez‐Borges M, Scadding G, Shamji MH, Sheikh A, Sturm GJ, Todo Bom A, Toppila‐Salmi S, Valentin‐Rostan M, Valiulis A, Valovirta E, Ventura M, Wahn U, Walker S, Wallace D, Waserman S, Yorgancioglu A, Zuberbier T. 2019 ARIA Care pathways for allergen immunotherapy. Allergy 2019; 74:2087-2102. [PMID: 30955224 DOI: 10.1111/all.13805] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 01/02/2023]
Abstract
Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.
Collapse
Affiliation(s)
- Jean Bousquet
- MACVIA‐France, Fondation partenariale FMC VIA‐LR Montpellier France
- INSERM U 1168, VIMA : Ageing and Chronic Diseases Epidemiological and Public Health Approaches Villejuif France
- UMR‐S 1168 Université Versailles St‐Quentin‐en‐Yvelines Montigny le Bretonneux France
- Euforea Brussels Belgium
- Charité‐Universitätsmedizin Berlin, Humboldt‐Universität zu Berlin Berlin Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Alkis Togias
- Division of Allergy, Immunology, and Transplantation (DAIT) National Institute of Allergy and Infectious Diseases, NIH Bethesda Maryland
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy McMaster University Hamilton Ontario Canada
| | | | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital University of Manchester Manchester UK
- Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou” University of Athens Athens Greece
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine University of Crete and International Primary Care Respiratory Group Crete Greece
| | - Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Josep M. Anto
- Centre for Research in Environmental Epidemiology (CREAL) ISGlobAL Barcelona Spain
- IMIM (Hospital del Mar Research Institute) Barcelona Spain
- Universitat Pompeu Fabra (UPF) Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Claus Bachert
- ENT Department, Upper Airways Research Laboratory Ghent University Hospital Ghent Belgium
| | - Anna Bedbrook
- MACVIA‐France, Fondation partenariale FMC VIA‐LR Montpellier France
| | - Karl‐Christian Bergmann
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Comprehensive Allergy Centre, Member of GALEN, Humboldt‐Uniersität zu Berlin Berlin Germany
| | - Sinthia Bosnic‐Anticevich
- Woolcock Institute of Medical Research, Woolcock Emphysema Centre and Local Health District University of Sydney Glebe New South Wales Australia
| | | | - Jan Brozek
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy McMaster University Hamilton Ontario Canada
| | - Moises A. Calderon
- Imperial College London ‐ National Heart and Lung Institute Royal Brompton Hospital NHS London UK
| | - Giorgio W. Canonica
- Personalized Medicine Clinic Asthma & Allergy, Humanitas Research Hospital Humanitas University Milan Italy
| | - Luigi Caraballo
- Institute for Immunological Research University of Cartagena, Campus de Zaragocilla Cartagena Colombia
- Foundation for the Development of Medical and Biological Sciences (Fundemeb) Cartagena Colombia
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine Hospital Vall d'Hebron & ARADyAL Research Network Barcelona Spain
| | - Thomas Casale
- Division of Allergy/Immunology University of South Florida Tampa Florida
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology USL Toscana Centro Prato Italy
| | - Derek Chu
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy McMaster University Hamilton Ontario Canada
| | - Elisio Costa
- UCIBIO, REQUIMTE, Faculty of Pharmacy, and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork) University of Porto Porto Portugal
| | - Alvaro A. Cruz
- ProAR – Nucleo de Excelencia em Asma Federal University of Bahia Salvador Brazil
- WHO GARD Planning Group Salvador Brazil
| | | | - Stephen R. Durham
- Allergy and Clinical Immunology Section, National Heart and Lung Institute Imperial College London London UK
| | - George Du Toit
- Guy's and st Thomas' NHS Trust, Kings College London London UK
| | - Mark Dykewicz
- Section of Allergy and Immunology Saint Louis University School of Medicine Saint Louis Missouri
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital Sagamihara Japan
| | - Jean Luc Fauquert
- Unité de pneumo‐allergologie de l'enfant, pôle pédiatrique CHU de Clermont‐Ferrand‐Estaing Clermont‐Ferrand France
| | | | - Wytske J. Fokkens
- Department of Otorhinolaryngology Academic Medical Centres Amsterdam The Netherlands
| | - João Fonseca
- CINTESIS, Center for Research in Health Technology and Information Systems Faculdade de Medicina da Universidade do Porto Porto Portugal
- Medida, Lda Porto Portugal
| | | | - Roy Gerth van Wijk
- Department of Internal Medicine, Section of Allergology Erasmus MC Rotterdam The Netherlands
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital Odense University Hospital Odense Denmark
| | - Peter W. Hellings
- Department of Otorhinolaryngology University Hospitals Leuven Leuven Belgium
- Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine University of Crete and International Primary Care Respiratory Group Crete Greece
| | - Tomohisa Iinuma
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | | | | | - Marek Jutel
- Department of Clinical Immunology Wrocław Medical University Wrocław Poland
| | - Igor Kaidashev
- Ukrainian Medical Stomatological Academy Poltava Ukraine
| | - Musa Khaitov
- Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular immunology National Research Center Moscow Russian Federation
| | - Omer Kalayci
- Pediatric Allergy and Asthma Unit Hacettepe University School of Medicine Ankara Turkey
| | | | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Marek L. Kowalski
- Department of Immunology and Allergy, Healthy Ageing Research Center Medical University of Lodz Lodz Poland
- Sach's Children and Youth Hospital, Södersjukhuset Stockholm Sweden
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital Medical University of Lodz Lodz Poland
| | - Violeta Kvedariene
- Department of Pathology, Faculty of Medicine, Institute of Biomedical Sciences Vilnius University Vilnius Lithuania
- Faculty of Medicine, Institute of Clinical medicine, Clinic of Chest diseases and Allergology Vilnius University Vilnius Lithuania
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology (IBIM) National Research Council (CNR) Palermo Italy
| | - Désirée Larenas‐Linemann
