Impact of asthma and comorbid allergic rhinitis on quality of life and control in patients of Italian general practitioners

Current Approaches in the Multimodal Management of Asthma in Adolescents-From Pharmacology to Personalized Therapy

Asthma and adolescence are two sensitive points and are difficult to manage when they coexist. The first is a chronic respiratory condition, with frequent onset in early childhood (between 3 and 5 years), which can improve or worsen with age. Adolescence is the period between childhood and adulthood (12-19 years), marked by various internal and external conflicts and a limited capacity to understand and accept any aspect that is delimited by the pattern of the social circle (of the entourage) frequented by the individual. Therefore, the clinician is faced with multiple attempts regarding the management of asthma encountered during the adolescent period, starting from the individualization of the therapy to the control of compliance (which depends equally on the adverse reactions, quality of life offered and support of the close circle) and the social integration of the subject, communication probably having a more important role in the monitoring and evolution of the condition than the preference for a certain therapeutic scheme. Current statistics draw attention to the increase in morbidity and mortality among children with bronchial asthma, an aspect demonstrated by the numerous hospitalizations recorded, due either to an escalation in the severity of this pathology or to faulty management. The purpose of this article is to review the delicate aspects in terms of controlling symptoms and maintaining a high quality of life among teenagers.

Allergic rhinitis in India

India is the home of nearly 20% of the global population with 1.35 billion people. Of all non-communicable diseases, allergic diseases such as allergic rhinitis (AR) and asthma appear to have increased in India over the past decades. Approximately 22% of adolescents currently suffer from AR in India. However, owing to the lack of adequate epidemiological studies in India, particularly in rural and suburban areas, this number may misrepresent the true burden of this disease. While the risk factors for AR are mainly environmental exposures or genetic factors, several new environmental, social, and behavioural risk factors such as the presence of dumpsters near residences, movement of vehicles near homes, and exposure to artificial light at night have been found to be associated with AR. However, despite international guidelines, the diagnosis and management of AR in India are often suboptimal, for multiple reasons such as the lack of specialized training in allergy and immunology among Indian clinicians, the lack of diagnostic facilities, and the high cost of medications. This review aims at highlighting the current scenario of AR in India and how it differs from the rest of the world. It also highlights the need for developing a strategic approach to enhance the quality of care for allergic diseases by upgrading education and training for healthcare professionals, creating awareness among clinicians and patients, and involving stakeholders and policymakers in making treatments accessible and affordable to patients.

Symptom control and health-related quality of life in allergic rhinitis with and without comorbid asthma: A multicentre European study

BACKGROUND

Allergic rhinitis (AR) is a major non-communicable disease that affects the health-related quality of life (HRQoL) of patients. However, data on HRQoL and symptom control in AR patients with comorbid asthma (AR + asthma) are lacking.

METHODS

In this multicentre, cross-sectional study, patients with AR were screened and administered questionnaires of demographic characteristics and health conditions (symptoms/diagnosis of AR and asthma, disease severity level, and allergic conditions). HRQoL was assessed using a modified version of the RHINASTHMA questionnaire (30, 'not at all bothered' - 150 'very much bothered') and symptom control was evaluated by a modified version of the Control of Allergic Rhinitis/Asthma Test (CARAT) (0, 'no control' - 30, 'very high control').

RESULTS

Out of 643 patients with AR, 500 (78%) had asthma as a comorbidity, and 54% had moderate-severe intermittent AR, followed by moderate-severe persistent AR (34%). Compared to the patients with AR alone, patients with AR + asthma had significantly higher RHINASTHMA (e.g., median RHINASTHMA-total score 48.5 vs. 84, respectively) and a significantly lower CARAT score (median CARAT-total score 23 vs. 16.5, respectively). Upon stratifying asthma based on severity, AR patients with severe persistent asthma had worse HRQoL and control than those with mild persistent asthma. The association was significantly higher among non-obese participants compared to obese ones, with RHINASTHMA-upper symptoms score but not with CARAT.

CONCLUSIONS

Our observation of poorer HRQoL and symptoms control in AR patients with comorbid asthma supports the importance of a comprehensive approach for the management of AR in case of a comorbid allergic condition.

