C. Pribil

Characteristics of intermittent and persistent allergic rhinitis: DREAMS study group

Background In the Allergic Rhinitis and its Impact on Asthma (ARIA) classification, intermittent and persistent rhinitis were proposed to replace seasonal and perennial allergic rhinitis (AR).

Prevalence of nasal polyposis in France: a cross-sectional, case-control study

Background:  The prevalence of nasal polyposis (NP) has never been established in France due to the lack of diagnostic tools for population‐based studies.

The association between asthma control, health care costs, and quality of life in France and Spain

BackgroundCurrent asthma management guidelines are based on the level of asthma control. The impact of asthma control on health care resources and quality of life (QoL) is insufficiently studied. EUCOAST study was designed to describe costs and QoL in adult patients according to level of asthma control in France and Spain.MethodsAn observational cost of illness study was conducted simultaneously in both countries among patients age greater or equal to 18 with a diagnosis of asthma for at least 12 months. Patients were recruited prospectively by GPs in 2010 in four waves to avoid a seasonal bias. Health care resources utilization of the three months before the inclusion was collected through physician questionnaires. Asthma control was evaluated using 2009 GINA criteria over a 3-month period. QoL was assessed using EQ-5D-3L®.Results2,671 patients (France: 1,154; Spain: 1,517) were enrolled. Asthma was controlled in 40.6% [95% CI: 37.7% - 43.4%] and 29.9% [95% CI: 27.6% - 32.3%] of French and Spanish patients respectively.For all types of costs, the percentage of patients using health care resources varied significantly according to the level of asthma control. The average cost (euros/3-months/patient) of controlled asthma was €85.4 (SD: 153.5) in France compared with €314.0 (SD: 2,160.4) for partially controlled asthma and €537.9 (SD: 2,355.7) for uncontrolled asthma (p<0.0001). In Spain, the corresponding figures were €152.6 (SD: 162.1), €241.2 (SD: 266.8), and €556.8 (SD: 762.4). EQ-5D-3L® score was higher (p<0.0001) in patients with controlled asthma compared to partially controlled and uncontrolled asthma in both countries (respectively 0.88; 0.78; 0.63 in France and 0.89; 0.82; 0.69 in Spain).ConclusionsIn both countries, patients presenting with uncontrolled asthma had a significantly higher asthma costs and lower scores of Qol compared to the others.

ER’Asthme, contrôle de l’asthme chez 16580 patients suivis en médecine générale

Resume Introduction Bien que le controle de la maladie soit un des objectifs du traitement de l’asthme, peu de donnees sont disponibles en France sur la realite de ce controle en medecine generale (MG). L’observatoire ER’Asthme a ete mis en place pour mesurer le controle de l’asthme des patients suivis en MG et en identifier les facteurs predictifs. Methodes Etude epidemiologique descriptive transversale, menee chez des asthmatiques diagnostiques depuis au moins 1 an, âges de 6 ans au moins et consultant en MG. Les donnees recueillies portaient notamment sur l’appreciation spontanee par le patient de son etat de sante, le niveau de controle de son asthme (evalue en fonction du Consensus canadien et repris par l’Anaes en 3 niveaux : optimal, acceptable et inacceptable), et l’observance (questionnaire PMAQ3w). Resultats 16580 patients asthmatiques ont ete inclus, 85 % avaient plus de 20 ans et 54 % etaient des hommes. A la question “Comment va votre asthme ?”, 53 % des patients ont declare que leur asthme allait “parfaitement bien” ou “bien”, 39 % “moyennement bien” et 8 % “mal”. En revanche, selon le medecin, le controle n’etait optimal que pour 21 % des patients, acceptable pour 7 % et inacceptable pour 72 %. La concordance entre l’evaluation du controle de l’asthme par les patients et par le MG etait mediocre : coefficient Kappa de 34,5 % (IC 95 % [33,5 ; 35,5]). Seuls 59 % des patients declaraient une observance totale de leur traitement de fond. En analyse multivariee, les facteurs associes a un controle optimal etaient par ordre decroissant d’importance : un traitement par association fixe (CSI + s2LA) (OR : 3,7 ; IC 95 % [3,5 ; 4,2]), un indice de masse corporelle (IMC) normal (OR : 2,4 ; IC 95 % [2,0 ; 2,9), l’absence de tabagisme (OR : 2,4 ; IC 95 % [2,1 ; 2,8]), un âge Conclusion Les patients asthmatiques surestimaient spontanement le niveau de leur controle qui etait insuffisant. Le traitement par association fixe, l’IMC, le tabac, l’âge et l’observance etaient des facteurs influencant le controle.

