Actual use of PROMs in asthma and rhinitis recommended by guidelines in clinical settings: PROMUSE respiratory study.

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Advances in upper airway diseases and allergen immunotherapy

Dupilumab improves patient-reported outcomes in patients with chronic rhinosinusitis with nasal polyps and comorbid asthma

Introduction. Chronic rhinitis is one of the common ENT diseases characterized by nasal congestion, leading to intermittent hypoxia and, consequently, to a disturbance in the balance of prooxidants and antioxidants in the blood plasma, which may reduce the quality of life of patients.Aim. To evaluate the impact of the "lipid peroxidation – antioxidant defense" system indicators on the quality of life of patients with chronic rhinitis of different phenotypes, using the SNOT-22 disease outcome assessment test.Materials and methods. The study groups included 45 patients with chronic allergic rhinitis, 49 patients with chronic vasomotor rhinitis, 32 patients with chronic atrophic rhinitis, 39 patients with chronic infectious rhinitis, and 40 individuals in the control group. Spectrophotometric method in blood plasma determined the indicators of the "lipid peroxidation – antioxidant defense" (LPO-AOD) system: diene conjugates, malondialdehyde, catalase, superoxide dismutase, ceruloplasmin, reduced glutathione, glutathione-S-transferase, glutathione peroxidase, and surveyed using the Russian version of the SNOT-22 questionnaire.Results. For all patients from the study groups with chronic rhinitis, a decrease in the concentration of antioxidant system components was characteristic. An increase in lipid peroxidation was found in chronic allergic, atrophic, and infectious rhinitis, with the most significant disturbance detected in chronic infectious rhinitis. A total of the highest number of disturbances in the LPO-AOD system was found in patients from the study groups with chronic infectious rhinitis – 7, with chronic atrophic rhinitis – 6, with chronic allergic rhinitis – 5, with chronic vasomotor rhinitis – 3. Patients with chronic rhinitis showed a decrease in quality of life across all compared indicators: physical (in all groups) and psychological (in chronic atrophic rhinitis) health components were impaired. A direct correlation (r=0.83; p=0.001) was established between the quality of life and the number of disturbances in the LPO-AOD system, with the most significant decrease in quality of life found in patients from the study groups with chronic infectious rhinitis with the maximum imbalance in the LPO-AOD system.Conclusion. The quality of life of patients is an important health indicator that depends on the disease phenotype and the performance of the LPO-AOD system. Identifying potential mechanisms for the formation of quality of life as an indicator with a predominantly subjective character under the conditions of an objectively existing disease presents a promising approach for defining measures aimed at improving the quality of life.

