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PACIENTES COM ASMA GRAVE E COM RINITE ASSOCIADA GERAM MAIORES CUSTOS PARA A FAMÍLIA E PARA O SISTEMA
DE SAUDE
EDUARDO V PONTE ROSANA FRANCO
HARRISSON FLORIANADELMIR SOUZA-MACHAD
MAURICIO L BARRET CHARLES K NASPIT
ALVARO A CRUZ
Programa de Controle da Asma e da Rinite Alergica da BahiaUniversidade Federal da Bahia
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Evidences
• Rhinitis is a risk factor for severe asthma
– Emergency room visit for acute asthma– Hospital admission for acute asthma– Asthma related quality of life– Cost of asthma
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Objetivo
• Avaliar se o custo da asma e maior em pacientes asmáticos com rinite em comparação com pacientes sem rinite
• Avaliar se a gravidade dos sintomas de rinite estão associados a maior custo da asma
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Patients
• Asthmatic patients at admission in ProAR
• Inclusion criteria
• Severe asthma• > 12 years old• ARIA criteria
• Exclusion criteria• Abnormal chest x-ray• Other pulmonary co-morbidities• Severe extra-pulmonary disease
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Study design
3 m 3 m 3 m 3 mV1 V2 V3 V4 V5Last study visit
V1: report of emergency room visit in the last year, provision of free topical medication and lung functionV2: report of emergency room visit, cost data and provision of free topical medicationV3: report of emergency room visit, cost data, provision of free topical medication and lung functionV4: report of emergency room visit, cost data and provision of free topical medicationV5: report of emergency room visit, cost data and provision of free topical medication and lung functionLast study visit: rhinitis evaluation, ACQ, AQLQ, lung function and clinical evaluation of asthma control
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Economic data
• Data from Patients were evaluated in order to estimate the direct and indirect cost of rhinitis and asthma for the public health system and for their families
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Table I. Clini cal and demographic characteristics of asthmatic pat ients with and
without rhinitis
No rhinitis
(n=21)
Rhinitis
(n=133)
p
Female gender (%) 15 (71) 118 (89) 0.03
Age (years) 53 (35-57) 49 (38-56) 0.61
Unlitterated patients (%) 3 (16) 18 (14) 0.54
Age at first asthma symptoms (years) 17 (6-31) 12 (4-27) 0.30
Inhaled CO for asthma (mcg/day) 800 (600-800) 800 (800-800) 0.03
Inhaled LABA for asthma (mcg/day) 24 (18-24) 24 (24-24) 0.11
Not controlled asthma (%) 4 (19) 80 (64) <0.01
Emergency room visit year(%) 8 (38) 76 (57) 0.10
Number of emergency room visit year 0 (0-2) 1 (0-3) 0.18
Positive skin prick test (%)* 8 (50) 54 (62) 0.36
ACQ score 1.50 (0.71-2.08) 2.07 (1.28-3.00) <0.01
AQLQ score 5.24 (3.92-6.48) 3.45 (2.48-4.99) <0.01
FEV1 60 (48-69) 67 (50-85) 0.09
FVC 86 (74-101) 91 (78-102) 0.50
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Table I I. Clinical and demographic characteristics of asthmatic patients according
rhinitis severity
No rhinitis
(n=21)
Mild Rhinitis
(n=82)
Moderate/severe
rhinitis (n=51)
P
Female gender (%) 15 (71) 73 (89) 45 (88) 0.10
Age (years) 53 (35-57) 51 (40-60) 46 (34-53) 0.17
Rhinits symptoms score _ 4 (2-5) 8 (6-9) <0.01
Not controlled asthma (%) 8 (38) 39 (50) 41 (85) <0.01
Emergency room visit year(%) 4 (19) 42 (51) 34 (67) 0.06
Nº of emergency room visit year 0 (0-2) 1 (0-2) 1 (0-3) 0.06
Positive skin prick test (%)*** 8 (50) 34 (64) 20 (59) 0.59
ACQ score** 1.50 (0.71-2.08) 1.71 (1.00-2.49) 3,00(2.14-3.46) <0.01
AQLQ score* 5.24 (3.92-6.48) 4.10 (2.95-5.52) 2.64 (2.13-3.53) <0.01
FEV1 60 (48-69) 68 (50-84) 63 (51-88) 0.24
FVC 86 (74-101) 91 (76-103) 90 (80-102) 0.71
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Graphic 1. Mean cost of asthma per patient/year according to rhinitis diagnosis
0
400
800
1200
1 2
Rhinitis diagnosis
P<0.01
1.No rhinitis 2.Rhinitis
U$
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1
Graphic 2. Mean cost of asthma per patient/year according to rhinitis severity
0
400
800
1200
1600
1 2 3
Rhinitis diagnosis
P=0.03
P<0.01
1.No rhinitis 2.Mild rhinitis 3.M oderate/severe rhinitis
U$
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Cost of asthma according to severity of rhinitis
No rhinitis
(n=21)
Mild rhinitis
(n=84)
Moderate/severe
rhinitis (n=50)
P
Cost for the family 6 (1-15) 6 (3-13) 9 (4-26) >0.05
Cost for the health care system 398 (315-457) 472 (328-575) 559 (392-670) <0.01
Annual cost of asthma 398 (315-457) 478 (352-579) 568 (426-697) <0.01
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Conclusion
• Preliminary data indicate that the cost of asthma is increased in rhinitis patients, and correlate with the severity of rhinitis