- Center of Excellence in Asthma and Allergy Médica Sur Clinical Foundation and Hospital México City Mexico
| | - Susanne Lau
- Department of Pediatric Pneumology and Immunology Charité Universitätsmedizin Berlin Germany
| | | | - Lan Le
- University of Medicine and Pharmacy Hochiminh City Vietnam
| | - Karin Lodrup Carlsen
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine, Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Olga Lourenço
- Faculty of Health Sciences and CICS – UBI, Health Sciences Research Centre University of Beira Interior Covilhã Portugal
| | | | | | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics University of Naples Federico II Naples Italy
| | - Gregoire Mercier
- Département de l’Information Médicale, Unité Médico‐Economie University Hospital Montpellier France
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department Hospital Clínic Barcelona Spain
- Clinical & Experimental Respiratory Immunoallergy IDIBAPS, CIBERES, University of Barcelona Barcelona Spain
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health Padua General University Hospital Padua Italy
| | - Robyn O’Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School Monash University Melbourne Victoria Australia
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | - Giovanni B. Pajno
- Department of Pediatrics, Allergy Unit University of Messina Messina Italy
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
| | - Petr Panzner
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases Ospedale Policlino San Martino ‐University of Genoa Genoa Italy
| | | | - Graham Roberts
- David Hide Centre, St Mary's Hospital Isle of Wight and University of Southampton Southampton UK
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | | | | | - Dermot Ryan
- Allergy and Respiratory Research Group, Medical School, Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK
| | - Bolesław Samolinski
- Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Medico‐Docente La Trinidad Caracas Venezuela
| | - Glenis Scadding
- The Royal National TNE Hospital University College London London UK
| | - Mohamed H. Shamji
- Immunomodulation and Tolerance Group Imperial College London London UK
- Allergy and Clinical Immunology Imperial College London London UK
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | - Gunter J. Sturm
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
- Outpatient Allergy Clinic Reumannplatz Vienna Austria
| | - Ana Todo Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Sanna Toppila‐Salmi
- Skin and Allergy Hospital, Helsinki University Hospital University of Helsinki Helsinki Finland
| | | | - Arunas Valiulis
- Clinic of Children's Diseases Vilnius University Institute of Clinical Medicine Vilnius Lithuania
- Department of Public Health Institute of Health Sciences Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS‐SP) Brussels Belgium
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, Terveystalo Allergy Clinic University of Turku Turku Finland
| | - Maria‐Teresa Ventura
- Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy
| | - Ulrich Wahn
- Pediatric Department Charité, Berlin Germany
| | | | - Dana Wallace
- Nova Southeastern University Fort Lauderdale Florida
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy McMaster University Hamilton Ontario
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Faculty of Medicine Celal Bayar University Manisa Turkey
| | - Torsten Zuberbier
- Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Comprehensive Allergy Centre, Member of GALEN, Humboldt‐Uniersität zu Berlin Berlin Germany
| | | |
Collapse
|
27
|
ARIA-Leitlinie 2019: Behandlung der allergischen Rhinitis im deutschen Gesundheitssystem. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
28
|
Tomisa G, Horváth A, Szalai Z, Müller V, Tamási L. Prevalence and impact of risk factors for poor asthma outcomes in a large, specialist-managed patient cohort: a real-life study. J Asthma Allergy 2019; 12:297-307. [PMID: 31576150 PMCID: PMC6768014 DOI: 10.2147/jaa.s211246] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background Risk factors for poor asthma outcomes may have considerable influence on the control level and medical care of asthmatic patients. Our objective was to conduct a study that provides data on the level of symptom control and the frequency of specific risk factors for poor asthma outcomes on a large patient cohort. Methods A cross-sectional, non-interventional real-life study was conducted among asthmatic patients treated by respiratory specialists in Hungary. Asthma control and risk factor assessment were done according to Global Initiative for Asthma guideline (Box 2–2). In the data analysis, phase descriptive statistics, graphical outputs, and Fisher’s exact tests were used. Results Of 12743 patients enrolled by 187 specialists, asthma was well controlled in 36.0%, partially controlled in 29.29%, and uncontrolled in 34.71% of the cases. The most common comorbidities were rhinitis/sinusitis (66.84%), cardiovascular diseases (43.81%), and gastroesophageal reflux disease (20.11%). The following risk factors had the strongest relationship with uncontrolled disease: incorrect inhaler technique causing side effects (odds ratio, OR 4.86, 3.51–6.8), previous severe exacerbation (OR 4.79, 4.02–5.72), high short-acting beta agonist (SABA) use (OR 4.46, 4.03–4.93), incorrect inhaler technique associated with an exacerbation (OR 3.91, 3.06–5.03), and persistently low forced expiratory volume in 1 s (FEV1, OR 3.14, 2.8–3.52). The most frequent risk factors were smoking (OR 1.47, 1.36–1.59) and obesity (OR 1.34, 1.24–1.45). Furthermore, high loss of control was associated with an initial low FEV1 (OR 2.21, 2.01–2.44), frequent oral corticosteroid (OCS) use (OR 1.83, 1.64–2.05), poor adherence to treatment (OR 2.51, 2.21–2.86), and allergen exposure (OR 1.63, 1.47–1.81). Conclusions This study indicated that the presence of risk factors for poor asthma outcomes listed by the Global Initiative for Asthma document significantly influenced actual control level in a real-world large patient cohort, with high SABA use, previous severe exacerbation, incorrect inhaler technique, persistently low FEV1, and poor adherence to treatment having the highest impact.