The importance of quality of life issues in health care practice and research is steadily growing. This growing interest fits into the definition of health as proposed by the World Health Organization (WHO) in 1948 (1). The WHO defines health as 'a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity'. The attention to health-related quality of life is reflected in the increase in the use of quality-of-life evaluation as a technique of clinical research since 1973, when only five articles listed 'quality of life' as a reference key word in the Medline data base; during the subsequent five-year periods there were 195, 273, 490, and 1252 such articles (2). Also in the field of allergy it has been recognized that allergic disease comprise more than the classical signs and symptoms being part of physical disorders such as allergic rhinitis, asthma and the atopic eczema/dermatitis syndrome (AEDS) (3). In the last decades an increasing effort has been made to understand the socioeconomic burden of atopic disease in terms of effects on health-related quality of life (HRQL) and healthcare costs. It has been acknowledged in several consensus reports that rhinitis and asthma are associated with impairments in the patients' functioning in day-to-day life at home, at work and at school 4-8). With the introduction of questionnaires designed to measure asthma- 9-11) and rhinitis-associated impairments of quality of life (12) it is clear that patients may be bothered by sleep disorders, emotional problems, impairment in activities and social functioning. Also, in general terms, patients with asthma (13) and allergic rhinitis (14) are impaired in their physical and mental functioning, including vitality and the perception of general health. From daily medical practice it can be easily understood that AEDS has a major impact on HRQL. In a way, the use of questionnaires focused on skin disease 15-17) formally confirms this association. Quality of life, QOL, has divergent meanings for different people. Also, HRQL may be considered as ill-defined. More agreement has been reached about the four domains of QOL which are considered to be important: 1) physical status and functional abilities; 2) psychological status and well-being; 3) social functioning; 4) economic and/or vocational status and factors ( 18 ). As the true quality of life value cannot be measured directly, researchers and clinicians have to resort to series of questions (items) to measure this construct indirectly. Combinations of items yield scores referring to physical, mental and social domains. An HRQL instrument must meet several criteria. It should address each component (symptom, condition) that is important to the patient. Attributes of an instrument are described in Table 1. It will be clear that the construction of quality of life questionnaires is a complex task, drawing from the fields of clinimetrics, psychometrics and clinical decision-making (2). Differences in approach, for instance item selection using factor analysis vs the impact method which select items that are most frequently perceived as important by patients -- yields different questionnaires (19). In general two types of instruments, generic and specific, have been used in allergy research. Generic questionnaires measure physical, psychological and social domains in all health conditions irrespective of the underlying disease. A frequently used generic instrument is the Medical Outcomes Survey Short Form 36 (SF-36) (20). The SF-36 was developed as part of the Medical Outcomes Study and analyzes health status using 36 questions to measure nine different health dimensions. It has been used to characterize patients with asthma. Bousquet (13) compared the FEV1 and a clinical score of asthma severity for 252 asthmatic patients. There was a significant positive correlation between all nine quality of life domains of the SF-36 and the clinical score of Aas. Eight of the nine domains also correlated with the FEV1. Also in perennial rhinitis there was a significant impairment in eight of nine QOL dimensions in patients compared with healthy subjects (14). Furthermore, the SF-36 is used to evaluate the effects of a nonsedating antihistamine on quality of life. In this study all of the nine quality of life dimensions improved significantly after one and six weeks of cetirizine treatment compared with placebo (21). Other generic instruments that have been used in allergy research are the Sickness Impact Profile (SIP) (22) and the Nottingham Health Profile (NHP) (23). The 136 items in 12 categories of the SIP describe activities of everyday living. This instrument has been used to evaluate the effect of salmeterol on asthma (24). Salmeterol led to significant improvements over salbutamol on virtually all clinical outcomes. Although all four quality of life instruments used in this study showed the same trend in favor of salmeterol, only the disease-specific Asthma Quality of Life Questionnaire (AQLQ) and the Rating Scale utilities showed significantly greater improvement on salmeterol than on salbutamol. In severe AEDS it was shown, using the SIP, that cyclosporin improves quality of life significantly (25). In particular, the SIP has been used for comparison with disease-specific instruments (24, 26-28). The NHP, the only generic instrument derived entirely from lay people, has been used to validate a disease-specific instrument for patients with dermatitis and psoriasis (29). In asthma the NHP was not able to capture clinical improvement by treatment with pulmonary steroids (30). The latter observations underline the disadvantage that the generic instruments miss depth and therefore may not be responsive enough to detect changes in general health states in spite of important changes in disease-related problems (26). The advantage of generic instruments, however, is that the burden of illness across different disorders and patient populations can be compared. In a comparison between asthma and epilepsy the major finding was that children with epilepsy had a relatively more compromised quality of life in the psychological, social, and school domains (31. In contrast, children with asthma had a more compromised quality of life in the physical domain. These findings suggested that attention simply to seizure control in the clinical setting will not address the full range of quality of life problems in children with epilepsy. Specific instruments have been designed by asking patients what kind of problems they experience from their disease. Both the frequency and the importance of impairments are measured