Allergic Rhinitis Control Research Articles

MP‐AzeFlu provides rapid and effective allergic rhinitis control: results of a non‐interventional study in Denmark

Allergic rhinitis (AR) control is a priority in the European Union (EU), and Allergic Rhinitis and its Impact on Asthma (ARIA) has endorsed a visual analogue scale (VAS) as the new language of AR control. This study evaluated the effectiveness of MP-AzeFlu (Dymista®, antihistamine [azelastine], and intranasal corticosteroid [fluticasone propionate]) using a VAS in real-life clinical practice in Denmark. The multicenter, prospective, non-interventional study included 170 patients (≥12 years) with ARIA-defined moderate-to-severe AR prescribed MP-AzeFlu. Patients assessed symptom severity using a VAS (0 to 100 mm) on days 0, 1, 3, and 7 and after ∼14 days of MP-AzeFlu use. On day 3, patients assessed their disease as well controlled, partly controlled, or uncontrolled. Proportions of patients achieving VAS score cutoffs (well-controlled, partly controlled) were also calculated. MP-AzeFlu reduced mean ± standard deviation VAS score from 67.1 ± 19.3 mm at baseline to 28.4 ± 23.7 mm on the last day, a reduction of 38.8 ± 27.3 mm. At day 3, 85.6% of patients considered their symptoms to be partly or well controlled. Effectiveness was consistent across disease severity, phenotype (seasonal, perennial, or combined AR), and patient age. Respectively, 28.2%, 44.2%, 61.6%, and 71.4% of patients achieved ≤38 mm well-controlled VAS score cutoff on days 1, 3, and 7, and the last day. MP-AzeFlu provided effective, rapid, and sustained symptom control in a real-life setting among patients from Denmark. These results align with EU and ARIA objectives and support the effectiveness of MP-AzeFlu for the treatment of AR in real life.

ОЦЕНКА ЭФФЕКТИВНОСТИ И БЕЗОПАСНОСТИ ПРИМЕНЕНИЯ ПРЕПАРАТА АКВА МАРИС® ЭКТОИН (ANS01) НАЗАЛЬНЫЙ СПРЕЙ В ТЕРАПИИ АЛЛЕРГИЧЕСКОГО РИНИТА У БЕРЕМЕННЫХ ЖЕНЩИН

The prevalence of allergic diseases is increasing: according to recent data, about 20% of the worlds' population suffers from allergic rhinitis. About 30% of the reproductive age women are known to suffer from allergic rhinitis, and in a third of cases, symptoms of allergic rhinitis increase during pregnancy. Allergic inflammation is the result of contact with a causative allergen and elimination of causative allergens is not always possible. The creation of a protective barrier preventing the adhesion of allergens on the surface of the nasal mucosa reduces the penetration of allergens and helps control allergic rhinitis. Aqua Maris® Nasal Spray Ectoin is a completely natural remedy that creates a physical barrier (“barrier”) for attaching allergens to the nasal mucosa and prevents the development of allergic rhinitis. Aqua Maris® Ectoin can be used for allergic rhinitis treatment in pregnant and nursing women. Non-comparative open-label trial investigating the efficacy and safety of the Aqua Maris® Nasal Spray Ectoin was carried out from September to June 2019 at the Center of early diagnosis of allergic diseases in women of childbearing age Pavlov First Saint Petersburg State Medical University. The study included 45 pregnant women with allergic rhinitis. Clinical efficacy was evaluated by the severity of clinical symptoms and rhinoscopic data of patients in dynamics during treatment. As a result of the use of Aqua-Maris Ectoin in pregnant women, a significant reduction in complaints on the 10th day of therapy and a decrease in inflammatory phenomena in the nasal cavity were observed. In addition, a significantly significant decrease in secretory nasal IgE was noted. This indicates the effectiveness of the Aqua Maris® Nasal Spray Ectoin in the treatment of allergic rhinitis in pregnant women. Adverse events associated with the use of Ectoin Aqua Maris® Nasal Spray in pregnant women were not detected. Aqua Maris® Nasal Spray Ectoin can be used for effective and safe treatment of allergic rhinitis in pregnant women.

