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1137 Profile and symptom severity of patients presenting to general practice with seasonal allergic rhinitis
5390
Abstracts
1137
Profiles and Symptom Severity of Patients Presenti,ng to General Practice With Seasonal Allergic Rhinitis P van Cauwenberge*, V Lundt, J Bousquet#, T El Akkod§ *University Hospital of Ghent, Ghent, Belgium tuniversity College London Medical School. London, United Kingdom $Maladies Respiratoire, INSERM U454, Montpellier, France §RhBne-Poulenc Rarer. Antony, France A muhicentre parallel group study involving 258 GPs from Belgium, France and UK was set up with the objective of validating the International Rhinitis Guidelines (1994). Each GP was randomized and was requested to recruit the first two patients between the ages of 18 and 50 who presented with seasonal allergic rhinitis and who had at least 1 year documented history. Data were available from a total of 431 patients. The mean age of the patients was 32 years and the mean duration of their rhinitis was 13 years. There was an equal distribution of males and females. Perennial allergic rhinitis was a co-existing condition in 25% of the patients and 15% had co-existing asthma. Other concomitant conditions were chronic sinusitis (2%). otitis media (1%) and polyposis (2%). In order to be able to implement the guidelines, a tool was designed using visual analogue scales (VAS) to categorize patients into different levels of severity at baseline. Patients were asked to indicate on a VAS, the severity of symptoms of nasal stuffiness, rhinorrhoea and sneezing for rhinitis, and of eye symptoms for conjunctivitis. Patients scoring 50% or more in any one rhinitis symptom were classified as having moderate/severe rhinitis. All others were classified as having mild rhinitis. Similarly for conjunctivitis symptoms, those patients scoring less than 50% were classified as having no/mild conjunctivitis and those scoring 50% or more were classified as having moderate/severe conjunctivitis. This method of classification categorized patients as follows:
RHlNOCONJUNCTlVlTlS
J ALLERGY CLIN IMMUNOL JANUARY 2000
CONJ”NCTl”lTlS SYMPTOMS
(RQLQ). SEVERITY CATEGORY 1
l
ASSESSED CATEGORY 2
BY VAS AND COMCATEGORY 3
CATEGORY 4
2.72
2.34
3.55
3.76
2.27
3.18
I.44
3.46
O=NOT TROUBLED, 3=MODERATELY TROUBLED, 6=EXTREMELY TROUBLED.
The VAS was simple to use and showed to be consistent with the RQLQ. Currently, there is no common and well established definition of mild, moderate and severe rhinitis. The VAS may
Comparison Safety, EWcacy, and Cost of Triamcinolone Acetonide and Fluticasone Propionate Nasal Sprays in Patients With Seasonal Allergic Rhinitis D Malone*, J Limt. L Townsendf, Nasacort Study Group f *University of Arizona, Tucson, AZ iRh6ne-Poulenc Rorer This study compared the cost of care for patients with seasonal allergic rhinitis (SAR) treated with triamcinolone acetonide aqueous nasal spray (TA) [Nasacort@ AQ] versus fluticasone propionate nasal spray (FP) [Ronase@]. In this multicenter, randomized, parallel-group. single-blind study, 352 patients with SAR were randomized to receive TAA 220 mcg or FP 200 mcg once daily for 3 weeks. There were no differences observed between treatments with regard to resource utilization (telephone contacts to health care providers, emergency room visits. hospitalizations and medications. Overall, the average costs of medical care during the study were significantly less with TA ($37.67) compared to FP ($48.23).
ECONOMIC ITEM
VALUE OF RESOURCE
UTILIZATION
NASACORTA0
FLONASE
N=172 MEAN so
N.180 MEDIAN
MEAN so
MEDIAN
P-VALUE
Among the other parameters examined in the study were safety and efficacy. There were no significant differences in reductions in total nasal score, nasal discharge, nasal stuffiness. sneezing, nasal itching and total eye symptoms between the TA and FP treatment groups. At all timepoints. both treatments significantly reduced all symptoms compared to baseline. Both treatments were equally well tolerated. The results of this study demonstrate TA and FP to be equally effective in the treatment of SAR. but medical care costs are less with TA as compared to FP.