Collapse
Affiliation(s)
- Gábor Tomisa
- Department of Pulmonology, Semmelweis University, Budapest 1125, Hungary.,Chiesi Hungary Ltd, Budapest 1138, Hungary
| | - Alpár Horváth
- Department of Pulmonology, Semmelweis University, Budapest 1125, Hungary.,Chiesi Hungary Ltd, Budapest 1138, Hungary
| | | | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest 1125, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest 1125, Hungary
| |
Collapse
|
29
|
Azzi EA, Kritikos V, Peters MJ, Price DB, Srour P, Cvetkovski B, Bosnic-Anticevich S. Understanding reliever overuse in patients purchasing over-the-counter short-acting beta 2 agonists: an Australian community pharmacy-based survey. BMJ Open 2019; 9:e028995. [PMID: 31412998 PMCID: PMC6701672 DOI: 10.1136/bmjopen-2019-028995] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Overuse of asthma relievers is associated with significant adverse consequences. This study aimed to better understand the population purchasing and using short-acting beta agonists (SABA) over the counter (OTC); and compare the demographic, clinical and behavioural characteristics of those who overuse SABA with those who do not. DESIGN AND SETTING Real-world cross-sectional observational study in community pharmacy. PARTICIPANTS Of 412 participants ≥16 years requesting SABA OTC, 289 were SABA overusers (used SABA more than twice per week in the past 4 weeks). MAIN OUTCOME MEASURE Reliever use, Global Initiative for Asthma-defined control, healthcare utilisation, patterns of preventer use. RESULTS 70.1% of participants were classified as SABA overusers, that is, reporting SABA use more than twice a week within the last 4 weeks, 73.6% reported not using a preventer daily and only 81.6% reported a doctor diagnosis of asthma. SABA overusers were more likely to have moderate-severe nasal symptoms (80.8% vs 63.0%, p<0.001) and a diagnosis of depression (11.1% vs 5.7%, p<0.001), when compared with SABA non-overusers. A higher proportion of SABA overusers had uncontrolled asthma (59.0% vs 15.4%, p<0.001), were more likely to use oral corticosteroids to manage worsening asthma symptoms (26.2% vs 13.5%, p<0.01) and visit the doctor for their asthma in the past 12 months (74.5% vs 62.5%, p<0.01), when compared to SABA non-overusers. CONCLUSIONS This study uncovers a hidden population of people who can only be identified in pharmacy with suboptimal asthma, coexisting rhinitis, poor preventer adherence and, in some cases, no asthma diagnosis.
Collapse
Affiliation(s)
- Elizabeth A Azzi
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Matthew J Peters
- Department of Respiratory Medicine, Concord Hospital, Concord, New South Wales, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David B Price
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Pamela Srour
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
30
|
Tan R, Cvetkovski B, Kritikos V, O'Hehir RE, Lourenço O, Bousquet J, Bosnic-Anticevich S. Identifying an effective mobile health application for the self-management of allergic rhinitis and asthma in Australia. J Asthma 2019; 57:1128-1139. [PMID: 31274044 DOI: 10.1080/02770903.2019.1640728] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: People with allergic rhinitis (AR) often self-manage in the community pharmacy setting without consulting health care professionals and trivialize their comorbidities such as asthma. A mobile health application (mHealth app) with a self-monitoring and medication adherence system can assist with the appropriate self-management of AR and asthma. This study aimed to identify an app effective for the self-management of AR and/or asthma.Methods: MHealth apps retrieved from the Australian Apple App Store and Android Google Play Store were included in this study if they were developed for self-management of AR and/or asthma; in English language; free of charge for the full version; and accessible to users of the mHealth app. The mHealth app quality was evaluated on three domains using a two-stage process. In Stage 1, the apps were ranked along Domain 1 (Accessibility in both app stores). In Stage 2, the apps with Stage 1, maximum score were ranked along Domain 2 (alignment with theoretical principles of the self-management of AR and/or asthma) and Domain 3 (usability of the mHealth app using Mobile App Rating Scale instrument).Results: Of the 418 apps retrieved, 31 were evaluated in Stage 1 and 16 in Stage 2. The MASK-air achieved the highest mean rank and covered all self-management principles except the doctor's appointment reminder and scored a total MARS mean score of 0.91/1.Conclusions: MASK-air is ranked most highly across the assessment domains for the self-management of both AR and coexisting asthma. This mHealth app covers the majority of the self-management principles and is highly engaging.