Hydropinotherapy with Sulphurous Mineral Water as Complementary Treatment to Improve Glucose Metabolism, Oxidative Status, and Quality of Life

Hydropinotherapy is a salus per aquam (Spa) treatment suitable as a complementary approach to treat several diseases, which strongly affect the quality of life (QoL). Hydropinotherapy with sulphurous mineral water exerts benefits thanks to components, such as hydrogen sulphide, which is considered mainly responsible for antioxidant and hypoglycaemic effects. Such properties, linked from each other, could favour an improvement in patients’ QoL. However, data on humans are scarce. This study aimed to investigate whether a cycle of sulphurous hydropinotherapy was able to modify plasma levels of glucose and reactive oxygen metabolites (ROMs) and improve QoL in patients suffering from several chronic disorders. A prospective, observational study involved patients with gastrointestinal diseases who received a prescription of a cycle of sulphurous hydropinotherapy (S-HT). Age- and sex-matched control group was enrolled (No S-HT). Glycaemia and plasma concentration of ROMs were measured in all subjects. The impact of spa treatment on the QoL was assessed using the Short Form 36 Health Status Survey questionnaire (SF-36). All parameters were measured at baseline and at the end of a 2-week treatment. Between the groups, no differences were found in glycaemia and ROMs at baseline. In the S-HT group, a reduction in glycaemia and ROMs, both in respect to baseline (p = 0.005 and p = 0.031, respectively) and to control group, as shown by the delta value calculated, as the difference between the values at 2 weeks and baseline (p = 0.0009 and p = 0.0001, respectively). In the S-HT, delta ROMs was the best predictor of delta glycaemia with a direct linear correlation (beta = 0.559, 95% CI 0.471 to 0.647, p < 0.0001). In the S-HT, the SF-36 total score was improved both when compared with baseline (p = 0.002) and with No S-HT (p = 0.001). Sulphurous hydropinotherapy induces a decrease in glycaemia and ROM levels, also ameliorating the patients’ QoL. Therefore, it could be considered a useful complementary therapeutic approach.

Association between environmental exposure to phthalates and allergic disorders in Korean children: Korean National Environmental Health Survey (KoNEHS) 2015-2017

BACKGROUND

Phthalates are common industrial chemicals that are used as plasticizers in plastics, personal care products, and building materials. Although these chemicals have been suspected as risk factors for allergic outcomes among children, inconsistent associations between environmental exposure to phthalates and allergic disorders have been found across different populations. Therefore, this study aimed to assess whether environmental phthalate exposure was associated with parent-reported current allergic symptoms (atopic dermatitis, AD; asthma; and allergic rhinitis, AR) and the index of allergic response (levels of serum total immunoglobulin E, IgE) in a nationally representative sample of children.

METHODS

In this study, children aged 3-17 years (n = 2208) were recruited from the Korean National Environmental Health Survey (KoNEHS) 2015-2017 to conduct an analysis of their current allergic symptoms. Among this number of children, the total IgE analysis included 806 participants because total IgE levels were only measured in children aged 12-17 years.

RESULTS

After adjusting for all covariates, mono-benzyl phthalate (MBzP) [OR (95% CI) = 1.15 (1.01, 1.30)], mono-(carboxyoctyl) phthalate (MCOP) [OR (95% CI) = 1.35 (1.02, 1.78)], and the sum of di-(2-ethylhexyl) phthalate metabolites (∑DEHP) [OR (95% CI) = 1.39 (1.09, 1.79)] were associated with increased odds of current AD. MCOP [OR (95% CI) = 1.19 (1.01, 1.40)], mono-(carboxynonyl) phthalate (MCNP) [OR (95% CI) = 1.24 (1.05, 1.45)], and ∑DEHP [OR (95% CI) = 1.22 (1.02, 1.44)] were also associated with increased odds of current AR. Individual DEHP metabolites showed similar associations with current AD and AR. In addition, MCNP was positively related to IgE levels [β (95% CI) = 0.26 (0.12, 0.40)]. MBzP [OR (95% CI) = 1.17 (1.01, 1.35)], MCOP [OR (95% CI) = 1.62 (1.12, 2.32)], and mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) [OR (95% CI) = 1.36 (1.06, 1.76)] showed positive relationships with allergic multimorbidity. Moreover, higher concentrations of MCNP were related to increased odds of experiencing both current AR and total IgE levels [OR (95% CI) = 1.98 (1.29, 3.04)], and children with elevated IgE levels (>100IU/mL) were more likely to have current AR associated with MCNP than those without elevated IgE levels (p = 0.007). Specifically, the relationship between MCNP and current AR was significantly mediated through alterations in IgE levels (14.7%), and MCNP also showed the positive association with current AR, independent of IgE (85.3%).