PATlENr Nw.laERS
Most of the patients seeking care in general practice had moderate to severe rhinitis (85 %) and very often moderate to severe rhinitis was associated with moderate to severe conjunctivitis (66%). Patients classified for the symptom severity were also assessed through the Rhinoconjunctivitis Quality of Life Questionnaire
RQLQ NASAL SYMPTOMS DOMAIN (O-6)’ RQLQ EYE SYMmOMS DOMAIN (O-6).
1138
SEVERITY CLASSIFIED BY VAS
RHINITIS CATEGORY SYMPTOMS
RHlNOCONJUNCTlVlTlS PAREDTO RQLQ
assist in determining the severity of Rhinoconjunctivitis in patient with SAR thus allowing appropriate treatment to be prescribed according to the guidelines.
1139
How Do Patients Decide When to Replace Their Intranasal Steroid (INS) Sprays? Vickie Holmes. Ronald Simon Scripps Clinic, La Jolla, CA INS are generally accepted as the most effective treatment for allergic rhinitis. However, there are a number of important aspects to proper use of these sprays that are important for maximium efftcacy. These include when to replace them and (for all but two) to shake prior to use. We sought to determine how frequently patients perform these parameters correctly. We gave questionnaires to 61 patients seen in the allergy division who met two criteria: receiving INS and for at least one month. The questionnaire was administered by VH who was available to clarify any of the questions. Fifty-eight of 61 shake before each use; three shake when residual volume seems low. Only two used priming sprays before each use. Fifty-nine use their INS until it no longer delivers any spray or a very weak spray. One subject replaced the INS each month and one after the number of actuations listed on the label. Only five knew the correct number of sprays contained in their INS and only five others even offered a number (which was at least 50% above or below correct number).
Abstracts
1137
Profiles and Symptom Severity of Patients Presenti,ng to General Practice With Seasonal Allergic Rhinitis P van Cauwenberge*, V Lundt, J Bousquet#, T El Akkod§ *University Hospital of Ghent, Ghent, Belgium tuniversity College London Medical School. London, United Kingdom $Maladies Respiratoire, INSERM U454, Montpellier, France §RhBne-Poulenc Rarer. Antony, France A muhicentre parallel group study involving 258 GPs from Belgium, France and UK was set up with the objective of validating the International Rhinitis Guidelines (1994). Each GP was randomized and was requested to recruit the first two patients between the ages of 18 and 50 who presented with seasonal allergic rhinitis and who had at least 1 year documented history. Data were available from a total of 431 patients. The mean age of the patients was 32 years and the mean duration of their rhinitis was 13 years. There was an equal distribution of males and females. Perennial allergic rhinitis was a co-existing condition in 25% of the patients and 15% had co-existing asthma. Other concomitant conditions were chronic sinusitis (2%). otitis media (1%) and polyposis (2%). In order to be able to implement the guidelines, a tool was designed using visual analogue scales (VAS) to categorize patients into different levels of severity at baseline. Patients were asked to indicate on a VAS, the severity of symptoms of nasal stuffiness, rhinorrhoea and sneezing for rhinitis, and of eye symptoms for conjunctivitis. Patients scoring 50% or more in any one rhinitis symptom were classified as having moderate/severe rhinitis. All others were classified as having mild rhinitis. Similarly for conjunctivitis symptoms, those patients scoring less than 50% were classified as having no/mild conjunctivitis and those scoring 50% or more were classified as having moderate/severe conjunctivitis. This method of classification categorized patients as follows:
RHlNOCONJUNCTlVlTlS
J ALLERGY CLIN IMMUNOL JANUARY 2000
CONJ”NCTl”lTlS SYMPTOMS
(RQLQ). SEVERITY CATEGORY 1
l
ASSESSED CATEGORY 2
BY VAS AND COMCATEGORY 3
CATEGORY 4
2.72
2.34
3.55
3.76
2.27
3.18
I.44
3.46
O=NOT TROUBLED, 3=MODERATELY TROUBLED, 6=EXTREMELY TROUBLED.
