Programa de Controle da Asma e da Rinite Alergica da Bahia PACIENTES COM ASMA GRAVE E COM RINITE ASSOCIADA GERAM MAIORES CUSTOS PARA A FAMÍLIA E PARA O SISTEMA DE SAUDE Programa de Controle da Asma e da Rinite Alergica da Bahia Universidade Federal da Bahia EDUARDO V PONTE  ROSANA FRANCO HARRISSON FLORIAN ADELMIR SOUZA-MACHAD MAURICIO L BARRET  CHARLES K NASPIT ALVARO A CRUZ

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

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

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

Study design V1 3 m 3 m 3 m 3 m Last study visit V2 V3 V4 V5 V1: report of emergency room visit in the last year, provision of free topical medication and lung function V2: report of emergency room visit, cost data and provision of free topical medication V3: report of emergency room visit, cost data, provision of free topical medication and lung function V4: report of emergency room visit, cost data and provision of free topical medication V5: report of emergency room visit, cost data and provision of free topical medication and lung function Last study visit: rhinitis evaluation, ACQ, AQLQ, lung function and clinical evaluation of asthma control

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

U$

U$

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 478 (352-579) 568 (426-697)

Conclusion Preliminary data indicate that the cost of asthma is increased in rhinitis patients, and correlate with the severity of rhinitis

Rhinitis and the risk of emergency room visit for acute asthma Bousquet J 2005 2.32 (1.12-4.80) Bousquet J, Allergy 2005

Rhinitis and the risk of hospital admission for acute asthma Kocevar V 2004 1,72 (1,34-2,21) Price D 2005 1,52 (1,03-2,24) Thomas M 2005 2,34 (1,41-3,91)

Increased asthma severity in patients with concomitant moderate/severe rhinitis Increased asthma severity and reduced response to treatment in patients with concomitant moderate to severe rhinitis OR (CI) Over 90% reduction in emergency room visits no rhinitis mild rhinitis moderate to severe rhinitis - 0.43 (0.19-0.94) 0.27 (0.12-0.60)

Increased asthma severity in patients with concomitant moderate/severe rhinitis Increased asthma severity and reduced response to treatment in patients with concomitant moderate to severe rhinitis OR (CI) Less than 10% improvement in FEV1 no rhinitis mild rhinitis moderate to severe rhinitis - 1.84 (0.98-3.44) 2.94 (1.48-5.85)

Quality of life and symptoms score in asthmatic patients with rhinitis No rhinitis (n = 77) Mild rhinitis (n = 262) Moderate/ severe rhinitis (n = 166) P ACQ score 1.5 + 1.0 1.8 + 1.0 2.7 + 1.0 < 0.01 AQLQ score 5.0 + 1.5 4.2 + 1.4 3.1 + 1.2

Rhinitis and asthma related quality of life AQLQ score p Rhinitis No rhinitis 4.2 + 1.1 > 0.05 Sinusitis No sinusitis 4.1 + 1.1 4.3 + 1.1 < 0.05 Dixon AE, Chest 2006

The annual cost of asthma in USA Asthma + rhinitis US$ 249 US$ 335 Yawn BP, JACI 1999

Increased asthma severity in patients with concomitant moderate/severe rhinitis Increased asthma severity and reduced response to treatment in patients with concomitant moderate to severe rhinitis OR (CI) Uncontrolled asthma no rhinitis mild rhinitis moderate to severe rhinitis - 1.23 (0.17-8.69) 12.68 (1.73-92.85)

The annual cost of asthma in Germany Asthma + rhinitis € 2,745 € 9,286 Schramm B, ERJ 2002

Rhinitis evaluation - last study visit ARIA criteria Mild Moderate/severe Questionnaire

Asthma evaluation - last study visit ACQ questionnaire AQLQ questionnaire Clinical evaluation of symptoms control Diagnosis of refractory asthma Lung function test

Characteristics of asthmatic patients enrolled in the study (n=557) Female gender (%) 438 (78) Age (years) 49 (38-59) Comorbidity (%) 146 (46) Alliterated patients (%) 60 (14) Smoking history > 10 pack years (%) 68 (12) Rhinitis diagnosis (%) no rhinitis mild moderate to severe 82 (15) 299 (54) 176 (31)

Characteristics of asthmatic patients enrolled in the study (n=557) Inhaled corticosteroid for asthma > 800 mcg/day (%) 470 (84) Any Emergency room visit in the year of follow up (%) 265 (47) Uncontrolled asthma (%) 67 (20) FEV1 pre-bronchodilator at last study visit 68 (54-82) FVC pre-bronchodilator at last study visit 91 (81-102)