CONCLUSION

These results suggest that environmental exposure to phthalates may affect the immune system and increase the occurrence of allergic symptoms in children.

Longitudinal Asthma Patterns in Italian Adult General Population Samples: Host and Environmental Risk Factors

Background: Asthma patterns are not well established in epidemiological studies. Aim: To assess asthma patterns and risk factors in an adult general population sample. Methods: In total, 452 individuals reporting asthma symptoms/diagnosis in previous surveys participated in the AGAVE survey (2011–2014). Latent transition analysis (LTA) was performed to detect baseline and 12-month follow-up asthma phenotypes and longitudinal patterns. Risk factors associated with longitudinal patterns were assessed through multinomial logistic regression. Results: LTA detected four longitudinal patterns: persistent asthma diagnosis with symptoms, 27.2%; persistent asthma diagnosis without symptoms, 4.6%; persistent asthma symptoms without diagnosis, 44.0%; and ex -asthma, 24.1%. The longitudinal patterns were differently associated with asthma comorbidities. Persistent asthma diagnosis with symptoms showed associations with passive smoke (OR 2.64, 95% CI 1.10–6.33) and traffic exposure (OR 1.86, 95% CI 1.02–3.38), while persistent asthma symptoms (without diagnosis) with passive smoke (OR 3.28, 95% CI 1.41–7.66) and active smoke (OR 6.24, 95% CI 2.68–14.51). Conclusions: LTA identified three cross-sectional phenotypes and their four longitudinal patterns in a real-life setting. The results highlight the necessity of a careful monitoring of exposure to active/passive smoke and vehicular traffic, possible determinants of occurrence of asthma symptoms (with or without diagnosis). Such information could help affected patients and physicians in prevention and management strategies.

Physicians' prescribing behaviour and clinical practice patterns for allergic rhinitis management in Italy

BACKGROUND

Despite availability of clinical guidelines, underdiagnosis, undertreatment, and poor adherence are still significant concerns in allergic rhinitis (AR) therapeutic management. We investigated clinical practice patterns and prescribing behavior of Italian healthcare professionals (HCPs) specialized in AR.

METHODS

One-hundred allergologists, 100 ear, nose and throat (ENT) specialists, and 150 general practitioners (GPs) were recruited. The survey assessed: socio-demographic, work experience, monthly caseload, prescription drivers. Next, HCPs were invited to retrospectively recover patients' clinical data to investigate: AR clinical characteristics, therapy management, prescription patterns, patient adherence. Descriptive statistics, Chi square, One-Way analysis of variance, and Two-Way Analysis of Variance were performed.

RESULTS

Allergologists visited more AR patients (31% of monthly caseload) than ENTs (21%, p < 0.001), while GPs' caseload was the lowest (6%). Clinical information of 2823 patients were retrieved of whom 1906 (67.5%) suffered from moderate/severe AR (discomfort score: 7.7 ± 1.3) and 917 (32.4%) from mild AR (5.7 ± 1.9). About one-third of mild patients had a discomfort score ≥ 7. Main prescription drivers were "effective on all symptoms" (54.3% patients) and "quick symptom relief" (47.8%), whereas minor drivers were "affordable price" (13.4%) and "refundable" (8.7%). The most prescribed drugs were antihistamines and intranasal corticosteroids (79% and 55% prescriptions), followed by fixed-dose-combination of intranasal azelastine/fluticasone (19%). Polytherapy was the most common treatment strategy (59.6%). HCPs' believe that the majority of the patients was adherent to treatment (88% with score > 7).

CONCLUSIONS

This survey describes the therapeutic approach adopted by Italian physicians to cope with AR and shows that HCPs underestimated AR severity and had a non-realistic perception of patients' adherence. These findings suggest that further efforts are required to improve AR clinical management in Italy.

The Burden of Self-Reported Rhinitis and Associated Risk for Exacerbations with Moderate-Severe Asthma in Primary Care Patients

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.

Asia-Pacific Survey of Physicians on Asthma and Allergic Rhinitis (ASPAIR): physician beliefs and practices about diagnosis, assessment, and treatment of coexistent disease

Background

Asthma and allergic rhinitis (AR) frequently coexist, and having both asthma and AR is associated with uncontrolled asthma and a heavier disease burden. The Asia-Pacific Survey of Physicians on Asthma and Allergic Rhinitis (ASPAIR) aimed to assess physicians’ perceptions and their management practices for patients with coexistent disease.

