Abstract
Allergic rhinitis (AR) is sub-optimally managed in the community and is responsible for a significant health and economic burden. Uncontrolled AR increases the risk of poorly controlled asthma and presents an increased susceptibility to thunderstorm asthma. With the availability of treatments over-the-counter, bypassing the health care professional (HCP), the role of the patient is paramount. Research on the role of the patient in AR management in the current environment is limited. This study aims to explore the patient perspective of AR management and understand why it is sub-optimally managed in the community. Patient perspectives of AR management were explored utilizing a qualitative, phenomenological approach. Adults with AR were included in the study and interviewed. Transcripts were analyzed for recurrent themes and emergent concepts. Forty-seven participants with AR were interviewed about their experiences. Patient reports of delayed diagnosis, treatment fatigue and confidence in the ability to manage their AR themselves, heavily influenced their management preferences. Patients also described barriers associated with AR management including financial expense as well as being mistaken for having an infectious disease. Patients described examples of the impact on their quality of life caused by their AR, yet they strongly believed they could manage it themselves. This belief that AR is a condition that should be entirely self-managed, contributes to its burden. It amplifies patients’ separation from HCPs and having access to guidelines aimed at optimizing their AR control.
Highlights
In 2014-2015, allergic rhinitis (AR) affected 4.5 million i.e., 19% of Australians, becoming the most prevalent respiratory condition in the mid-teenage years; peaking in working aged adults.[1]
Its prevalence and poor control is of worldwide concern.[2,3,4,5,6,7]. The burden of this highly prevalent respiratory condition, while often trivialized, is staggering, with uncontrolled AR impacting on the quality of life (QOL), work productivity, school performance, social interactions driving ability and sleep[8,9,10] of those who suffer from the condition
In Australia, the burden of AR has recently been highlighted as a consequence of a fatal “Thunderstorm Asthma” event.[11,12]
Summary
In 2014-2015, allergic rhinitis (AR) affected 4.5 million i.e., 19% of Australians, becoming the most prevalent respiratory condition in the mid-teenage years; peaking in working aged adults.[1]. In Australia, the burden of AR has recently been highlighted as a consequence of a fatal “Thunderstorm Asthma” event.[11,12] During this event, an unprecedented, unexpected demand was made on health care facilities by people in respiratory distress, 90% of which had a history of AR.[13,14] Questions arose about how such a fatal event could have been avoided, given the availability of comprehensive, evidence-based guidelines both for the treatment of AR and asthma.[15,16,17,18,19]
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