Collapse
Affiliation(s)
- Rachel Tan
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Robyn E O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Immunology, Monash University, Melbourne, VIC, Australia
| | - Olga Lourenço
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Jean Bousquet
- MACVIA-France, Contre les MAladies Chroniques Pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| |
Collapse
|
31
|
Exploring the Asthma Network in People with Allergic Rhinitis Utilizing an Egocentric Social Network Analysis. Pulm Ther 2019; 5:235-245. [PMID: 32026406 PMCID: PMC6967048 DOI: 10.1007/s41030-019-0095-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Asthma and allergic rhinitis (AR) are chronic respiratory diseases of a united airway. Poor AR control is a risk factor for uncontrolled asthma. We know that people with AR feel confident in making their own treatment choices with over-the-counter therapies, yet only 16% of purchases were the optimal selection. With the high level of poor asthma control and overuse of over-the-counter, short-acting beta-agonists, we must consider whether poor AR self-management behaviours are extended to asthma management in those with both diseases. This study aims to investigate asthma management from the perspective of the patient with asthma and AR and understand the influences behind their asthma management decisions. Methods This study utilized a mixed methods approach based on the theoretical and analytical framework of social network theory, including mapping of the asthma network and exploring the roles and influence of those that appear within the network. Results Twenty-two people with asthma and allergic rhinitis participated in this study. General practitioners (GPs), pharmacists and respiratory physicians were the most commonly reported influences behind participants’ asthma management decisions. Although non-healthcare professional (HCP) influences appear within the asthma network, they represented a smaller proportion. Conclusion The asthma network of people with AR is dominated by HCP influences. This network is unique and different to other previously published asthma and AR networks. Further research on the impact of AR on asthma management patient behaviour is required. Electronic Supplementary Material The online version of this article (10.1007/s41030-019-0095-9) contains supplementary material, which is available to authorized users.
Collapse
|
32
|
Bosnic‐Anticevich S, Costa E, Menditto E, Lourenço O, Novellino E, Bialek S, Briedis V, Buonaiuto R, Chrystyn H, Cvetkovski B, Di Capua S, Kritikos V, Mair A, Orlando V, Paulino E, Salimäki J, Söderlund R, Tan R, Williams DM, Wroczynski P, Agache I, Ansotegui IJ, Anto JM, Bedbrook A, Bachert C, Bewick M, Bindslev‐Jensen C, Brozek JL, Canonica GW, Cardona V, Carr W, Casale TB, Chavannes NH, Correia de Sousa J, Cruz AA, Czarlewski W, De Carlo G, Demoly P, Devillier P, Dykewicz MS, Gaga M, El‐Gamal Y, Fonseca J, Fokkens WJ, Guzmán MA, Haahtela T, Hellings PW, Illario M, Ivancevich JC, Just J, Kaidashev I, Khaitov M, Khaltaev N, Keil T, Klimek L, Kowalski ML, Kuna P, Kvedariene V, Larenas‐Linnemann DE, Laune D, Le LTT, Lodrup Carlsen KC, Mahboub B, Maier D, Malva J, Manning PJ, Morais‐Almeida M, Mösges R, Mullol J, Münter L, Murray R, Naclerio R, Namazova‐Baranova L, Nekam K, Nyembue TD, Okubo K, O'Hehir RE, Ohta K, Okamoto Y, Onorato GL, Palkonen S, Panzner P, Papadopoulos NG, Park H, Pawankar R, Pfaar O, Phillips J, Plavec D, Popov TA, Potter PC, Prokopakis EP, Roller‐Wirnsberger RE, Rottem M, Ryan D, Samolinski B, Sanchez‐Borges M, Schunemann HJ, Sheikh A, Sisul JC, Somekh D, Stellato C, To T, Todo‐Bom AM, Tomazic PV, Toppila‐Salmi S, Valero A, Valiulis A, Valovirta E, Ventura MT, Wagenmann M, Wallace D, Waserman S, Wickman M, Yiallouros PK, Yorgancioglu A, Yusuf OM, Zar HJ, Zernotti ME, Zhang L, Zidarn M, Zuberbier T, Bousquet J. ARIA pharmacy 2018 "Allergic rhinitis care pathways for community pharmacy": AIRWAYS ICPs initiative (European Innovation Partnership on Active and Healthy Ageing, DG CONNECT and DG Santé) POLLAR (Impact of Air POLLution on Asthma and Rhinitis) GARD Demonstration project. Allergy 2019; 74:1219-1236. [PMID: 30565275 DOI: 10.1111/all.13701] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/22/2018] [Accepted: 10/11/2018] [Indexed: 12/16/2022]
Abstract
Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.
