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