by means of the questionnaires. These instruments have the advantage that they describe the disease-associated problems of the patients. As stated above, they seem to be more responsive to changes in HRQL than do the generic instruments. Several instruments for patients with asthma have been developed. The Asthma Quality of Life Questionnaire of Juniper is focused on symptoms, emotions, exposure to environmental stimuli, and activity limitation (32). Modifications of this questionnaire have been published recently (33, 34). When using HRQL outcome in clinical trials, the question arises whether a change in HRQL is of clinical importance. For the AQLQ, which uses a seven-point scale, the minimal important difference of quality of life score per item is considered to be very close to 0.5 (35). A change of 1.0 in the score represents a moderate change and a change in score of greater than 2.0 represents a large change in HRQL. The minimal important difference as described by Juniper is based upon patient opinions. Measures such as the standardized response mean or the effect size can be used to standardize changes. These measures are based solely upon the distribution of the observed data, in particular upon the variance (36). Recently, it has been shown that both the SF-36 and AQLQ were able to characterize a group of patients with moderate asthma very well, whereas the AQLQ domains were found to have the best discriminative properties (37. The Asthma Quality of Life Questionnaire of Marks captures breathlessness, physical restrictions, mood disturbance and concerns for health (38). St. George's Respiratory Questionnaire (11) is designed for patients with asthma and chronic obstructive pulmonary disorder COPD. It can be applied in both reversible and fixed airway obstruction. In contrast to other questionnaires, the Living with Asthma Questionnaire (10) does not include impairments experienced as a direct consequence of asthma symptomatology. Other instruments are presented in Table 2. The properties of the most frequently used questionnaire are described in Table 3. Specific instruments have been developed for children and caregivers (Table 2). In addition, questionnaires have been constructed for different age-groups of patients with rhinitis (12, 39-41). A simple practical questionnaire technique for routine clinical use, the Dermatology Life Quality Index (DLQI) has been introduced to characterize patients with skin disorders (15). This instrument has been used to compare patients with psoriasis and dermatitis (42). Also versions for children are available: the Children's Dermatology Life Quality Index (CDLQI) and the Infant's Dermatology Life Quality Index (IDLQI) (16). Other questionnaires are the Skindex (43) the Dermatology-Specific Quality of Life (DSQL) (17) and the patient-generated Dermatology Quality of Life Scales (DQOLS) (44). Recently, a questionnaire has been developed to measure HRQL in patients with allergy to insect stings. Subsequently, this instrument has been used in the evaluation of venom immunotherapy (45). It appeared that venom immunotherapy resulted in a statistically and clinically significant improvement in HRQL. Both in clinical practice and in research physicians and investigators rely on physiological and objective measures, whenever possible. However in asthma an increase in FEV1 or a decrease in PC20 histamine or methacholine may occur without any improvement experienced by the patient. Medical intervention may improve physiologic measures, whereas for instance side-effects of drugs or the cumbersome aspects of subcutaneous immunotherapy may unfavorably influence day-to-day life and compliance with treatment. It has been put forward that the classical outcome variables may only partially characterize the disease of the patient. From that point of view it has been advocated to measure HRQL along with the conventional clinical indices (46). In line with this reasoning is the weak association between classical asthma measures and the outcome of HRQL questionnaires. Comparison between de AQLQ of Marks with asthma symptoms and lung function variables revealed that a change in AQLQ score was weakly correlated with change in symptom score (r = 0.37, 95% CI 0.04–0.64) and change in BHR (r = 0.38, 95% CI 0.06–0.64). The association with change in peak flow variability was weak (r = 0.12, 95% CI 0.26–0.47) (27). Similar observations have been reported by others 47-50). An interesting study shows that the mere presence of respiratory symptoms or a (gradually) reduced lung function is insufficient reason for patients to seek medical help. Subjects are more likely to consult their general practitioner once their quality of everyday life is affected or they experience variability in lung function (51). Also, rhinitis related quality of life appears to be moderately correlated to the more classical outcome variables used in clinical trials, such as daily symptom scores and nasal hyperreactivity (52). Another argument to use quality of life instruments lies in the headstart with respect to the knowledge of their validation, reliability and responsiveness compared to the common symptom scores or visual analogue scores (VAS) scales used at clinical trials. In the field of nasal allergy, validation or standardization of symptom scores has rarely been the subject of research. In asthma, even quite recently introduced measures, such as the number of symptom-free days, merit more attention in terms of standardization and validation (53). Other reasons to assess quality of life are conceivable. Measurement of quality of life can also be useful for screening purposes or for evaluation of therapy. Quality of life may be a determinant of effectiveness or efficacy of treatment. Moreover, its assessment might be relevant to striving for optimal decision-making. As the perception of patients is clearly important in the management of disease and patient compliance (Fig. 1), measurement of this 'dimension' by HRQL questionnaires in clinical trials may be justified. The emphasis on quality of life has sometimes resulted in a routine inclusion of HRQL questionnaires in clinical trials. The inclusion of such an instrument is valuable only if the changes can be interpreted by clinicians and contributes to optimal medical decision-making. In an editorial, criticism has been directed to the routine inclusion of such instruments when the structure of the evaluation and its rationale appears ill-defined (54). A model representing the relationships between clinical aspects of therapy, HRQL and factors influencing HRQL (adapted from Cramer and Spilker (17)). Generally in clinical trials the effect of treatment or intervention on HRQL runs parallel with the effect on conventional medical outcome measures. However, in some studies differences can be found. In a study evaluating the combined effect of steroids and antihistamines no differences were demonstrated between patients treated with antihistamine and steroids vs steroids alone in terms of quality of life, whereas for some patient-rated symptoms the combination turned out to be superior (55). In a large multicenter study comparing budesonide and fluticasone it was found that both drugs were equally effective in suppressing symptoms (56), although budesonide had a better effect on general quality of life (57). This might indicate that patients perceive differences not captured by conventional symptom scores. The reverse situation, i.e. significant effects on classical outcomes (symptom scores, medication use, peak flow or FEV1) without important change in two generic and two specific HRQL measures has been described in a study on the effect of formoterol, a long-acting α2-agonist, in mild to moderate asthmatic patients (58). The latter discrepancies can be explained by a limited performance of HRQL measures in mild asthmatic patients. Alternatively, it is possible that the minor changes in symptom scores and lung function due to the intervention are not perceived by patients as relevant. Moreover, patients with a chronic condition may adapt themselves to their disease. The strength of HRQL questionnaires, that is the patient-centred approach, is also one of its weaknesses. Perceptions of quality of life experienced by persons may shift in time. It is easy to understand that a dramatic personal accident or a serious disease will not only cause deterioration in quality of life but will eventually also influence the patient's values and internal standards. For instance, in a study of quality of life after radiotherapy for laryngeal cancer, a temporary deterioration of physical functioning and symptoms was reported, mostly caused by side-effects of treatment. Despite physical deterioration, there was an improvement of emotional functioning and mood after treatment, probably as a result of psychological adaptation and coping processes (59). It is possible also that in less dramatic circumstances, disease and treatments will induce shifts in perception due to changes in the patient's values. Such subjective changes in patients' perception are known as response shift. Socioeconomic status is an additional important independent factor influencing HRQL. In a recent study with asthmatic patients it was shown that socioeconomic status attributes to HRQL. More importantly, in this study it was difficult to separate out the unique effects of socioeconomic status and race/ethnicity (60). Recently, a significant relationship between the mental health of children with asthma and family functioning has been shown (61). These findings suggest that the domains comprising the HRQL of children with asthma are related to both disease and non-disease factors. Psychological functioning influences the burden of a specific disease. A study designed to assess the effects of depressive symptoms on asthma patients' reports of functional status and health-related quality of life revealed that asthma patients with more depressive symptoms reported worse health-related quality of life than asthma patients with similar disease activity, but fewer depressive symptoms (62). Interestingly, these findings were seen not only in generic (SF-36) but also in specific (AQLQ) instruments. This means that a disease-specific instrument may be also influenced by phenomena such as fear and depression. Finally, patients may either intentionally or unconsciously mask their symptoms or trivialize their diseases. They may tend to ignore or discount those problems which they believe are unrelated to their illness. Others may tend to give socially desirable answers. Response shifts and illusory mental health (63) are not easily captured with HRQL instruments, but they will certainly influence the outcome of a clinical trial, when HRQL is chosen as the primary endpoint. In summary, one has to realize that the translation of clinical effects of treatment into perceived and reported changes in quality of life finds a place at the integration level of the patient and this is, in a way, a black box which is not easy to assess (Fig. 1). For these reasons it is strongly recommended to use HRQL outcome measures in parallel with conventional physiological outcome measures. Asthma, allergic rhinitis and AEDS often coexist. The question to what extent concomitant allergic disease affects quality of life has infrequently been addressed. In a recent study the SF-36 questionnaire from 850 subjects recruited in two French centers participating in the European Community Respiratory Health Survey was evaluated. Both asthma and allergic rhinitis were associated with impairment in quality of life. However, 78% of asthmatics also had allergic rhinitis. Subjects with allergic rhinitis but not asthma were more likely to report problems with social activities, difficulties with daily activities as a result of emotional problems, and low mental well-being than subjects with neither asthma nor rhinitis. Patients with both asthma and allergic rhinitis experienced more physical limitations than patients with allergic rhinitis alone, but no difference was found between these two groups for concepts related to social/mental health (64). In another study focusing on asthma, rhinitis and AEDS, comprising 325 subjects allergic to house dust mites, it was found that patients did show impaired quality of life compared to irrespective of the of the atopic Patients with the of asthma did out in terms of physical In addition, asthma symptoms with a visual had a major effect on social functioning, emotional functioning and disorders, in patients with AEDS, appeared to be associated with physical functioning, social functioning, mental health and general health It is not only concomitant atopic disease that has an impact on quality of life. such as and and nasal may patients with rhinitis and asthma. the SF-36 and a quality of life measure it has been shown that HRQL is impaired and that may improve quality of life for patients that is a other specific instruments such as the Index and the have been The impact of on social life in children during the four of life is not easily can be by use of a specific which measures the quality of life is a chronic disease of