Materials and methods

A total of 1,204 general physicians and pediatricians from six countries in Asia, who routinely treat asthma patients, were interviewed in-person. Physicians were questioned about their attitudes and beliefs of coexistent asthma-AR, how they diagnose and treat patients, and their knowledge of international guideline recommendations.

Results

Physicians reported that 45% of their patients with asthma have coexistent AR and 37% of their patients with AR have coexistent asthma. Most physicians (77%) agreed that coexistent asthma-AR is a genuine condition and that patients suffer worse symptoms with both the conditions vs one alone (86%). Although nearly all agreed that both asthma and AR should be treated (91%) and that intranasal (INS) and inhaled corticosteroids (ICS) could be given concurrently to these patients, 40% also thought that treating both conditions effectively at the same time is difficult, and approximately a quarter believed that corticosteroid therapy should be delayed in children for both asthma and AR. While there was universal recognition and acceptance that guidelines provide sufficient information for treating uncontrolled coexistent disease (≥80% physicians in all countries), physicians revealed that 41% of their asthma patients are treated with short-acting rescue medications alone, and only 47% responded that treatment with concurrent INS and ICS, as recommended in the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, was their preferred treatment for coexistent disease.

Conclusion

The ASPAIR survey demonstrates a widespread acceptance of coexistent asthma-AR, and the associated burden, but highlights the need for increased healthcare practitioner communication and awareness to improve appropriate treatment and management of these coexistent conditions.

Cold weather increases respiratory symptoms and functional disability especially among patients with asthma and allergic rhinitis

Cold weather affects the respiratory epithelium and induces bronchial hyperresponsiveness. We hypothesized that individuals with allergic rhinitis or/and asthma experience cold weather-related functional disability (FD) and exacerbation of health problems (EH) more commonly than individuals without these. This was a population-based study of 7330 adults aged 25–74 years. The determinants of interest, including doctor-diagnosed asthma and allergic rhinitis, and the outcomes, including cold weather-related FD and EH, were measured using a self-administered questionnaire. The prevalences of cold-related FD and EH were 20.3% and 10.3%, respectively. In Poisson regression, the risk of FD increased in relation to both allergic rhinitis (adjusted prevalence ratio (PR) 1.19, 95% CI 1.04–1.37 among men; 1.26, 95% CI 1.08–1.46 among women), asthma (1.29, 0.93–1.80; 1.36, 0.92–2.02, respectively) and their combination (1.16, 0.90–1.50; 1.40, 1.12–1.76, respectively). Also the risk of cold weather-related EH was related to both allergic rhinitis (1.53, 1.15,−2.04 among men; 1.78, 1.43–2.21 among women), asthma (4.28, 2.88–6.36; 3.77, 2.67–5.34, respectively) and their combination (4.02, 2.89–5.59; 4.60, 3.69–5.73, respectively). We provide new evidence that subjects with allergic rhinitis or/and asthma are more susceptible to cold weather-related FD and EH than those without pre-existing respiratory diseases.

The Influence of Asthma Exacerbations on Health-Related Quality of Life

The purpose of this study was to determine the influence of asthma on the quality of life (QoL) of patients hospitalized for an exacerbation of the disease and those with controlled asthma receiving outpatient treatment, and to establish the patients' somatic status and the level of health care utilization. This study involved 239 adults with asthma (123 hospitalized patients and 116 outpatients of family physicians). The authors used: WHOQOL-BREF questionnaire and a questionnaire measuring health care utilization. There were no differences in QoL levels between the patients with severe and controlled asthma. The psychological domain was assessed higher by hospitalized patients (p = 0.02). QoL levels correlated negatively with age, place of residence, and marital status, and positively with education. The general QoL level was most strongly influenced by gender, age, education, the number of home visits and interventions of a district nurse, and the somatic index (p < 0.05). Somatic symptoms were more severe in hospitalized patients. The QoL assessment of asthma patients in relation to somatic symptoms, health care services and socio-demographic variables allows better understanding of the complex health situation of patients at various stages of the disease, and tailoring the therapy to individual needs. Patients receiving outpatient treatment require professional psychotherapeutic support.