Prospective observational study validating the German version of the Control of Allergic Rhinitis and Asthma Test (CARAT10)

The Control of Allergic Rhinitis and Asthma Test (CARAT10), developed by Portuguese experts, is the only questionnaire assessing asthma control under additional consideration of a frequently concurrent allergic rhinitis (AR), providing sub-scores for both diseases. Aims of this study were the translation and validation of its German version. Asthma patients both with and without AR were included at three primary care pulmologists´ practices in Southern Germany. After translation process, patients completed the CARAT10, the Asthma Control Questionnaire (ACQ), the Asthma Control Test (ACT), and the Standardised Asthma Quality of Life Questionnaire (AQLQ(S)). Item and scale characteristics as well as measures of reliability and validity of the CARAT10 were determined. A confirmatory factor analysis was conducted to test factorial validity. Data of 213 patients were analysed, 101 (47%) of them with concurrent AR. Missing responses were minimal and unsystematic. Cronbach´s α was 0.87 for the CARAT10 total score (TS) and 0.84 for each sub-score. Spearman´s correlation coefficients for the association of the CARAT10 TS with ACQ, ACT and AQLQ(S) were moderate to high and slightly higher in patients with AR. Higher correlations were found for its lower airway sub-score than the upper airway sub-score (all around 0.8 to all around 0.3). Confirmatory factor analysis confirmed the two-factorial scale structure of the CARAT10, with a two-factor model showing a better fit to the data than a one-factor model. The German version of the CARAT10 is an acceptable, reliable and valid tool. Our results suggest a recommended use in asthma patients with AR.

Validity and the reliability of the Turkish version of the control of allergic rhinitis and asthma test for children (CARATKids)

Aim: Asthma occurs in association with allergic rhinitis. Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) is a questionnaire to assess control of both diseases. The aim of this study was to assess the validity and reliability of the CARATKids in Turkish children aged 6–12 years. Methods: After a cultural adaptation process, children with asthma and allergic rhinitis were recruited. CARATKids, childhood Asthma Control Test, total nasal symptom score, visual analog scale scores for asthma and rhinitis, peak nasal inspiratory flow and peak expiratory flow values were obtained at baseline and after 4–6 weeks. The patients were classified according to the control level for asthma and rhinitis and stable/unstable groups. Discriminative properties, internal consistency, test–retest reliability, responsiveness, validity and minimal clinically important difference (MCID) were assessed. Receiver operating characteristic curve analysis was performed. Results: About 174 patients were included. The Cronbach’s alpha was 0.841. Correlation coefficients between CARATKids and external measures of control were 0.42–0.77, and between the score changes of CARATKids and external measures of control it was 0.56–0.78. Guyatt’s responsiveness index was −1.88, within-patient change of CARATKids score was significant. The intra-class correlation coefficient was 0.973. The MCID was 4. A cutoff score of ≤5 on the CARATKids had a sensitivity of 100% to distinguish the controlled groups according to both the GINA and ARIA. Conclusion: CARATKids is a reliable and valid tool to assess asthma and allergic rhinitis control in Turkish children. A score of ≤5 on CARATKids defines controlled disease for both diseases simultaneously.

Lower airway flow influences peak nasal inspiratory flow in school-aged children.

Rhinitis and asthma frequently coexist. Peak nasal inspiratory flow (PNIF) objectively evaluates nasal obstruction. Lower airway flow's impact on PNIF has seldom been analysed in children. We aimed to study the associations between PNIF and: 1)forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) in children with allergic rhinitis and asthma and healthy controls; 2)allergic rhinitis and asthma control subjective evaluation. Sequential assessments of PNIF before and after nasal decongestion and spirometry with bronchodilation test were performed in 65 children (6-12 years) with allergic rhinitis and asthma, and 24 gender, age-matched healthy controls. The Control of Allergic Rhinitis and Asthma Test in children (CARATkids) was used for control assessment. Associations were investigated by multiple linear regression models. Baseline and decongested PNIF correlated with baseline and post-bronchodilation FEV1 and PEF, observed independently of rhinitis and asthma diagnosis. The best model for PNIF included PEF, age and gender. No association was found between PNIF and CARATkids scores, except for nasal obstruction self-report. In school-aged children, besides age and gender, PEF values should ideally be known to interpret PNIF values. PNIF can be complementary to subjective control assessment in children with allergic rhinitis and asthma.

