A survey of management practices in coexistent allergic rhinitis and asthma (Asia-pacific Survey of Physicians on Asthma and allergic Rhinitis): results from Thailand

BACKGROUND: Underdiagnosis and undertreatment of allergic rhinitis (AR) in patients with asthma can worsen treatment outcomes. There is limited evidence of clinical practices for management of coexistent AR-asthma in Thailand. METHODS: A multicountry, cross-sectional study (Asia-pacific Survey of Physicians on Asthma and allergic Rhinitis) to evaluate physician perceptions and management practices related to AR-asthma overlap in 6 Asian countries was conducted. For Thailand specifically, AR-asthma linkage questionnaires were developed and translated to Thailaland. General physicians (GPs) or pediatricians, randomly selected from hospitals in urban cities, routinely treating >10 asthma patients/month were interviewed. Here we present the results for Thailand. RESULTS: Two hundred physicians (100 GPs and 100 pediatricians), of whom 70% worked in government hospitals, were interviewed. In their experience, 50% of asthma patients had AR and 28% of AR patients had asthma. Among diagnosed asthma patients, 65% of physicians routinely asked for any AR symptoms at every visit. Among diagnosed AR patients, 63% of physicians routinely asked for any asthma symptoms at every visit. In patients with coexisting AR-asthma, 91% of physicians treated both diseases simultaneously, while 6% of physicians treated asthma as a chronic disease but managed AR symptomatically. The most preferred treatment options for patients with AR-asthma were inhaled corticosteroids with intranasal steroids (46% in GPs, 71% in pediatricians). CONCLUSION: The physicians interviewed in Thailand are aware about coexistent asthma-AR. There is a need to increase the awareness further for coexistent AR-asthma and to educate nonspecialist physicians in the proper management of AR-asthma patients.

The effectiveness of highly active antiretroviral therapy among HIV-infected children in Asian countries

Background: Worldwide, there are 2.1 million children under 15 years of age living with HIV infection. In the past five years, there has been significant progress in providing antiretroviral therapy (ART) to children in resource-limited countries. According to the World Health Organization, an estimated 200,000 children were receiving ART by the end of 2007.Objective: To conduct a general review of pediatric ART effectiveness in Asian countries.Methods: Published articles in PubMed and abstracts from the international HIV conferences were searched for articles related to pediatric ART in Asian countries from 1999 up to 2008.Results: Available reports consistently demonstrated beneficial outcomes of first-line antiretroviral therapy, including significant reductions in mortality and hospitalization rates, and good immunological and virological outcomes. However, there were limited data on the availability of second-line ART and the management of children who failed first-line regimens. There was also a need for improved access to early diagnostic testing and treatment in infancy, and more data on ART selection for children exposed to antiretrovirals for prevention of mother to child transmission.Conclusion: The highly active antiretroviral therapy is effective among HIV-infected children in Asia. Strategies for improved diagnosis and implementation of the life-saving antiretroviral programs including second -line ART, throughout Asia is encouraged.