Collapse
Affiliation(s)
- Sinthia Bosnic‐Anticevich
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | - Elisio Costa
- UCIBIO REQUIMTE Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork) University of Porto Porto Portugal
| | | | - Olga Lourenço
- Faculty of Health Sciences and CICS – UBI Health Sciences Research Centre University of Beira Interior Covilhã Portugal
| | - Ettore Novellino
- Department of Pharmacy of University of Naples Federico II Naples Italy
| | - Slawomir Bialek
- Department of Biochemistry and Clinical Chemistry Faculty of Pharmacy with the Division of Laboratory Medicine Warsaw Medical University Warsaw Poland
| | - Vitalis Briedis
- Department of Clinical Pharmacy of Lithuanian University of Health Sciences Kaunas Lithuania
| | | | | | - Biljana Cvetkovski
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | | | - Vicky Kritikos
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | - Alpana Mair
- DG for Health and Social Care Scottish Government Edinburgh UK
| | | | | | | | - Rojin Söderlund
- Department of Nephrology and Endocrinology Karolinska University Hospital Stockholm Sweden
| | - Rachel Tan
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | - Dennis M. Williams
- Eshelman School of Pharmacy University of North Carolina Chapel Hill North Carolina
| | - Piotr Wroczynski
- Department of Biochemistry and Clinical Chemistry Faculty of Pharmacy with the Division of Laboratory Medicine Warsaw Medical University Warsaw Poland
| | | | | | - Josep M. Anto
- ISGlobAL Centre for Research in Environmental Epidemiology (CREAL) Barcelona Spain
- IMIM (Hospital del Mar Research Institute) Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
- Universitat Pompeu Fabra (UPF) Barcelona Spain
| | - Anna Bedbrook
- MACVIA‐France Fondation Partenariale FMC VIA‐LR Montpellier France
| | - Claus Bachert
- Upper Airways Research Laboratory ENT Department Ghent University Hospital Ghent Belgium
| | | | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Research Center for Anaphylaxis (ORCA) Odense Denmark
| | - Jan L. Brozek
- Department of Health Research Methods, Evidence, and Impact Division of Immunology and Allergy Department of Medicine McMaster University Hamilton Ontario Canada
| | - Giorgio Walter Canonica
- Personalized Medicine Clinic Asthma & Allergy Humanitas Research Hospital Humanitas University Rozzano, Milan Italy
| | - Victoria Cardona
- Allergy Section Department of Internal Medicine Hospital Vall ‘dHebron & ARADyAL Research Network Barcelona Spain
| | - Warner Carr
- Allergy and Asthma Associates of Southern California Mission Viejo California
| | - Thomas B. Casale
- Division of Allergy/Immunology University of South Florida Tampa Florida
| | - Niels H. Chavannes
- Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Braga Portugal
- ICVS/3B's PT Government Associate Laboratory Braga/Guimarães Portugal
| | - Alvaro A. Cruz
- ProAR – Nucleo de Excelencia em Asma Federal University of Bahia Bahia Brazil
- WHO GARD Planning Group Brasilia Brazil
| | | | - Giuseppe De Carlo
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations Brussels Belgium
| | - Pascal Demoly
- Department of Respiratory Diseases Montpellier University Hospital Montpellier France
- Epidemiology of Allergic and Respiratory Diseases Department Institute Pierre Louis of Epidemiology and Public Health Medical School Saint Antoine INSERM and UPMC Sorbonne Université Paris France
| | - Philippe Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220 Hôpital Foch Suresnes Université Versailles Saint‐Quentin Université Paris Saclay Saclay France
| | - Mark S. Dykewicz
- Section of Allergy and Immunology Saint Louis University School of Medicine Saint Louis Missouri
| | - Mina Gaga
- ERS President 2017‐2018 Athens Chest Hospital 7th Resp Med Department and Asthma Center Athens Greece
| | - Yehia El‐Gamal
- Pediatric Allergy and Immunology Unit Children's Hospital Ain Shams University Cairo Egypt
| | - João Fonseca
- CINTESIS Center for Research in Health Technologies and Information Systems Faculdade de Medicina da Universidade do Porto Porto Portugal
- MEDIDA, Lda Porto Portugal
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Academic Medical Centre Amsterdam The Netherlands
| | | | - Tari Haahtela
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Peter W. Hellings
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | - Maddalena Illario
- Division for Health Innovation Campania Region and Federico II University Hospital Naples (R&D and DISMET) Naples Italy
| | | | - Jocelyne Just
- Allergology Department Centre de l'Asthme et des Allergies Hôpital d'Enfants Armand‐Trousseau (APHP) Sorbonne Universités UPMC Univ Paris 06 UMR_S 1136 Institut Pierre Louis d'Epidémiologie et de Santé Publique Equipe EPAR Paris France
| | - Igor Kaidashev
- Ukrainian Medical Stomatological Academy Poltava Ukraine
| | - Musa Khaitov
- National Research Center Institute of Immunology Federal Medicobiological Agency Laboratory of Molecular immunology Moscow Russian Federation
| | | | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Institute for Clinical Epidemiology and Biometry University of Wuerzburg Wuerzburg Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Marek L. Kowalski
- Department of Immunology and Allergy Healthy Ageing Research Center Medical University of Lodz Lodz Poland
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland
| | | | | | | | - Lan T. T. Le
- University of Medicine and Pharmacy Hochiminh City Vietnam
| | - Karin C. Lodrup Carlsen
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical MedicineUniversity of Oslo Oslo Norway
| | - Bassam Mahboub
- Department of Pulmonary Medicine Rashid Hospital Dubai UAE
| | | | - Joao Malva
- Faculty of Medicine Coimbra Institute for Clinical and Biomedical Research (iCBR) University of Coimbra Coimbra Portugal
- Ageing@Coimbra EIP‐AHA Reference Site Coimbra Portugal
| | - Patrick J. Manning
- Department of Medicine (RCSI) Bon Secours Hospital Glasnevin, Dublin Ireland
| | | | - Ralph Mösges
- Institute of Medical Statistics, and Computational Biology Medical Faculty University of Cologne Cologne Germany
- CRI‐Clinical Research International‐Ltd Hamburg Germany
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic ENT Department Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy IDIBAPS CIBERES University of Barcelona Barcelona Spain
| | - Lars Münter
- Danish Committee for Health Education Copenhagen East Denmark
| | | | | | - Leyla Namazova‐Baranova
- Scientific Centre of Children's Health under the MoH, Russia, Russian National Research Medical University named Pirogov Moscow Russia
| | - Kristof Nekam
- Hospital of the Hospitaller Brothers in Buda Budapest Hungary
| | | | - Kimi Okubo
- Department of Otolaryngology Nippon Medical School Tokyo Japan