The Allergic Rhinitis Control Test Questionnaire Is Valuable in Guiding Step-Down Pharmacotherapy Treatment of Allergic Rhinitis

Allergic Rhinitis Control Test (ARCT) has been validated in the allergic rhinitis (AR) step-up pharmacotherapy management approach. The aim of our study was to evaluate the potential of ARCT in AR step-down pharmacotherapy. In an open-labeled randomized controlled study, patients with AR controlled with intranasal corticosteroid (INS) plus antihistamine (step 4) were included and randomized into an ARCT or a control group. In the ARCT group, the patients were followed up every 15 days; if the ARCT score was ≥20 (controlled AR), the patient would step down to step 3 (INS), step 2 (daily antihistamine), step 1 (antihistamine as needed), and step 0 (no medication) consecutively; if the ARCT score was strictly <20, the treatment would not be adjusted. In the control group, patients would be treated with step 4 medications during the whole study. Rhinitis Quality-of-Life Questionnaire (RQLQ), Morisky Questionnaire, and Brief Illness Perception Questionnaire (B-IPQ) were completed at baseline and the end of the study. Medication use and side effects were recorded. A total of 255 patients with AR were enrolled into the study; 27 patients dropped out. The control rates at day 45 were 77.8% in the ARCT group and 85.8% in the control group (P>.05). The ARCT group had less mean medication use than the control group (INS 1.27 vs 2.22 bottle, antihistamines 35.9 vs 61.4 tablets) (P < .05). RQLQ, Morisky, and B-IPQ score were significantly improved in both groups after treatment (P < .05). Stepping down AR medications in controlled patients led to similar clinical outcomes at reduced cost compared with those who maintained their current treatment level. ARCT is an optimal tool for evaluating the step-down eligibility.

The “one airway, one disease” concept in light of Th2 inflammation

Introduction A pathophysiological continuum was described between nose and bronchus in allergic respiratory diseases. Nasal epithelium brushings are routinely used in clinical practice to diagnose airway diseases in infants, but no study as directly compared gene expression profiles of nasal and bronchial epithelium in a same individual. In this study, we assessed whether bronchial Th2 status, a clinical marker of asthma, can be correctly recapitulated from nasal epithelium, to validate nasal sampling as good surrogates of the bronchi. Methods Thirty-nine patients with allergic rhinitis and asthma (AR, n = 12), isolated allergic rhinitis (R, n = 14) and healthy controls (C, n = 13) were included. Nasal and bronchial cells were collected by brushings. Cellular composition of samples was assessed by flow cytometry. Gene expression was analyzed by RNA-seq. Th2, Th17 and interferon (IFN) signatures compatible for studies of bronchial and nasal epithelia were derived from the literature. For each inflammation signature, z-scores of gene expression were calculated for each gene, and a patient was considered to have high level of inflammation when 75 % of the markers from the signature had a z-score > 0. Results A high level of PMN cells infiltration in nasal samples excluded 30 % of the initial cohort. A signature of 63 transcripts strongly distinguished nasal and bronchial brushings, regardless of their pathological status. Concordance of Th2 status assessment between nose and bronchi was poor, with 71 % concordance in AR and 60 % in R only. Of note, 4/10 R patients had a Th2-high signature in bronchi correlating with asthma history in childhood. Even if most AR patients were correctly predicted based on their nasal gene expression profiles, we observed that nasal cells can hardly be considered as reliable surrogate because of the influence of the Th17 and IFN responses. IFN response in particular was found more frequently elevated in the nose than in the bronchi. IFN and Th17 responses were correlated together, but not with Th2 response. Th2 scores correlated with mastocyte counts and numbers of sensitizations. Th17 score was correlated with PMN counts. Conclusion The large variability of cell composition of nasal brushings and the types of inflammation present in this part of the airways restrict its use as a surrogate to assess bronchial Th2 inflammation in asthmatic patients.