Characteristics and predictors of allergic rhinitis undertreatment in primary care

Although allergic rhinitis is considered a raising medical problem in many countries it is often undertreated. The reasons for this phenomenon are not completely clear.The aim of this study is to evaluate factors associated with allergic rhinitis under-/no treatment.A sample of 518 allergic rhinitis patients recruited by their primary care physicians, as a part of the ARGA study, were invited to fill in a specific questionnaire regarding rhinitis symptoms, treatment, and rhinitis-related work/social disability. Chi-square test and logistic regression were performed to assess risk factors for allergic rhinitis under-/no treatment.Over one out of four patients had no treatment despite the symptoms and 13.5% were inadequately treated. Participants with asthma (OR 0.47, 95% CI 0.30-0.75) and conjunctivitis (0.44, 95% CI 0.27-0.71) were at lower risk of allergic rhinitis under-/no treatment: in asthmatics this reduction was related mainly to the concomitant asthma treatment (OR 0.19, 95% CI 0.10-0.37).Asthmatics with under-/not treated rhinitis had the highest prevalence of rhinitis-related quality of life impairment.Under-/no treatment for allergic rhinitis is still rather frequent despite the relevance of this disease. The simultaneous presence of asthma and an anti-asthmatic therapy are able to influence positively the treatment. Targeted interventions toward a better characterization and a tight follow-up of rhinitis patient without asthma are needed.

Establishing the relationship of inhaler satisfaction, treatment adherence, and patient outcomes: a prospective, real-world, cross-sectional survey of US adult asthma patients and physicians

Background

Inhaled asthma medications are the mainstay of treatment for chronic asthma. However, nonadherence rates for long-term inhaler therapy among adults are estimated to exceed 50 %. Nonadherence is associated with unfavorable clinical outcomes and diminished quality of life. Research suggests that adherence is associated with patients’ satisfaction with their treatment regimen and other factors, such as concomitant allergic rhinitis and tobacco use.

Methods

This prospective, cross-sectional survey of physicians and their patients evaluated the relationship between patient satisfaction with attributes of inhaler devices, treatment adherence, and clinical outcomes. Primary care and specialist physicians completed a physician-reported patient record form for patients with a confirmed asthma diagnosis. Patients for whom a physician-reported form was completed were invited to complete a patient-reported form. Both surveys collected information about demographics, symptoms, exacerbation history, treatment, smoking status, comorbidities, type of inhaler device, and treatment adherence. Patients also indicated the degree to which they were satisfied with attributes of their currently prescribed inhaler device(s). Partial least squares path modeling quantified relationships between latent variables and clinical outcomes.

Results

A total of 243 patients were included in our analysis and 41 % had poorly controlled asthma. More favorable clinical outcomes were significantly associated with greater patient satisfaction with drug delivery (P = 0.002), higher medication adherence (P = 0.049), no history of tobacco use (P < 0.001), and absence of comorbid allergic rhinitis (P = 0.005). Attributes associated with device satisfaction included patient perceptions of consistency in the amount of drug delivery to the lungs, ease of use, and feedback about the number of remaining doses.

Conclusions

Higher patient satisfaction with their asthma drug delivery inhaler device is a significant predictor of more favorable clinical outcomes while allergic rhinitis and smoking history were negatively associated with optimal control of asthma. These findings provide clinicians with opportunities to improve patients’ clinical outcomes by tailoring choice of inhaler device therapy and providing education about the correct way to use the device to ensure optimal outcomes. Patients will likely benefit from medical therapy to manage comorbid allergic rhinitis and smoking cessation interventions. Patients unable to stop smoking may require alternative medical therapies to improve their clinical outcomes.

Impact of an Innovative Educational Strategy on Medication Appropriate Use and Length of Stay in Elderly Patients

To evaluate the impact of an educational strategy on potentially inappropriate medications (PIMs) and length of stay in hospitalized elderly patients.

DESIGN

An open study, with two cross-sectional surveys interspersed with an educational program (PRE phase and POST phase), has been performed in order to compare the PIMs number before and after the introduction of an educational strategy. The study included 2 phases: PRE, in which patients were enrolled as control group; POST, in which an educational strategy on the PIMs use was introduced among physicians, and patients were enrolled as intervention group.

SETTING

Italian residential rehabilitation Centre. Inclusion criteria were ≥ 2 active chronic diseases and the current use of ≥ 4 medications. The educational strategy consisted of a 3-day course on strategies to prevent PIMs and a computerized tool running on a Personal Digital Assistant (PDA) device to check for PIMs.