| | - Robyn E. O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine Alfred Hospital and Central Clinical School Monash University Melbourne Victoria Australia
- Department of Immunology Monash University Melbourne Victoria Australia
| | - Ken Ohta
- National Hospital Organization Tokyo National Hospital Tokyo Japan
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | | | - Susanna Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations Brussels Belgium
| | - Petr Panzner
- Department of Immunology and Allergology Faculty of Medicine and Faculty Hospital in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine Royal Manchester Children's Hospital University of Manchester Manchester UK
- Allergy Department 2nd Pediatric Clinic Athens General Children's Hospital “P&A Kyriakou” University of Athens Athens Greece
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section for Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Jim Phillips
- Centre for Empowering Patients and Communities Faulkland, Somerset UK
| | - Davor Plavec
- Children's Hospital Srebrnjak Zagreb, School of Medicine University J.J. Strossmayer Osijek Croatia
| | | | - Paul C. Potter
- Allergy Diagnostic and Clinical Research Unit University of Cape Town Lung Institute Cape Town South Africa
| | - Emmanuel P. Prokopakis
- Department of Otorhinolaryngology University of Crete School of Medicine Heraklion Greece
| | | | - Menachem Rottem
- Division of Allergy Asthma and Clinical Immunology Emek Medical Center Afula Israel
| | - Dermot Ryan
- Honorary Clinical Research Fellow Allergy and Respiratory Research Group The University of Edinburgh Past President SLAAI FACAAI Edinburgh UK
| | - Bolesław Samolinski
- Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Médico‐Docente la Trinidad Caracas Trinidad
- Clínica El Avila Altamira, Caracas Venezuela
| | - Holger J. Schunemann
- Department of Health Research Methods, Evidence, and Impact Division of Immunology and Allergy Department of Medicine McMaster University Hamilton Ontario Canada
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | | | - David Somekh
- European Health Futures Forum (EHFF) Isle of Wright UK
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno Salerno Italy
| | - Teresa To
- The Hospital for Sick Children Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
| | - Ana Maria Todo‐Bom
- Imunoalergologia Centro Hospitalar Universitário de Coimbra Coimbra Portugal
- Faculty of Medicine University of Coimbra Coimbra Portugal
| | | | - Sanna Toppila‐Salmi
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Antonio Valero
- Pneumology and Allergy Department CIBERES and Clinical & Experimental Respiratory Immunoallergy IDIBAPS University of Barcelona Barcelona Spain
| | - Arunas Valiulis
- Clinic of Children's Diseases and Institute of Health Sciences Department of Public Health Vilnius University Institute of Clinical Medicine Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS‐SP) Brussels Belgium
| | - Errka Valovirta
- Department of Lung Diseases and Clinical Immunology University of Turku and Terveystalo allergy clinic Turku Finland
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy
| | - Martin Wagenmann
- Department of Otorhinolaryngology Universitätsklinikum Düsseldorf Dusseldorf Germany
| | - Dana Wallace
- Nova Southeastern University Fort Lauderdale Florida
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy McMaster University Hamilton Ontario Canada
| | - Magnus Wickman
- Centre for Clinical Research Sörmland Uppsala University Eskilstuna Sweden
| | - Panayiotis K. Yiallouros
- Cyprus International Institute for Environmenta & Public Health in Association with Harvard School of Public Health Cyprus University of Technology Limassol Cyprus
- Department of Pediatrics Hospital “Archbishop Makarios III” Nicosia Cyprus
| | | | | | - Heather J. Zar
- Department of Paediatrics and Child Health Red Cross Children's, Hospital, and MRC Unit on Child & Adolescent Health University of Cape Town Cape Town South Africa
| | | | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital Beijing Institute of Otolaryngology Beijing China
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases Golnik Slovenia
| | - Torsten Zuberbier
- Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Institute of Health Comprehensive Allergy Center A member of GALEN Berlin Germany
| | - Jean Bousquet
- MACVIA‐France Fondation Partenariale FMC VIA‐LR Montpellier France
- Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Institute of Health Comprehensive Allergy Center A member of GALEN Berlin Germany
- University Hospital Montpellier France
- INSERM U 1168 VIMA: Ageing and chronic diseases Epidemiological and public health approaches Villejuif France
- Université Versailles St‐Quentin‐en‐Yvelines UMR‐S 1168 Montigny le Bretonneux France
| |
Collapse
|
33
|
Mobile technology offers novel insights into the control and treatment of allergic rhinitis: The MASK study. J Allergy Clin Immunol 2019; 144:135-143.e6. [PMID: 30951790 DOI: 10.1016/j.jaci.2019.01.053] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/05/2019] [Accepted: 01/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mobile health can be used to generate innovative insights into optimizing treatment to improve allergic rhinitis (AR) control. OBJECTIVES A cross-sectional real-world observational study was undertaken in 22 countries to complement a pilot study and provide novel information on medication use, disease control, and work productivity in the everyday life of patients with AR. METHODS A mobile phone app (Allergy Diary, which is freely available on Google Play and Apple stores) was used to collect the data of daily visual analogue scale (VAS) scores for (1) overall allergic symptoms; (2) nasal, ocular, and asthma symptoms; (3) work; and (4) medication use by using a treatment scroll list including all allergy medications (prescribed and over-the-counter) customized for 22 countries. The 4 most common intranasal medications containing intranasal corticosteroids and 8 oral H1-antihistamines were studied. RESULTS Nine thousand one hundred twenty-two users filled in 112,054 days of VASs in 2016 and 2017. Assessment of days was informative. Control of days with rhinitis differed between no (best control), single (good control for intranasal corticosteroid-treated days), or multiple (worst control) treatments. Users with the worst control increased the range of treatments being used. The same trend was found for asthma, eye symptoms, and work productivity. Differences between oral H1-antihistamines were found. CONCLUSIONS This study confirms the usefulness of the Allergy Diary in accessing and assessing behavior in patients with AR. This observational study using a very simple assessment tool (VAS) on a mobile phone had the potential to answer questions previously thought infeasible.
