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
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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
3m
V2
3m
V3
3m
V4
3m
V5
Last study visit
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
Table I. Clini cal and demographic characteristics of asthmatic patients w ti h and
w ithout rhinitis
No rhinitis
Rhinitis
(n=21)
(n=133)
15 (71)
118 (89)
0.03
53 (35-57)
49 (38-56)
0.61
3 (16)
18 (14)
0.54
17 (6-31)
12 (4-27)
0.30
800 (600-800)
800 (800-800)
0.03
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
Female gender (%)
Age (years)
Unlitterated pati
ents (%)
Age at first asthmasy mptoms (years)
Inhaled CO for asthma (mcg/day)
Inhaled LABA for asthma (mcg/day)
p
Table II. Clinic al and demographic characteristicsof asthmatic patients according
rhinitis severity
No rhinitis
Mild Rhinitis Moderate/severe
P
(n=21)
(n=82)
rhinitis(n=51)
15 (71)
73 (89)
45 (88)
0.10
53 (35-57)
51 (40-60)
46 (34-53)
0.17
_
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
N¼of 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
Female gender (%)
Age (years)
Rhinitssymptoms score
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
U$
U$
Cost of asthma according to severity of
rhinitis
No rhinitis
Mild rhinitis
Moderate/severe
(n=21)
(n=84)
rhinitis (n=50)
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
Cost for the family
P
Conclusion
• Preliminary data indicate that the cost of asthma is increased in
rhinitis patients, and correlate with the severity of rhinitis