A Three-Year Course of House Dust Mite Sublingual Immunotherapy Appears Effective in Controlling the Symptoms of Allergic Rhinitis.

Background Allergic rhinitis is the most common allergic disorder. Although the management of the disease is successful in many patients, based on guidelines, some of them remain with symptoms uncontrolled with pharmacotherapy. Presently, there is no substantiated information on the control of allergic rhinitis in patients who underwent sublingual immunotherapy. Objective The purpose of this prospective follow-up study was to assess the control of allergic rhinitis in adults after a three-year course of house dust mite sublingual immunotherapy. Methods This prospective real-life study was designed to include adults with moderate to severe allergic rhinitis sensitized to house dust mite who underwent a three-year course of sublingual immunotherapy. Control of symptoms was assessed by Rhinitis Control Assessment Test (RCAT) after three years of house dust mite sublingual immunotherapy. Additionally, patients assessed their symptoms by utilizing a visual analog scale. Results A total number of 86 consecutively enrolled patients (46 (53.49%) men; mean age 26.10 years (SD = 5.85)) with moderate to severe allergic rhinitis and clinically relevant sensitization to house dust mite were evaluated. When assessed by RCAT on the third year, 74 (86.05%) had well-controlled symptoms and 20 (27.03%) of them were completely controlled. A significant reduction in visual analog scale scores-from 7.52 cm at baseline to 2.31 cm-was established ( P < 0.0001). There was a strong negative correlation between RCAT scores and visual analog scale (r = -0.65; P < 0.01). Conclusion This study provided evidence that a three-year course of house dust mite sublingual immunotherapy appears effective in controlling the symptoms of allergic rhinitis.

MP-AzeFlu provides rapid and effective allergic rhinitis control: results of a non-interventional study in Romania.

Allergic Rhinitis and its Impact on Asthma (ARIA) and the European Union (EU) recommend a shift to guide allergic rhinitis (AR) treatment decisions from symptom severity to disease control, using a simple visual analogue scale (VAS). Using this VAS we assessed, in a real-life study in Romania, the effectiveness of MP-AzeFlu nasal spray. In this multi-centre, prospective, non-interventional study, 253 patients (over 11 years old) with moderate-to-severe AR were prescribed MP-AzeFlu and assessed their symptoms on a VAS (0 (not at all bothersome) to 100 mm (very bothersome)) on Days 0, 1, 3, 7 and 14. The proportion of patients who achieved a defined VAS score cut-off for well-controlled (38 mm) AR were also calculated. Patients perception of disease control was assessed on Day 3. MP-AzeFlu use was associated with a mean (standard deviation) VAS score reduction from 78.4 (15.1) mm at baseline to 14.7 (15.1) mm on the last day. Effectiveness was consistent irrespective of disease severity, phenotype or patient age. 83.4% of patients achieved the smaller than 39 mm well-controlled VAS score cut-off by last day and 95.2% considered their symptoms to be well- or partly controlled at Day 3. MP-AzeFlu provided rapid, effective and sustained AR symptom control in a real-life setting in Romania, irrespective of severity, phenotype or patient age, aligning with ARIA and EU recommendations and supporting the position of MP-AzeFlu as the drug of choice for the treatment of moderate-to-severe AR.