the respiratory which is frequently associated with respiratory compared the HRQL in patients with nasal with those of patients with perennial rhinitis and healthy It appeared that nasal impaired HRQL more than perennial allergic rhinitis The impairment of HRQL was greater when nasal was associated with asthma In addition, of nasal symptoms, and pulmonary function were after the evaluation in patients with nasal These demonstrated that nasal treatment either with nasal steroids or significantly improved both nasal symptoms and QOL without significant changes in pulmonary may a if the or is in one particular disease. A recent study the effects of on the of QOL measures an analysis of data from clinical trials with asthma, and The study suggest that conditions significantly and patients' scores on generic QOL measures and of treatment whereas their influence on disease-specific QOL scores and of treatment effect is although not These findings have significant practical for the of true treatment control of and the of QOL trials. 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The of asthma and of asthma is increasing It has been that of asthma can be to of asthma at work more on the of of underlying asthma than on the of possible asthma. It can be that patients with asthma may have a more severe impairment in quality of life of the between work and disease. In a study designed to address this question a statistically significant difference was seen in the scores of the AQLQ from a group of patients with asthma and a control group of subjects with asthma of The mean difference in the score was on a of limitation or of the to limitation or all the at the of the patient with asthma The difference between both groups was other more generic instruments focused on detect more showed that both asthma and rhinitis work with asthma are less likely to be at those rhinitis is a more determinant of work effectiveness In the allergic rhinitis in school days, and reduced activity per These data are derived from persons allergic rhinitis in with persons medical treatment. These data indicate that allergic rhinitis may have an important impact on and Patients are bothered by with performance and at and and may and only disease but also may influence work It has been that of treated their allergic rhinitis with antihistamines at for per Patients these antihistamines are more likely to The of include and With the antihistamines these problems have been significantly reduced studies have the for treatment of allergic rhinitis, asthma and associated In asthma in the for an A comparison of asthma in developed suggested an burden from to per of the asthma were to direct medical For the it has been that the when allergic was the primary were in The when allergic was a to other disorders such as asthma and was at The of allergic asthma and rhinitis and concerns about health care the increasing interest for only does the efficacy of treatment have to be but also its In these studies measures must be in to across patient populations and for different It is, however, difficult to the generic SF-36 or disease-specific HRQL scores into For this utilities such as the have been which measure the value that patients themselves place on their health some utilities measure the value that on health are the and Health An advantage of utilities is their to life associated with different medical can easily be into instruments are mostly A recent rhinitis specific the has been developed as a patient outcome for clinical trials and for studies comparing medical treatments for rhinitis The same group introduced an asthma specific the Asthma Index Also, disease-specific versions of the and have been developed for patients with asthma The interest in quality of life for patients with allergy that allergy is by a significant socioeconomic the introduction of HRQL outcome measures physicians were that patients cannot be by physiological measures. In a way, HRQL outcome measures of the from the with which clinicians are in their day-to-day The of these in the HRQL questionnaires it possible to include the patient in clinical trials and the in this field will improve medical decision-making and management of disease. of these outcome measures in the evaluation and management of patients be the However, HRQL questionnaires are in the of being in terms of and introduction of of instruments of QOL data is based on the that there are no measurement in the of is an technique for and which measurement into An important of is that it of whether a model fits the observed With this it has been shown that some changes in the of the SF-36 are when it is applied to evaluation of QOL for patients with or disease and with experienced criticism has been the of instruments and the to the measurement of quality of life It has been that attention has to be to better for of and of measures, these instruments will be for use in clinical practice and for use as primary in clinical trials Also, in the field of allergy the number of outcome measures is growing. 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BackgroundThis study was conducted to assess the effect of comorbidity, ethnicity, occupation, smoking and place of residence on allergic rhinitis (AR), acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS).MethodsA GA2LEN (The Global Allergy and Asthma European Network) screening questionnaire was sent to a random sample of the Dutch population (n = 16700) in three different areas of the Netherlands.ResultsFifty percent (8347) of the questionnaires sent were returned. A total of 29% respondents (27–31% in different areas) met the criteria for AR, 18% (17–21%) for ARS and 16% (13–18%) for CRS. Risk factors for AR were itchy rash, eczema, adverse response after taking a painkiller, asthma, CRS and ARS. Moreover, the risk of AR was twice as low for full-time housewives/househusbands than for people with jobs. The risk of ARS or CRS was significantly higher in respondents with a doctor’s diagnosis of CRS, AR, itchy rash or smoking. The risk of CRS was also significantly higher in respondents with an adverse response after taking painkillers, active smoking or asthma. Caucasians are generally less likely to have AR or CRS than Latin-Americans, Hindustani and African-Creoles, and more likely to have ARS than Asian, Hindustani, Mediterranean and African-Creoles.ConclusionsThis study found shared and distinct risk factors for AR, ARS and CRS and therefore provides support for the belief that they have shared symptoms but are different diseases with different aetiologies.

