ABSTRACT
BACKGROUND: Asthma is a chronic disease affecting 30 million people in Europe under 45y. Poor control of Asthma is the main cause of emergency-department (ED) access, becoming the strongest determinant of the economic burden of asthma management. OBJECTIVE: To examine the characteristics of adult patients admitted to ED for acute asthma attack, focusing on previous diagnosis of asthma (DA) and current therapy. METHODS: During a one-year period, a structured questionnaire, assessing asthma diagnosis and management, was administered to all patients admitted for asthma attack, to the ED of a South-Italy town. Only patients with subsequently confirmed asthma were enrolled. The data on oxygen saturation (Sat.O2), heart and respiratory-rate, severity code ED-admission, hospitalization or discharge, had been obtained. RESULTS: Two hundred one patients (mean 50.3ys), were enrolled. One hundred eighteen had a DA, made 17.5 ± 5.88 years before, and 35.6% had a specialist-examination in the last year. 53.3% of DA-patients used a self-medication before ED access with short-acting-beta-2-agonist and oral-corticosteroids, although none had a written-asthma-action-plan (WAAP). Almost all DA-patients were on regular therapy: inhaled-corticosteroids (ICS) in 61%, associated with LABA in 85%. 16.7% of DA-patients had previous DA-access. The overall hospitalization-rate was 39%, higher in DA compared to unknown asthmatic patients (UA)(p = 0.017). Significant risk factors for hospitalization were Sat-O2 ≤ 94% breathing ambient air (OR9.91, p < 0.001), inability-to-complete a sentence (OR9.42,p < 0.001) and the age (OR1.02,p = 0.049). CONCLUSION: Despite the asthma guidelines-recommendation, up to 40% of patients received the asthma diagnosis in ED, only 61% of DA-patients were taking ICS. It is disappointing that DA-patients did not have a WAAP, which could explain the poor patient-self-medication at ED admission.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Anti-Asthmatic Agents/administration & dosage , Asthma/drug therapy , Emergency Service, Hospital/statistics & numerical data , Administration, Inhalation , Adolescent , Adult , Child , Female , Humans , Italy , Logistic Models , Male , Middle Aged , Multivariate Analysis , Nebulizers and Vaporizers , Patient Discharge/statistics & numerical data , Practice Guidelines as Topic , Young AdultABSTRACT
INTRODUCTION: Allergic rhinitis (AR) is the most common allergic disease, and it has a relevant impact on the quality of life of the patient. Treatment of AR includes a combination of strategies of proven efficacy and effectiveness; however, a relevant proportion of patients remain uncontrolled. AREAS COVERED: This review article summarizes emerging therapeutic approaches to AR; these approaches include nasal sprays, oral drugs, alternative allergen immunotherapy administration routes, and biologic agents. EXPERT OPINION: The agents discussed require further clinical trials to prove their efficacy in the treatment of AR. Some of these agents, in particular, allergen immunotherapies and biologics, have the potential to form crucial precision medicine approaches to AR. Those that prove their efficacy in clinical trials must also be evaluated from a pharmacoeconomic perspective, possibly in real-life studies; this will define which therapeutic strategies achieve the most convenient and cost-effective ratio, thus yielding a novel opportunity for the most severe and previously treatment-resistant allergic patients.