Lack of eosinophilia can predict remission in wheezy infants

Background Early wheezing in infants is a potential risk factor for persistence of asthma into adulthood. Moreover, a personal or familial history of atopy are risk factors associated with persistence of pre‐existing wheezing during childhood. However, their relative importance remains unclear.

Impact économique de la BPCO en France : étude SCOPE

Resume Introduction La broncho-pneumopathie chronique obstructive (BPCO) represente un probleme de sante publique a l’impact economique mal evalue. Materiel et methodes SCOPE est une etude observationnelle economique, prospective et retrospective, menee en France en 2001, aupres de 114 medecins generalistes et 57 pneumologues. Son objectif est de decrire la prise en charge des patients atteints de BPCO et d’en evaluer le cout annuel en fonction du stade de severite. Des questionnaires ont permis de recueillir des informations sur les consommations de soins pendant douze mois, pour deux cent quatre-vingt cinq patients. Resultats L’analyse economique etait de type cout de la maladie en « prevalence ». La severite des troubles et la consommation de soins etaient plus importantes chez les patients suivis par un pneumologue. La BPCO et ses complications (suivi habituel du patient, exacerbations, autres complications) sont responsables de 66 % des couts, les 34 % restants n’etant pas lies a la maladie respiratoire et a ses complications. Les principaux postes de depenses etaient les hospitalisations (35 %, soit 1 509,9 euros/an/patient) et les medicaments (31 %, soit 1 340,6 euros/an/patient). Le cout direct total augmentait avec le stade de severite de la maladie, essentiellement du fait des depenses d’hospitalisation et d’assistance respiratoire. Discussion Cette etude confirme l’impact economique de la prise en charge de la BPCO en France. Des mesures permettant de ralentir l’evolution des troubles et de prevenir les exacerbations pourraient en reduire les couts.

The Burden Associated with Ocular Symptoms in Allergic Rhinitis

Background: Ocular symptoms remain widely neglected while they concern the majority of subjects with allergic rhinitis (AR) and impair their daily activities. We describe the characteristics of ocular symptoms in subjects suffering from AR in the French INSTANT study and their impact on daily activities. Methods: This cross-sectional observational survey was carried out in November 2006 using face-to-face interviews. Results: 31.7% of the population-based sample (n = 4,019) suffered from AR and 52.0% of AR subjects (n = 663) described ocular symptoms. Men had significantly less ocular symptoms than women (odds ratio 0.71, 95% CI 0.57–0.89). 57.5% of subjects suffered from ocular symptoms for >5 years, 30.2% for >6 months in the past 12 months, and 92.2% during the pollen season. The troublesome ocular symptoms were itching eyes (51.1%), watery eyes (38.6%), red eyes (6.6%) and swollen eyelids (3.6%). The trigger factors were pollens (51.3%), household dust and mites (34.8%), pets (12.2%) and air pollution (3.8%). Ocular symptoms had a negative impact on daily activities (blurred sight 47.8%, reduction in daily activities 38.8%, reduction in efficacy at work 25.8%, sleep disturbances 16.3%, and sick leave 12.9%). They were diagnosed in 38.9% of subjects and followed up in 34.8%. Treatment for ocular symptoms was prescribed to 35.4% of subjects and to 61.9% of subjects with a regular follow-up care. Conclusions: This survey confirms the impact of ocular symptoms on AR patients’ lives and suggests that they are still neglected and undertreated.

Impact of innate and environmental factors on wheezing persistence during childhood.