Allergic Rhinitis and Its Impact on Asthma

RATIONALE Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) are two highly prevalent airway diseases in the United States. While the co-prevalence of CRS and asthma is well-recognized, little is known about the development of new-onset asthma in CRS, especially when taking into consideration the presence or absence of AR. Thus, we aimed to assess the impact of prior diagnoses of CRS and AR on the incidence of new-onset asthma within the United States utilizing a large, nationally representative electronic health record (EHR) database. METHODS The TriNetX Analytics U.S. Collaborative Network, a federated research platform that aggregates de-identified electronic health record data, was queried to create two cohorts of adult patients with an ICD-10 diagnosis of CRS and CRS with concurrent ARS between 2019-2024. These cohorts were then propensity score matched to controls without CRS and CRS only, respectively, based on demographics and comorbidities. The primary outcome was the risk of a new ICD-10 encounter diagnosis of asthma at 1, 2, and 5 year follow-ups. RESULTS Compared to patients without pre-existing CRS, patients with an ICD-10 diagnosis of CRS were significantly more likely to develop asthma at all timepoints: 1 year (aRR= 1.7, 95% CI 1.67,1.73, p<0.0001), 2 years (aRR= 1.7, 95% CI 1.68,1.73, p<0.0001), and 5 years (aRR= 1.58, 95% CI 1.56,1.60, p<0.0001). Similarly, patients with ICD-10 co-diagnoses of CRS and AR were significantly more likely to develop asthma than patients with CRS only: 1 year (aRR= 1.85, 95% CI 1.78,1.91, p<0.0001), 2 years (aRR=1.80, 95% CI 1.74,1.85, p<0.0001), and 5 years (aRR=1.70, 95% CI 1.65,1.74, p<0.0001). CONCLUSIONS This study demonstrates that CRS is associated with an increased risk of developing new-onset asthma, with this risk further amplified in patients who also have AR. The findings highlight the importance of recognizing CRS and AR as contributory factors in asthma development, underscoring the need for integrated management strategies for patients with these overlapping inflammatory airway diseases. Further studies are needed to examine whether addressing CRS and AR may help reduce asthma incidence and improve preventative care in the U.S.