Collapse
|
34
|
Tan R, Cvetkovski B, Kritikos V, Yan K, Price D, Smith P, Bosnic-Anticevich S. Management of allergic rhinitis in the community pharmacy: identifying the reasons behind medication self-selection. Pharm Pract (Granada) 2018; 16:1332. [PMID: 30416632 PMCID: PMC6207357 DOI: 10.18549/pharmpract.2018.03.1332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/20/2018] [Indexed: 12/14/2022] Open
Abstract
Background: Community pharmacists have a key role to play in the management of allergic rhinitis (AR). Their role is especially important because the majority of medications used to treat AR are available for purchase over-the-counter (OTC), allowing patients to self-select their own medications and bypass the pharmacists. Patients’ self-selection often results in suboptimal treatment selection, undertreated AR and poor clinical outcomes. In order for pharmacists to optimise the care for AR patients in the pharmacy, pharmacists need to be able to identify patient cohorts who self-select and are at high risk of mismanagement. Objectives: This study aimed to compare the demographics, clinical characteristics and medication selected, between pharmacy customers who choose to self-select and those who speak with a pharmacist when purchasing medication for their AR in a community pharmacy and identify factors associated with AR patients’ medication(s) self-selection behaviour. Methods: A cross-sectional observational study was conducted in a convenience sample of community pharmacies from the Sydney metropolitan area. Demographics, pattern of AR symptoms, their impact on quality of life (QOL) and medication(s) selected, were collected. Logistic regressions were used to identify factors associated with participants’ medication self-selection behaviour. Results: Of the 296 recruited participants, 202 were identified with AR; 67.8% were female, 54.5% were >40 years of age, 64.9% had a doctor’s diagnosis of AR, and 69.3% self-selected medication(s). Participants with AR who self-select were 4 times more likely to experience moderate-severe wheeze (OR 4.047, 95% CI 1.155-14.188) and almost 0.4 times less likely to experience an impact of AR symptoms on their QOL (OR 0.369, 95% CI 0.188-0.727). Conclusions: The factors associated with AR patients’ self-selecting medication(s) are the presence of wheeze and the absence of impact on their QOL due to AR symptoms. By identifying this cohort of patients, our study highlights an opportunity for pharmacists to engage these patients and encourage discussion about their AR and asthma management.
Collapse
Affiliation(s)
- Rachel Tan
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney. Sydney (Australia).
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney. Sydney, NSW (Australia).
| | - Vicky Kritikos
- Clinical Researcher Pharmacist. Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney; & Department of Respiratory Medicine, Royal Prince Alfred Hospital. Sydney, NSW (Australia).
| | - Kwok Yan
- Department of Respiratory Medicine, Royal Prince Alfred Hospital. Sydney, NSW (Australia).
| | - David Price
- Academic Primary Care, University of Aberdeen, Aberdeen (United Kingdom).
| | - Peter Smith
- Institution: Clinical Medicine, Griffith University. Southport, QLD (Australia).
| | - Sinthia Bosnic-Anticevich
- Professor and Principal Research Fellow. Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney; & Sydney Local Health District, Sydney, NSW (Australia).
| |
Collapse
|
35
|
Cvetkovski B, Tan R, Kritikos V, Yan K, Azzi E, Srour P, Bosnic-Anticevich S. A patient-centric analysis to identify key influences in allergic rhinitis management. NPJ Prim Care Respir Med 2018; 28:34. [PMID: 30213945 PMCID: PMC6137238 DOI: 10.1038/s41533-018-0100-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/01/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022] Open
Abstract
Allergic rhinitis (AR) is increasingly becoming a patient self-managed disease. Just under 70% of patients purchasing pharmacotherapy self-select their treatment with no health-care professional intervention often resulting in poor choices, leading to suboptimal management and increased burden of AR on the individual and the community. However, no decision is made without external, influencing forces. This study aims to determine the key influences driving patients’ decision-making around AR management. To accomplish this aim, we utilised a social network theory framework to map the patient’s AR network and identify the strength of the influences within this network. Adults who reported having AR were interviewed and completed an AR network map and AR severity and quality of life questionnaires. Forty one people with AR completed the study. The AR networks of the participants had a range of 1–11 influences (alters), with an average number of 4 and a median of 5. The larger the impact of AR on their quality of life, the greater the number of alters within their network. The three most commonly identified alters were, general practitioners, pharmacists and the participants’ ‘own experience’. The strength of the influence of health-care professionals (HCPs) was varied. The proportion of HCPs within the AR network increased as the impact of AR on their quality of life increased. By mapping the AR network, this study demonstrated that there are multiple influences behind patient’s decisions regarding AR management but the role of the HCP cannot be dismissed. In-depth interviews with allergy sufferers about their treatment decisions highlights a need for healthcare professionals to help optimize allergy management. Allergic rhinitis (AR), a set of conditions including hayfever, is often poorly managed by patients, partly due to the growing availability of over-the-counter medications. However, little is known about what influences patients’ self-management decisions. Biljana Cvetkovski at the University of Sydney, Australia, and co-workers interviewed 41 adults with AR. The participants also completed quality of life questionnaires and created network maps of key influencers. Cvetkovski found that patients followed many different influences when making treatment decisions, including online resources, family, friends and healthcare professionals. Three of the key influencers were general practitioners, pharmacists and patients’ own experience. Those with severe AR had a larger, more diverse network of influences and often reported treatment fatigue.