The control of allergic rhinitis in real life: a multicenter cross-sectional Italian study

BackgroundAllergic Rhinitis (AR) is a high-prevalence disease. In Europe about 25% of the general population is affected, and in Italy the prevalence is estimated to be 19.8%. The Allergic Rhinitis and its Impact on Asthma (ARIA) international document underlined that the prevalence of severe or refractory or overlapping rhinitis is increasing and represents a non-negligible socio-economic burden. In general, despite the social healthcare costs, allergic rhinitis remains underestimated, not sufficiently controlled and often undertreated.Aim of the studyIn this multi-center Italian observational and prospective study we assessed the control of AR in patients (> 16 years) without previous asthma diagnosis, referred to Allergy Centers.MethodsPatients of both sexes and older than 16 with rhinitis symptoms and without asthma were studied. A Visual Analogue Scale (VAS) and the CARAT (Control of Allergic Rhinitis and Asthma Test) were used as patient reported outcome. The possible causes of poor control of AR, as per protocol, were assessed accordingly.ResultsWe observed 250 patients in a real-life setting: more than 60% of them had an uncontrolled AR, only about 50% used multiple medications, and only a minority were receiving allergen immunotherapy.ConclusionThis survey, conducted in a real-life setting, confirmed that AR is overall poorly controlled. The VAS assessment well correlates with the structured CARAT questionnaire and with the relevant symptoms of AR.

Onset of action for loratadine tablets for the symptomatic control of seasonal allergic rhinitis in adults challenged with ragweed pollen in the Environmental Exposure Unit: a post hoc analysis of total symptom score

BackgroundLoratadine is a second-generation, non-sedating antihistamine used for the relief of allergic rhinitis symptoms. Previous studies reported that when loratadine was encapsulated, the onset of action for symptom relief was 180 min. However, unmodified loratadine tablets were not evaluated at that time. Using data from a previously published Environmental Exposure Unit (EEU) study comparing azelastine nasal spray with loratadine tablets, cetirizine tablets, and placebo, this post hoc analysis determines the onset of action of loratadine tablets (i.e. unmodified) by analyzing the total symptom score for the relief of nasal and ocular seasonal allergic rhinitis (SAR) symptoms.MethodsA Phase IV, randomized, single-center, double-blind, placebo-controlled, double-dummy, four-way crossover study was conducted in the EEU. Seventy participants were randomized sequentially into one of the four treatments during ragweed pollen exposure. Nasal and ocular symptom scores were self-reported by the participants and recorded. The original study analysis was carried out by evaluating the nasal symptom scores only. For this post hoc analysis, both nasal and ocular data from the loratadine and placebo treatment arms were analyzed. The primary endpoint for this analysis was the onset of action of loratadine as measured by the change in total symptom score (TSS) from baseline in comparison to placebo. The onset of ocular symptom relief using the total ocular symptom score (TOSS) was also reported.ResultsLoratadine tablets demonstrated a significant and durable improvement in both TSS (P = .005) and TOSS (P = .013) at 75 min post-treatment administration compared to placebo. The mean proportion of participants reporting none or mild for all component symptoms of TSS and TOSS at 75 min and thereafter was significantly higher in the loratadine (TSS, P = .0005; TOSS, P ≤ .0001) vs. placebo treatment arm.ConclusionsThe onset of action of loratadine tablets was 75 min for the relief of nasal and ocular symptoms in adults with SAR. These results suggest a faster onset of action for loratadine tablets (75 min) compared to previously reported studies which were conducted with modified (i.e. gelatin-encapsulated) loratadine tablets (180 min).Trial registration Clinicaltrials.gov identifier NCT00561717

Assessing patient-reported outcomes in asthma and COPD patients: which can be recommended in clinical practice?

There is a clear need for simple and reliable patient-reported outcome measures for chronic obstructive pulmonary disease (COPD) and asthma in daily practice. The purpose of this review is to facilitate the choice for clinicians of patient-reported outcomes which they can use in their daily practice. More than 50 patient-reported outcome measures for asthma and COPD exist and clinicians are often left confused on which to use. Four tools (two for asthma and two for COPD) can be suggested based on validity/reliability, responsiveness, practicality and are particularly convenient in terms of time to measure. On the basis of ample evidence, the COPD assessment test and the clinical COPD questionnaire for COPD and asthma control questionnaire and the asthma control test for asthma can be recommended for use in both primary care and other clinical settings. A simple guide figured as smiley faces has been designed to assist physicians to easily select the appropriate measure. With the current direction of thinking into treatable traits, targeted measures that evaluate the upper airways like the control of allergic rhinitis and asthma test may also be more used in the future.