The VAS was simple to use and showed to be consistent with the RQLQ. Currently, there is no common and well established definition of mild, moderate and severe rhinitis. The VAS may
Comparison Safety, EWcacy, and Cost of Triamcinolone Acetonide and Fluticasone Propionate Nasal Sprays in Patients With Seasonal Allergic Rhinitis D Malone*, J Limt. L Townsendf, Nasacort Study Group f *University of Arizona, Tucson, AZ iRh6ne-Poulenc Rorer This study compared the cost of care for patients with seasonal allergic rhinitis (SAR) treated with triamcinolone acetonide aqueous nasal spray (TA) [Nasacort@ AQ] versus fluticasone propionate nasal spray (FP) [Ronase@]. In this multicenter, randomized, parallel-group. single-blind study, 352 patients with SAR were randomized to receive TAA 220 mcg or FP 200 mcg once daily for 3 weeks. There were no differences observed between treatments with regard to resource utilization (telephone contacts to health care providers, emergency room visits. hospitalizations and medications. Overall, the average costs of medical care during the study were significantly less with TA ($37.67) compared to FP ($48.23).
ECONOMIC ITEM
VALUE OF RESOURCE
UTILIZATION
NASACORTA0
FLONASE
N=172 MEAN so
N.180 MEDIAN
MEAN so
MEDIAN
P-VALUE
Among the other parameters examined in the study were safety and efficacy. There were no significant differences in reductions in total nasal score, nasal discharge, nasal stuffiness. sneezing, nasal itching and total eye symptoms between the TA and FP treatment groups. At all timepoints. both treatments significantly reduced all symptoms compared to baseline. Both treatments were equally well tolerated. The results of this study demonstrate TA and FP to be equally effective in the treatment of SAR. but medical care costs are less with TA as compared to FP.
PATlENr Nw.laERS
Most of the patients seeking care in general practice had moderate to severe rhinitis (85 %) and very often moderate to severe rhinitis was associated with moderate to severe conjunctivitis (66%). Patients classified for the symptom severity were also assessed through the Rhinoconjunctivitis Quality of Life Questionnaire
RQLQ NASAL SYMPTOMS DOMAIN (O-6)’ RQLQ EYE SYMmOMS DOMAIN (O-6).
1138
SEVERITY CLASSIFIED BY VAS
RHINITIS CATEGORY SYMPTOMS
RHlNOCONJUNCTlVlTlS PAREDTO RQLQ
assist in determining the severity of Rhinoconjunctivitis in patient with SAR thus allowing appropriate treatment to be prescribed according to the guidelines.
1139
How Do Patients Decide When to Replace Their Intranasal Steroid (INS) Sprays? Vickie Holmes. Ronald Simon Scripps Clinic, La Jolla, CA INS are generally accepted as the most effective treatment for allergic rhinitis. However, there are a number of important aspects to proper use of these sprays that are important for maximium efftcacy. These include when to replace them and (for all but two) to shake prior to use. We sought to determine how frequently patients perform these parameters correctly. We gave questionnaires to 61 patients seen in the allergy division who met two criteria: receiving INS and for at least one month. The questionnaire was administered by VH who was available to clarify any of the questions. Fifty-eight of 61 shake before each use; three shake when residual volume seems low. Only two used priming sprays before each use. Fifty-nine use their INS until it no longer delivers any spray or a very weak spray. One subject replaced the INS each month and one after the number of actuations listed on the label. Only five knew the correct number of sprays contained in their INS and only five others even offered a number (which was at least 50% above or below correct number).