Patient and parent oriented tools to assess health-related quality of life, activity of daily living and caregiver burden in SMA. Rome, 13 July 2019

Chronic rhinosinusitis (CRS) and allergic rhinitis are associated with functional limitations, but these impacts are not known on a population basis. Our objective was to epidemiologically determine functional limitations and workdays lost that are associated with CRS and allergic rhinitis in adults. The Medical Expenditure Panel Survey for calendar year 2007 was examined to identify cases of CRS and allergic rhinitis. Functional limitation variables for activity limitation, work limitation, social limitation, and cognitive limitation determined by the survey also were extracted. Using multivariate models adjusting for age, gender, race, ethnicity, education level, insurance status, geographic region, as well as the Charlson comorbidity index, incremental differences in workdays lost and these functional limitations were determined for patients with and without CRS and allergic rhinitis. Among 225.1 million adults, the prevalences of CRS and allergic rhinitis were 4.9 ± 0.2% and 7.9 ± 0.3%, respectively. Patients with CRS demonstrated an incremental 1.04 ± 0.3 workdays lost per year along with significant increased adjusted odds ratios for activity limitation (odds ratio, 1.54), work limitation (1.50), and social limitation (1.49, all p < .005) but not cognitive limitation (1.05, p = .213). Patients with allergic rhinitis demonstrated an incremental 0.60 ± 0.45 workdays lost along with significant increased adjusted odds ratios for activity limitation (1.42), work limitation (1.43), social limitation (1.47), and cognitive limitation (1.32, all p < .019). Both CRS and allergic rhinitis impart significantly increased odds ratios for activity, work, and social limitations. Allergic rhinitis also carries with it statistically significant odds of functional cognitive limitation. The total aggregate workdays missed in the United States may be estimated at 11.5 million workdays and 10.7 million workdays for CRS and allergic rhinitis, respectively.

This study was conducted to assess the relation between allergic rhinitis (AR), acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) and environment, comorbidity and ethnicity. A posted GA2LEN screening questionnaire was sent to all those in a random sample of Dutch population (n=16700) in three different areas. The prevalence of ARS is significantly related to AR, a doctor's diagnosis of CRS, urticaria, eczema, smoking, gender, ethnicity and age. The prevalence of CRS is significantly related to AR, a doctor's diagnosis of CRS, urticaria, adverse response to painkiller, smoking, ethnicity, asthma and age. The prevalence of AR is significantly related to a doctor's diagnosis of CRS, urticaria, eczema, adverse response to painkillers, smoking, occupation, ethnicity, asthma, age, CRS and ARS Some environmental factors, comorbidity and ethnicity are positively or negatively related to AR, ARS and CRS. Place of residence in the Netherlands is not related to the prevalence of these diseases.

Psychometric validation of the Standard Tests for Asthma, Allergic Rhinitis, and Chronic Rhinosinusitis in the United States.

Development of National Research and Clinical Agendas for Patient-Reported Outcomes in IR: Proceedings from a Multidisciplinary Consensus Panel

Rhinitis phenotypes correlate with different symptom presentation and risk factor patterns of asthma

Correlation of patient reported outcome measures with endoscopic findings in pediatric chronic adenoiditis and chronic rhinosinusitis