OUTCOMES

The primary was the PIMs number, the secondary the length of stay.

RESULTS

A total of 790 patients, 450 controls and 340 cases, were enrolled. According to the Beers criteria, 52.3% of the study population received ≥ 1 PIMs, 18.73% ≥ 2, and 2.4% ≥ 4 PIMs. A significant reduction of PIMs (P = 0.020) and length of stay (P < 0.0001) were seen in the intervention group. At multivariate analysis, PIMs significantly correlated with age, drugs number, and the intervention, and the length of stay significantly correlated with disease count, comorbidities, and intervention. These data suggest that our educative instrument may be useful in reducing the PIMs number and length of hospitalization in elderly with a high number of drugs and comorbidities.

Asthma with allergic rhinitis management in China: a nationwide survey of respiratory specialists at tertiary hospitals

BACKGROUND

Many asthmatic patients have coexisting allergic rhinitis (AR). This study aims to investigate the compliance of physicians with respiratory medicine specialty (PRMs) to Global Initiative for Asthma (GINA) and Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines during the management of their asthma-AR patients.

METHODS

This cross-sectional questionnaire study surveyed the diagnostic methods and treatment patterns for asthma-AR comorbidity by PRMs from 98 hospitals across China.

RESULTS

PRMs reported an estimated prevalence of asthma-AR comorbidity of >30% at their clinics. PRMs with greater work experience and a higher professional title estimated treating a significantly higher proportion of patients with AR within the previous month (p = 0.002 and p < 0.001, respectively); they also estimated a higher incidence of patients with AR in the autumn (p < 0.001 and p < 0.001). A higher percentage of PRMs with ≥11 years work experience prescribed nasal steroids for AR as compared to those with 1 to 10 years experience (56.9% vs 44.7%, p = 0.002). A greater proportion of chief physicians used leukotriene modifiers and a lower proportion used antihistamine H1 -receptor blockers for AR as compared to residents (resident vs assistant chief: 27.5% vs 11.6%, p = 0.002; and resident vs chief PRMs: 27.5% vs 9.5%, p = 0.001).

CONCLUSION

PRMs in China demonstrated an up-to-date comprehension of asthma management (>90%); however, knowledge gaps existed in their concepts of AR and asthma-AR comorbidity. Thus, further education is warranted for PRMs regarding the importance of AR in asthma patients, definitive diagnosis (allergy tests), classifications of AR, and treatment guidelines for the asthma-AR comorbidity.

A computerized asthma-specific quality of life: a novel tool for reflecting asthma control and predicting exacerbation

BACKGROUND

Proper assessment of health-related quality of life is essential to achieve and maintain a controlled status in asthmatic patients. We developed our own computerized asthma-specific quality-of-life (cA-QOL) questionnaire based on in-depth interviews with adult asthmatic patients. In this study, we evaluated this cA-QOL in terms of the Asthma Control Test (ACT) score and Global Initiative for Asthma (GINA) guidelines as well as asthma exacerbation, and compared it with the asthma-related quality-of-life questionnaire (AQLQ).

METHODS

We conducted a multicenter, prospective, observational study in 133 adult asthmatic patients recruited from 5 university hospitals in South Korea, who were randomized into 2 groups according to the operating order of the cA-QOL and AQLQ. At every visit (3-month interval), physicians evaluated asthma control status with monitoring spirometry. The self-administered cA-QOL, AQLQ(S) and ACT were completed.

RESULTS

The cA-QOL scores correlated significantly with ACT and AQLQ(S) scores (r = 0.814, p < 0.001; r = 0.900, p < 0.001). The cA-QOL score was significantly lower where the ACT score was <19, in the patients with an uncontrolled asthma status according to the GINA guidelines and in those with asthma exacerbation (p < 0.001, respectively). A multivariate analysis showed that this cA-QOL was a significant parameter associated with an uncontrolled asthma status and asthma exacerbation (p < 0.001, p = 0.045, p = 0.019, respectively).

CONCLUSION

The cA-QOL is a valid tool for reflecting current asthma control status and for assessment to predict the future risk of asthma exacerbation in adult asthmatics.

Asthma and allergic rhinitis increase respiratory symptoms in cold weather among young adults

BACKGROUND

The occurrence of cold temperature-related symptoms has not been investigated previously in young adults, although cold weather may provoke severe symptoms leading to activity limitations, and those with pre-existing respiratory conditions may form a susceptible group. We tested the hypothesis that young adults with asthma and allergic rhinitis experience cold-related respiratory symptoms more commonly than young adults in general.