Collapse
Affiliation(s)
- Biljana Cvetkovski
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia.
| | - Rachel Tan
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Kwok Yan
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Elizabeth Azzi
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia
| | - Pamela Srour
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Point Road, Glebe, Sydney, NSW, 2037, Australia.,Central Sydney Local Area Health District, Level 11, KGV Building, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| |
Collapse
|
36
|
Choi JY, Yoon HK, Lee JH, Yoo KH, Kim BY, Bae HW, Kim YK, Rhee CK. Nationwide use of inhaled corticosteroids by South Korean asthma patients: an examination of the Health Insurance Review and Service database. J Thorac Dis 2018; 10:5405-5413. [PMID: 30416788 PMCID: PMC6196168 DOI: 10.21037/jtd.2018.08.110] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/17/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous studies have found that the prescription rates of inhaled corticosteroid (ICS) were considerably low although it is recommended as the optimal asthma treatment. The aim of this study was to analyze the current status of ICS prescription for asthma patients in the South Korea. METHODS We evaluated quality assessment data based on nationwide Health Insurance Review and Service (HIRA) database from July 2013 to June 2014. ICS prescription rates in asthma patients were analyzed by types and specialty of medical institutions. Also, we graded medical institutions by their ICS prescription rate. In addition, ICS prescription rates were calculated by patient gender, age, and insurance type. RESULTS This study included 831,613 patients and 16,804 institutions in the analysis. The overall mean ICS prescription rate was 22.58%. Tertiary hospitals had the highest mean prescription rate (84.16%) whereas primary healthcare clinics had the lowest (20.71%). By specialty, internal medicine physicians prescribed ICS more frequently compared to other specialists. Of all, 47.17% of medical institutions prescribed ICS to <10% of asthma patients, while less than 6% of institutions prescribed ICS to >80% of asthma patients. Also, we found that female and patients with age >90 or <20 years exhibited lower ICS prescription rate. CONCLUSIONS The ICS prescription rate was found to be inadequate, given the importance of ICS as an asthma treatment. The prescription rates were especially low in primary healthcare clinics, and by specialists in fields other than internal medicine.
Collapse
Affiliation(s)
- Joon Young Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jae Ha Lee
- Division of Pulmonology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Bo Yeon Kim
- Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Hye Won Bae
- Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Young Kyoon Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
37
|
Price DB, Smith PK, Harvey RJ, Carney AS, Kritikos V, Bosnic-Anticevich SZ, Christian L, Skinner D, Carter V, Durieux AM. Real-life treatment of rhinitis in Australia: a historical cohort study of prescription and over-the-counter therapies for patients with and without additional respiratory disease. Pragmat Obs Res 2018; 9:43-54. [PMID: 30147391 PMCID: PMC6101013 DOI: 10.2147/por.s153266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The aim of the study was to explore rhinitis therapy purchases in different Australian regions for patients with and without additional respiratory disease, using both doctor's prescriptions and over-the-counter (OTC) medications. PATIENTS AND METHODS It was a historical cohort study of pharmacy-related claims that included prescription or OTC rhinitis therapy, with or without asthma/COPD therapy, from January 2013 to December 2014. RESULTS Overall, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over a calendar year; the majority were single-therapy purchases for rhinitis only patients. More multiple-therapy was purchased for rhinitis and asthma/COPD patients (4.4%) than for rhinitis only patients (4.0%), with a greater proportion purchased in VIC, SA and TAS (4.7% of rhinitis only patients and 4.5% of rhinitis and asthma/COPD patients) than in other areas. Dual therapy of oral antihistamine (OAH) and intranasal corticosteroid (INS) were the most frequently purchased multiple-therapy, with higher purchasing rates for rhinitis and asthma/COPD patients (2.6%) than for rhinitis only patients (1.6%). The most frequently purchased single therapy was OAH (70.1% of rhinitis only patients and 57.3% of rhinitis and asthma/COPD patients). First-line INS therapy was more likely to be purchased for rhinitis and asthma/COPD patients (15.3% by prescription and 11.7% OTC) than for rhinitis only patients (5.0% by prescription and 9.2% OTC); however, geographical differences in the proportion of therapies purchased OTC were noted, with a lower proportion of OTC OAH and INS purchases in Queensland and the Northern Territory for patients with and without comorbid respiratory disease. CONCLUSION Purchases of first-line INS therapy are more likely for patients with comorbid respiratory disease if they have received prescriptions and information/advice from their general practitioner. The study results indicate a need for patient information/education at the point-of-sale of OTC OAHs to enable patients to assess their nasal symptoms and receive treatment support from pharmacists. Greater availability to INSs in pharmacies as well as guidance from current guidelines and instruction in correct intranasal technique may also lead to greater uptake of INSs.
Collapse
Affiliation(s)
- David B Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK,
- Observational and Pragmatic Research Institute, Singapore, Singapore,
- Optimum Patient Care, Cambridge, UK,
| | - Pete K Smith
- Clinical Medicine, Griffith University, Southport, QLD, Australia
| | - Richard John Harvey
- Rhinology and Skull Base, Applied Medical Research Centre, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - A Simon Carney
- Department of Otolaryngology - Head and Neck Surgery, Flinders University, Adelaide, SA, Australia
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, University of Sydney, NSW, Australia
| | - Sinthia Z Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, NSW, Australia
- Central Sydney Area Health Service, Sydney, NSW, Australia
| | | | | | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore,
- Optimum Patient Care, Cambridge, UK,
| | - Alice Ms Durieux
- Observational and Pragmatic Research Institute, Singapore, Singapore,
| |
Collapse
|