The Allergic Rhinitis and its Impact on Asthma (ARIA) score of allergic rhinitis using mobile technology correlates with quality of life: The MASK study.

Mobile technology has been used to appraise allergic rhinitis control, but more data are needed. To better assess the importance of mobile technologies in rhinitis control, the ARIA (Allergic Rhinitis and its Impact on Asthma) score ranging from 0 to 4 of the Allergy Diary was compared with EQ-5D (EuroQuol) and WPAI-AS (Work Productivity and Activity Impairment in allergy) in 1288 users in 18 countries. This study showed that quality-of-life data (EQ-5D visual analogue scale and WPA-IS Question 9) are similar in users without rhinitis and in those with mild rhinitis (scores 0-2). Users with a score of 3 or 4 had a significant impairment in quality-of-life questionnaires.

Transfer of innovation on allergic rhinitis and asthma multimorbidity in the elderly (MACVIA-ARIA) - EIP on AHA Twinning Reference Site (GARD research demonstration project).

The overarching goals of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) are to enable European citizens to lead healthy, active and independent lives whilst ageing. The EIP on AHA includes 74 Reference Sites. The aim of this study was to transfer innovation from an app developed by the MACVIA-France EIP on AHA reference site (Allergy Diary) to other reference sites. The phenotypic characteristics of rhinitis and asthma multimorbidity in adults and the elderly will be compared using validated information and communication technology (ICT) tools (i.e. the Allergy Diary and CARAT: Control of Allergic Rhinitis and Asthma Test) in 22 Reference Sites or regions across Europe. This will improve the understanding, assessment of burden, diagnosis and management of rhinitis in the elderly by comparison with an adult population. Specific objectives will be: (i) to assess the percentage of adults and elderly who are able to use the Allergy Diary, (ii) to study the phenotypic characteristics and treatment over a 1-year period of rhinitis and asthma multimorbidity at baseline (cross-sectional study) and (iii) to follow-up using visual analogue scale (VAS). This part of the study may provide some insight into the differences between the elderly and adults in terms of response to treatment and practice. Finally (iv) work productivity will be examined in adults.

The association between allergic rhinitis control and sleep quality

Allergic rhinitis (AR) is the most common form of atopic disease, comprising 50% of atopic diseases. Recently, this disease has increasingly been the focus of intensive research. Previous work has shown that AR has asignificant impact on sleep quality. To date there are no published studies demonstrating aquantitative association between the extent of control of AR and the severity of compromised sleep quality. Patients with AR were prospectively recruited into our cross-sectional study. Sleep quality was assessed using five of the sleep subdomain questions from the 22-item Sinonasal Outcome Test (SNOT-22). Control of AR was assessed using the Rhinitis Control Assessment Test (RCAT). Association was sought between the degree of allergic rhinitis control (RCAT) as independent variable and sleep quality as dependent variable using linear regression. A total of 104 patients (54.8% female and 45.2% male) with an average age of 41.4years (SD: 15.9years) were included in the study. There were statistically significant associations between the RCAT score and the score of each of the five SNOT-22 questions used to assess decreased sleep quality (p< 0.001). These associations remained significant (p< 0.001) even after controlling participants' clinical and demographic characteristics. This is the first study showing that level of control of AR correlates with the severity of subjectively perceived sleep quality detriment. These results indicate that an improvement in AR control could lead to improved subjective sleep quality but aprospective interventional study is needed to confirm these results.

Use of the Control of Allergic Rhinitis and Asthma Test and pulmonary function tests to assess asthma control in pregnancy.