METHODS

A population-based study of 1623 subjects 20-27 years old was conducted with a questionnaire inquiring about cold weather-related respiratory symptoms, doctor-diagnosed asthma and rhinitis, and lifestyle and environmental exposures.

RESULTS

Current asthma increased the risk of all cold weather-related symptoms (shortness of breath adjusted PR 4.53, 95% confidence interval 2.93-6.99, wheezing 10.70, 5.38-21.29, phlegm production 2.51, 1.37-4.62, cough 3.41, 1.97-5.87 and chest pain 2.53, 0.82-7.79). Allergic rhinitis had additional effect especially on shortness of breath (7.16, 5.30-9.67) and wheezing (13.05, 7.75-22.00), some on phlegm production (3.69, 2.49-5.47), but marginal effect on cough and chest pain.

INTERPRETATION

Our study shows that already in young adulthood those with asthma, and especially those with coexisting allergic rhinitis, experience substantially more cold temperature-related respiratory symptoms than healthy young adults. Hence, young adults with a respiratory disease form a susceptible group that needs special care and guidance for coping with cold weather.

Potential mechanisms linking atherosclerosis and increased cardiovascular risk in COPD: focus on Sirtuins

The development of atherosclerosis is a multi-step process, at least in part controlled by the vascular endothelium function. Observations in humans and experimental models of atherosclerosis have identified monocyte recruitment as an early event in atherogenesis. Chronic inflammation is associated with ageing and its related diseases (e.g., atherosclerosis and chronic obstructive pulmonary disease). Recently it has been discovered that Sirtuins (NAD⁺-dependent deacetylases) represent a pivotal regulator of longevity and health. They appear to have a prominent role in vascular biology and regulate aspects of age-dependent atherosclerosis. Many studies demonstrate that SIRT1 exhibits anti-inflammatory properties in vitro (e.g., fatty acid-induced inflammation), in vivo (e.g., atherosclerosis, sustainment of normal immune function in knock-out mice) and in clinical studies (e.g., patients with chronic obstructive pulmonary disease). Because of a significant reduction of SIRT1 in rodent lungs exposed to cigarette smoke and in lungs of patients with chronic obstructive pulmonary disease (COPD), activation of SIRT1 may be a potential target for chronic obstructive pulmonary disease therapy. We review the inflammatory mechanisms involved in COPD-CVD coexistence and the potential role of SIRT1 in the regulation of these systems.

The ARGA study with Italian general practitioners: prescriptions for allergic rhinitis and adherence to ARIA guidelines

BACKGROUND

General practitioners (GPs) are the healthcare professionals to whom patients with rhinitis firstly refer for their symptoms.

OBJECTIVE

In the present study, we assessed drug prescriptions for allergic rhinitis (AR) and evaluated prescriptive adherence to ARIA treatment guidelines.

METHODS

Data on 1379 AR patients were collected by 107 Italian GPs. Adherence to ARIA guidelines was evaluated according to AR severity classification.

RESULTS

AR was diagnosed by GPs as mild intermittent for 46.2% of patients, mild persistent for 26.6%, moderate-severe intermittent for 20.2%, and moderate-severe persistent for 7%; 43.7% of AR patients had concomitant asthma. The most frequently prescribed therapeutic groups were antihistamines (anti-H, 76%) and nasal corticosteroids (NCS, 46%). Anti-H were significantly used more often to treat AR alone than AR + asthma (85 vs. 68%, p < 0.001), whereas NCS were used more often to treat AR + asthma than AR alone (50 vs. 42%, p = 0.01). Among patients with only mild intermittent AR, 39% were prescribed combined therapy. Among patients with moderate-severe persistent AR, 30% of those with AR alone and 18% of those with AR + asthma were prescribed monotherapy based on anti-H. GPs were more compliant with ARIA guidelines while treating AR alone (57%) than AR + asthma (46%) patients. The adherence increased according to the severity grade and was satisfactory for moderate-severe persistent AR (89% for AR alone and 95% for AR + asthma).

CONCLUSIONS

Adherence to ARIA guidelines is satisfactory only for treatment of more severe patients, thus GPs often tend to treat patients independently from ARIA guidelines. Since prescription data only provide limited information to judge prescribing quality, some deviation from the gold standard are to be expected.