Allergic rhinitis (AR) is a very common disease with over 600 million people (200 million of them with concomitant asthma) worldwide suffering from it. The majority of patients who seek medical advice are seen in primary care. Although there is a selection of guidelines focused on the management of AR, there is a paucity of guidance on how best to identify patients who would most benefit from treatment. The aim of this paper was to review the best practice for primary care with respect to the diagnosis of AR within that clinical environment.
Our results show that discrimination between asthma patients with controlled and uncontrolled asthma symptoms, based on the ACQ, is possible with a reasonable margin of test inaccuracy. Thus, the ACQ may be an important tool for health care professionals who aim to optimize the level of asthma control in their patient population.
A diagnosis of AR was an independent risk factor for asthma in our primary care study population. Having physician-diagnosed AR increased the risk almost fivefold for a future asthma diagnosis.
Airway hyperresponsiveness (AHR) is a characteristic feature of asthma, but it is unclear whether asymptomatic AHR is associated with a higher risk of asthma. The present study assessed whether there is an association between asymptomatic AHR in adolescence and asthma in adulthood. The association between allergy and development of asthma was also investigated.A follow-up study of a general population cohort of adolescents was performed 14 yrs after baseline. Respiratory status was assessed at baseline in 1989 and at follow-up in 2003-2004 by a respiratory symptoms questionnaire, spirometry and histamine challenge. Allergy status was also assessed.The respiratory status of 199 subjects was assessed twice. In total, 91 (46%) subjects had the same AHR status in combination with respiratory symptoms at follow-up as at baseline. Adjusted for age, sex, allergy, family history of asthma and smoking history, having asymptomatic AHR was not significantly related to having asthma 14 yrs later (odds ratio (OR) 2.15, 95% confidence interval (CI) 0.67-6.83). For subjects with allergy at baseline, the OR for developing asthma was 4.45 (95% CI 1.46-13.54).Screening for asymptomatic airway hyperresponsiveness in adolescence does not identify subjects at risk of developing asthma. Conversely, the presence of allergy in adolescence does seem to be a risk factor for asthma development.
Background:Inhaled corticosteroids (ICS) are recommended in prevailing guidelines for use in patients with persistent asthma or moderate-to-severe chronic obstructive pulmonary disease (COPD) and recurrent exacerbations. Recent data from Australia showed that 44% of patients with a single ICS dispensing and without other respiratory inhalation medications (‘one-off ICS’) were co-dispensed oral antibiotics. Evidence of the merit of ICS for treating respiratory infections in subjects without asthma or COPD is lacking.Aims:The aims of the study were to describe the rate of one-off ICS dispensing in combination with oral antibiotics in subjects without chronic respiratory conditions in the Netherlands, and to compare this with the rate of one-off ICS dispensing in combination with oral antibiotics as reported earlier from Australia.Methods:Dispensing data were obtained from the Dutch Foundation of Pharmaceutical Statistics. Additional information was available on patients’ age, sex and prescriber. Patients with any ICS dispensing in 2011 were selected.Results:Data were available from 1,725 Dutch community pharmacies (88%). Of 845,068 ICS users in 2011, 10% were dispensed one-off ICS, among which 13% had oral antibiotics co-dispensed. These ICS were mainly prescribed by general practitioners, mostly during winter months, for elderly persons, after high dosages of oral corticosteroids, and in single-inhaler combinations with a long-acting β2-agonist. The extrapolated total annual expense for this ICS use was € 555,000.Conclusion:In the Netherlands one-off ICS dispensing in combination with oral antibiotics in subjects without chronic respiratory conditions was considerably lower than in Australia.
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