Budesonide Aqueous Nasal Spray Improved Quality of Life in Patients with Perennial Allergic Rhinitis Assessed by a Disease Specific Quality of Life Questionnaire E SrBhlJ, M Bendez. K Svensson’, T Carrilld, I VUna4. M da Graca Castelo-Branch. L Arhedenl 1AstraZeneca Lund, Sweden *Central Hospital, Skovde, Sweden 3Hospitai Nuestra Senora del Pino, Las PaimasGran Canaria, Spain 4PtYTE. Budapest, Hungary sHospita1 de Sao Joao, Pot-to, Portugal The aim was to compare the change in Quality of Life (QoL) in patients with perennial allergic rhinitis (PAR). 337 patients, aged between 16 and 74 years, (mean age=31 years) from four countries were randomized to budesonide aqueous nasal spray (BANS), either 256 or 128 pg. or placebo for a 4-week period. QoL was assessed at baseline and after study completion. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) consisting of 28 items in 6 domains was used (scale: 0-6,O=not troubled, 6=extremeiy troubled). At baseline, the three groups had similar values of RQLQ overall score: I .99, 2.25 and 2.25 after BANS 256 pg, BANS 128 pg. and placebo, respectively. Adjusted mean changes from baseline were as follows: BANS 256 BANS 128
OVERALL SLEEP PROBLEMS NONE HAY FEVER PROBLEMS PRACTICAL. PROBLEMS NASAL SYMPTOMS EYE SYFTMOMS EMOTIONAL FUNCllON
J ALLERGY CLIN IMMUNOL JANUARY 2000
Overall RQLQ as well as ail domains were significantly improved for both doses of BANS compared with placebo (p <0.005 for all domains and overall score). No significant differences were seen between the two doses of BANS. CONCLUSION: Budesonide aqueous nasal spray improved health-related quality of life in patients with perennial allergic rhinitis assessed by the Rhinoconjunctivitis Quality of Life Questionnaire.
280 An Inner
City Hospital Approach to Asthma Disease Management D Schull. V Tidwell, S Basmadjian, D Kennerly Parkland Health & Hospital System, Dallas, TX Parkland Health and Hospital System, a publicly supported hospital, provides outpatient, emergency and specialty medical care to Dallas County residents. The Asthma Clinic with referrals from the Emergency Department and Primary Clinics manages 1100 moderately severe to severe high risk patients, a sub population of the 15,000-20.000 patients with asthma who are served by the hospital system. The projects within this program include a hospital based and community education, a 24 hour call center, a provider education program, dust encasement program, cockroach abatement program, and nebuiizer program. Hospital-based Asthma Clinic: A multidisciplinary program with specialty based care provided pharmacy and nursing directed education classes, social work assessment, skin testing and pulmonary function tests. Community Oriented Primary Care Clinic: A multidisciplinary program with primary care provided asthma risk assessments and asthma patient education. Asthma Education Booklet and Care Plan: Multicultural educational materials in English and Spanish for adults with asthma. Deveiaped with extensive input from patient focus groups. Asthma Call Center: A general call center addressing patient ques-
tions, assessing patient needs and triage. Issues involve general asthma education, medication usage and refills, revising clinic appointments to meet subacute needs, referral for social service support, and medication changes during acute exacerbations. More than 3 100 calls recieved during the first year of operation. Dust Encasement Program: Provided free dust encasements to inner city patients with positive allergies to dust mites. Nebuiizer Program: Provided free nebulizers to inner city patients with moderate to severe asthma and frequent emergency department admissions. Cockroach Abatement Program: Provided free roach entrapments in the community to prevent asthma exacerbations triggered by cockroach sensitivity. Outcomes were monitored through the use of a pharmacy and clinical database. The outcome of these programs included a 39% decrease in emergency department utilization, linkage of urgentbased care with primary and specialty care. improved patterns of care by providers, and improved patient self-management of asthma. The Impact of Inhaled Corticosteroid Therapy on the Natural Course of Childhood Asthma. Does it Improve the Prognosis? Neritl N. Bahceciler; IfI B. Bar/an. Mujdat M. Basaran Marmara University Hospital. Pediatric Allergy & Immunology Division, Istanbul, Turkey Although a number of risk factors have been shown to influence the persistence of respiratory symptoms in childhood asthma, the majority of patients included in those studies were either receiving inadequate treatment or no treatment at ail. In this study, we aimed to assess the effect of the currently recommended therapeutic approach on the course of childhood asthma. For this purpose a retrospective review was performed on the records of 279 children with asthma and an end of study interview, results of spirometry and prick tests completed the data. The study was approved by the ethical committee of the hospital. The mean age at referral and at final survey was 6.2 yr and 8.9 yr. respectively: and the children were followed up for a mean of 3 years. Treatments included beta-2 agonists pm (mild intermittent) and inhaled budesonide (mild persistent, moderate. severe). Eighty-five of the 279 patients (30%) experienced no respiratory symptoms in the previous 12 months. There was no significant difference between those with and without current respiratory symptoms with respect to age, gender, age at onset of symptoms, follow-up period, age at referral, therapy, severity of asthma and duration of symptoms at referral. For subjects with current respiratory symptoms the initial serum total IgE level, and the percentage of prick test positivity was significantly higher than those without current respiratory symptoms (p=O.O027, p=O.Ol 1. respectively). Although the initial FBF2s.,s, FBV,, and FBV,@VC was significantly lower in those with current respiratory symptoms (p=O.O03, p=O.O05, p=O.O4. respectively), there was no difference between lung functions of the two groups at the end of follow-up. In logistic regression analysis. the persistence of respiratory symptoms was found to be significantly predicted by initial FBFz,.,, and sensitivity to allergens (p=O.O3, p=O.O4, respectively). We concluded that treatment with inhaled steroids may alter the long-term outcome of asthmatic children by leading to sustained control of symptoms and thus favouring optimal lung growth throughout childhood.
Characteristics of Patients Experiencing NearFatal and Fatal Asthma: Results of a Regional Survey of 400 Asthma Specialists PJ Hannnway Salem, MA BACKGROUND: Case-control studies now describe a growing number of younger patients with varying levels of asthma severity who experience near-fatal or fatal asthma unexpectedly at home, en route to the hospital or in public places.