Background. Persistent asthma in adults starts often early in childhood and is associated with alterations in respiratory function that occur early in life. Objectives. The aim of this study was to evaluate the importance of innate and environmental factors associated with occurrence of asthma during childhood in a population of recurrent wheezing infants followed prospectively. Methods. A cohort of infants less than 30 months old with recurrent wheezing was established in order to assess severity of respiratory symptoms and to look for the presence of atopy and environmental risk factors. At the age of 6 years, they were reevaluated with respect to remission or persistence of wheezing over the previous 12-month period. Results. Data were available for 219 subjects aged 15 ± 5 months. In 27% of the infants with recurrent wheeze, wheezing persisted until the age of 6 years. In multivariate analysis, stepwise logit analysis showed that the risk factors for persistent wheezing are eosinophilia ≥470/mm3, allergenic sensitization, and a father with asthma. Environmental factors present during the first year of life that protect from persistence of wheezing are (1) breastfeeding for longer than 3 months, (2) pets at home, and (3) ≥3 siblings. The detection rate for persistent wheezing in this model is 72%. The persistence score showed good specificity 91% but low sensitivity 35%. Conclusion. This study confirms the role of atopic host factors on wheezing persistence during childhood and detected protective environmental factors.

The daily cost of ICU patients: A micro-costing study in 23 French Intensive Care Units

OBJECTIVES To estimate the daily cost of intensive care unit (ICU) stays via micro-costing. METHODS A multicentre, prospective, observational, cost analysis study was carried out among 21 out of 23 French ICUs randomly selected from French National Hospitals. Each ICU randomly enrolled 5 admitted adult patients with a simplified acute physiology II score ≥ 15 and with at least one major intensive care medical procedure. All health-care human resources used by each patient over a 24-hour period were recorded, as well as all medications, laboratory analyses, investigations, tests, consumables and administrative expenses. All resource costs were estimated from the hospitals perspective (reference year 2009) based on unitary cost data. RESULTS One hundred and four patients were included (mean age: 62.3 ± 14.9 years, mean SAPS II: 51.5 ± 16.1, mean SOFA on the study day: 6.9 ± 4.3). Over 24 hours, 29 to 186 interventions per patient were performed by different caregivers, leading to a mean total time spent for patient care of 13:32 ± 05:00 h. The total daily cost per patient was € 1425 ± € 520 (95% CI = € 1323 to € 1526). ICU human resources represented 43% of total daily cost. Patient-dependent expenses (€ 842 ± € 521) represented 59% of the total daily cost. The total daily cost was correlated with the daily SOFA score (r = 0.271, P = 0.006) and the bedside-time given by caregivers (r = 0.716, P < 0.0001). CONCLUSION The average cost of one day of ICU care in French National Hospitals is strongly correlated with the duration of bedside-care carried out by human resources.

Limited treatment adaptation despite poor asthma control in asthma patients treated with inhaled corticosteroids

Abstract Objective: Current asthma guidelines recommend use of inhaled corticosteroids (ICS) in patients with persistent disease. This study was designed to investigate (1) the proportion of patients prescribed ICS-containing maintenance treatment who achieve asthma control, (2) determinants of control and (3) how physicians adapt treatment to the level of control. Methods: General practitioners (GPs) and chest physicians (CPs) in France recruited patients consulting for asthma and prescribed an ICS. Over a 2-year follow-up period, asthma symptoms in the previous 3 months and treatments prescribed were documented at each visit. Variables independently associated with asthma control were determined by multiple logistic regression. Results: Data were available for 924 patients recruited by GPs and 455 recruited by CPs. Asthma control was acceptable in only 24% of patients at inclusion, and in 33.6% at the last follow-up visit. Five factors were independently associated with asthma control: age (or time since diagnosis), gender, smoking status, allergic aetiology of asthma and treatment. Most patients (56.3%) were prescribed the same ICS dose regimen at the end of follow-up as at inclusion. The intensity of controller therapy had been increased in only 12.2% of patients unacceptably controlled at inclusion. Conclusions: Asthma was unacceptably controlled in most patients receiving ICS-containing maintenance treatment and remained so during follow-up. Despite this, treatment adaptations by GPs and CPs were very infrequent. This unsatisfactory situation may be improved by adopting a more dynamic approach to tailoring controller therapy to the needs of the patient.