Asthma is one of the most prevalent chronic medical conditions to complicate pregnancy. Similarly, active management strategies that prioritise asthma control in this vulnerable population can have a far-reaching impact. To describe lung function parameters and results of the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaire in pregnant asthmatics and to analyse correlations between lung function tests and CARAT results. All pregnant asthmatics who performed spirometry and CARAT between September 2014 and August 2015 were included. A medical records review was performed and data regarding demographics, sensitisation and medical prescriptions were recorded. Control of asthma and rhinitis was defined by CARAT total score (CARAT (T))≥24; upper airways (U) control if CARAT (U)>8; lower airways (L) control if CARAT (L)>15. Forty-two pregnant asthmatics were included, with a median age (interquartile range)of 32 (27-34) years; all had a previous medical diagnosis of asthma and rhinitis, 76% were atopic, 94% sensitised to dust mites and 43% were polissensitised. More than 80% presented poor control (CARAT (T)<24) in the first assessment and 15% had a percentage forced expiratory volume in the first second <80%. There were significant negative correlations between CARAT (L) and CARAT (T) scores and step-up of controller medication, (correlation coefficients =-0.453 and -0.392, respectively). The use of tools such as spirometry and validated questionnaires to objectively assess asthma control during pregnancy should be routinely applied to assist in the management of these patients. These data reinforce the importance of close monitoring of pregnant asthmatics to achieve and maintain better disease control.

Self-management research of asthma and good drug use (SMARAGD study): a pilot trial

Background Community pharmacists play an important role in supporting patients for optimal drug use. Objective To assess the effectiveness of monitoring in asthma patients with inhaled corticosteroids (ICS) on disease control. Setting Asthma patients using ICS were invited from two intervention (IG) and two control pharmacies (CG). Method Participating patients completed questionnaires at the study start and at 6-month follow-up, including the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaire. IG patients completed the CARAT questionnaire every 2 weeks and received counselling on disease management, ICS adherence, and inhalation technique when scores were suboptimal, deteriorating, or absent. For Turbuhaler users, additional electronic monitoring (EMI) was available, with daily alerts for ICS intake. Main outcome measure As the primary outcome, CARAT scores at follow-up were compared between IG and CG using linear regression. As secondary outcome, refill adherence was compared using logistic regression. Results From March to July 2015, we enrolled 39 IG and 41 CG patients. At follow-up, CARAT scores did not differ between IG and CG (−0.19; 95% confidence interval [CI], −2.57 to 2.20), neither did patient numbers with ICS adherence >80% (0.82; 95% CI, 0.28–2.37). Among EMI users, CARAT scores did not differ, but ICS adherence >80% showed a 4.52-fold increase (95% CI, 1.56–13.1) compared with EMI nonusers. Conclusion Among community-dwelling asthma patients, pharmacist monitoring did not affect CARAT scores, but EMI use showed improved ICS refill adherence.

ОСОБЛИВОСТІ ПЕРЕБІГУ ТА ЛІКУВАННЯ АЛЕРГІЧНОГО РИНІТУ У ВАГІТНИХ

Мета дослідження – розгляд особливостей клінічної картини, перебігу, терапії та профілактики сезонного алергічного риніту у вагітних жінок.Матеріали та методи. Проведено огляд наукової літератури вітчизняних та зарубіжних авторів і видань у медичній бібліотеці Закарпатського обласного медичного інформаційно-аналітичного центру, оглянуто та проаналізовано джерела Інтернету.Результатидослідження та їх обговорення. У статті розглянуто причини виникнення сезонного алергічного риніту у вагітних жінок, зазначено особливості його перебігу. Також показано вплив алергічного риніту на вагітність та плід, можливі ускладнення та наслідки даного захворювання. Наводяться особливості лікування алергічного риніту під час вагітності, розглядаються питання, що пов’язані з діагностикою та вибором лікарського засобу з урахуванням ступеня потенційної небезпеки препаратів для вагітної та майбутньої дитини. Проаналізувавши дані літературних джерел, авторами статті було виявлено, що від сезонного алергічного риніту страждає близько третини жінок репродуктивного віку, що підкреслює актуальність та наукову значимість даної теми. При вагітності симптоматика захворювання дещо змінюється, що утруднює його діагностику. В статті розглядається питання щодо терапії сезонного алергічного риніту у вагітних, особливістю якої є те, що під час призначення медикаментозної терапії вагітним потрібно керуватися класифікацією категорій ризику призначених препаратів (класифікація FDA).Висновок. Вагітні з алергічним ринітом потребують динамічного спостереження, адекватного лікування, контролю і оцінки ефективності призначеної терапії. Рекомендується проведення консиліуму у складі алерголога-імунолога, акушера-гінеколога, а при необхідності й інших спеціалістів, для визначення тактики лікування та профілактики загострень алергічних захворювань при вагітності. Незначна кількість праць та видань з даної теми свідчить про те, що дослідженням особливостей перебігу, діагностики, лікування та профілактики алергічних захворювань під час вагітності майже не займаються ні акушери-гінекологи, ні алергологи. Оскільки ряд серйозних ускладнень даного захворювання може призвести до негативного впливу як на організм матері, так і дитини, тому питання розробки способів профілактики та безпечної і ефективної терапії є дуже важливим і може значно покращити якість життя. Ось чому для збереження здоров’я майбутньої матері і народження здорової дитини є необхідними знання про перебіг алергічного риніту у вагітних і причини його виникнення. Адже це дасть можливість правильно проводити підготовку, спостереження та лікування хворих на всіх строках вагітності.

Control of Allergic Rhinitis and Asthma Test for Children (CARATKids): Validation in Brazil and cutoff values

BackgroundThe Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) assesses asthma and allergic rhinitis control in children younger than 12 years. ObjectiveTo validate the Brazilian Portuguese version of the CARATKids and to define the cutoff values for identifying uncontrolled disease. MethodsChildren aged 6 to 12 years with asthma and allergic rhinitis were studied (n = 102). CARATKids, childhood Asthma Control Test (cACT), total nasal symptom score (TNSS), and visual analog scale (VAS) scores were obtained at baseline and after 4 to 6 weeks. Internal consistency, test-retest reliability, responsiveness, and validity of the Brazilian CARATKids were assessed according to the Consensus-based Standards for the Selection of Health Measurements Instruments checklist. The minimal clinically important difference (MCID) was evaluated using distribution and anchor methods. Spearman correlations were used to compare CARATKids scores with external measures of control. Receiver operating characteristic curve analysis was performed to establish cutoff values. ResultsFifty children completed both visits. The Cronbach α and intraclass correlation coefficient of CARATKids were 0.81 and 0.85, respectively. The Guyatt responsiveness index was −1.34, and within-patient change in clinically unstable patients (n = 31) was significant (P = .02). As for cross-sectional and longitudinal validity, correlation coefficients ranged from 0.58 to 0.77 (P < .001) and 0.30 to 0.57 (P < .05), respectively. The estimated MCID for CARATKids was 3. The optimal cutoffs (sensitivity and specificity) to exclude uncontrolled and controlled disease were 3 or less (97% and 67%) and 6 or greater (56% and 96%), respectively. ConclusionCARATKids is a reliable and valid tool to assess asthma and allergic rhinitis control in Brazilian children. A score of 6 or higher on CARATKids identifies uncontrolled disease, and a score of 3 or lower excludes poor disease control.

Midwifery management of asthma and allergies during pregnancy, birth, and the postpartum

Asthma and allergies can cause serious complications during pregnancy and often they are misdiagosed or mistreated. Anna Nolte, Marie Hastings-Tolsma and Flavia Hoyte look at ways nurses and midwives can recognise the symptoms quicker Asthma and allergic rhinitis are two of the most common health problems worldwide and can present serious complication during pregnancy. While these diseases may improve, remain unchanged, or become exacerbated during pregnancy, they are frequently underdiagnosed and undertreated. The inflammatory processes involved in asthma and allergic rhinitis are superimposed on the normal respiratory changes of pregnancy, making early intervention crucial. Recognition of factors that can aggravate asthma, implementation and adherence to treatment guidelines, and diligent follow-up are important in midwifery management. Patient education is particularly important for prevention of asthma exacerbations. With careful control of asthma and allergic rhinitis, if present, excellent obstetric outcomes can be expected.