Impact of smoking on asthma symptoms, healthcare resource use, and quality of life outcomes in adults with persistent asthma.

BACKGROUND: Smoking habits of asthmatics are similar to those of the general population. However, little attention has been paid to the associations between smoking and asthma-related outcomes. OBJECTIVE: To evaluate relationships between cigarette smoking, asthma symptoms, and asthma-related resource utilization in subjects with persistent asthma. METHOD: A stratified, random sample of adults from France, Germany, and the UK with persistent asthma were surveyed in 2001 through 2004. Statistical analyses compared asthma symptoms and healthcare resource utilization for cigarette smokers compared with those for non-smokers. RESULTS: Analyses included 1109 subjects with persistent asthma symptoms in 2001-2003 and 852 subjects with persistent asthma symptoms in 2004. Using multivariate analysis of data from eligible subjects in 2004 that did not have concomitant chronic obstructive pulmonary disease and adjusting for subjects' baseline and demographic characteristics, cigarette smokers were more likely to experience nighttime symptoms (OR 1.46, 95% CI 1.07, 1.97 P = 0.015) and were more likely to use healthcare resources than were non-smokers (P < or = 0.004). Findings were similar in a secondary analysis of subjects < or =55 years of age. CONCLUSIONS: Cigarette smoking appears to be associated with more asthma symptoms and more ED visits and hospitalizations in adults with persistent asthma.

Healthcare utilisation and costs associated with adding montelukast to current therapy in patients with mild to moderate asthma and co-morbid allergic rhinitis: PRAACTICAL study.

OBJECTIVE: To evaluate the healthcare resource use and costs associated with adding montelukast to therapy in patients with mild to moderate persistent asthma and co-morbid seasonal allergic rhinitis whose asthma is inadequately controlled by their current asthma therapy. METHODS: A multicentre, pre-post retrospective cohort study was conducted in three European countries (Italy, Poland and Spain). Consecutive patients who were receiving inhaled corticosteroid therapy (monotherapy or combination therapy with long-acting beta(2)-adrenoceptor agonists) and who started concomitant treatment with montelukast between January 1999 and December 2002 were identified from clinical charts. Asthma/seasonal allergic rhinitis-related concomitant medications and asthma-related outpatient care, ED visits and hospitalisations for the periods 12 months before and 12 months after montelukast initiation were recorded from patient charts and combined with country-specific published unit costs (adjusted to 2004 values). The analysis was performed from a third-party-payer perspective and thus direct healthcare resource utilisation due to asthma/seasonal allergic rhinitis and associated costs for each country were estimated. RESULTS: A total of 98 physicians provided data for 696 asthmatic patients with seasonal allergic rhinitis (Italy: n = 158; Poland: n = 334; and Spain: n = 204). The mean age of patients was 32.7 years, 57.5% were female and patients had asthma that was considered either mild-persistent (54.5%) or moderate-persistent (45.5%) according to the Global Initiative for Asthma classifications. The introduction of montelukast (10 mg/day daily cost range euro0.8-1.68) was associated with increases in the total annual mean healthcare cost per patient of 11.9%, 60.4% and 5.5% for Italy, Poland and Spain, respectively. However, mean annual costs for asthma-related outpatient care, ED visits and hospitalisations dropped significantly in all three countries (Italy: from euro805.00 to euro281.60 [p < 0.01]; Poland: from euro127.10 to euro99.00 [p < 0.01]; and Spain: from euro463.40 to euro119.70 [p < 0.01]). CONCLUSIONS: The addition of montelukast to therapy in patients with mild to moderate asthma and concomitant seasonal allergic rhinitis whose asthma was inadequately controlled by current asthma therapy significantly reduced the use of concomitant asthma-allergy medications, ED visits, outpatient care visits and hospitalisation. The total direct healthcare cost obtained after the addition of montelukast increased only as a result of the montelukast treatment cost.

Asthma control in patients with asthma and allergic rhinitis receiving add-on montelukast therapy for 12 months: a retrospective observational study.

BACKGROUND: Montelukast, a potent leukotriene receptor antagonist, is approved for treatment of both asthma and allergic rhinitis (AR). No studies to date have examined whether montelukast can improve asthma control over a long period of time in patients with seasonal AR and asthma. OBJECTIVE: To evaluate asthma control and use of asthma-related medical resources by patients with inadequately controlled mild to moderate persistent asthma and seasonal AR who required addition of montelukast as part of routine care. METHODS: This multicenter, 24-month, pre-post retrospective observational study included patients receiving current inhaled corticosteroid (ICS) therapy (alone or in combination with long-acting beta-agonist [LABA]), who received add-on treatment with montelukast for 12 consecutive months. The incidence of asthma attacks, defined as emergency department visit, hospitalization, or oral corticosteroid use for asthma, was compared for the year before and the year after addition of montelukast to therapy. RESULTS: For the 696 patients from Italy, Poland, and Spain who were included in the analyses, the proportion of patients experiencing an asthma attack declined from 31.5% in the year before to 10.1% (p < 0.001) the year after addition of montelukast to therapy. Proportions of patients with an asthma-related emergency room visit, hospitalization, and oral corticosteroid use declined from 18.7% to 3.9%, from 5.2% to 1.4%, and from 17.5% to 5.9% (all p < 0.01), respectively. The incidence of these outcomes declined in all three countries, regardless of baseline asthma severity or asthma therapy (ICS alone or ICS + LABA). Important study limitations include the possibility of selection bias or missing medical chart data in this retrospective study design. Also noteworthy is the inclusion of only those patients who remained persistent with montelukast therapy. Therefore, the results of the study are relevant for patients who remain persistent with montelukast therapy. CONCLUSIONS: Addition of montelukast to current ICS therapy improved long-term asthma control and resulted in substantial reductions in asthma-related resource use by patients with mild or moderate persistent asthma and concomitant seasonal AR who were persistent with montelukast therapy in this retrospective observational study.

Treatment and outcomes in patients with asthma and allergic rhinitis in the United kingdom.

BACKGROUND: Since allergic rhinitis in asthma patients is associated with worse asthma control, the treatment of the comorbid condition may improve outcomes. METHODS: A 1-year retrospective study using the UK Mediplus database (2001-2004) included asthmatic patients aged 15-55 with allergic rhinitis. Patients starting therapy based on the Global Initiative for Asthma guidelines, defined as an increase in inhaled corticosteroids (high-dose inhaled corticosteroids, hdICS), or the addition of montelukast (ICS+MON) or long-acting beta-agonists (ICS+LABA) to ICS, were studied. Univariable and multiple logistic regressions evaluated asthma-related outcomes. RESULTS: Among 2,596 asthma and allergic rhinitis patients, 83.2% initiated ICS+LABA, 12.1% hdICS and 4.7% ICS+MON. The mean age was 34 years and 60% were female. ICS+MON patients had more moderate-severe asthma (p = 0.04). Approximately 84% of the ICS+LABA patients experienced an asthma control failure compared to 50% in the other groups (p < 0.0001). The proportions of patients requiring treatment change were 73.8, 22 and 27.3% in the ICS+LABA, hdICS and ICS+MON groups, respectively (p = 0.001). Asthma-related resource use was similar among all groups. The ICS+MON group received fewer mean prescriptions for oral corticosteroids (p = 0.024) than the other groups (p = 0.026). CONCLUSIONS: In asthma and allergic rhinitis, treatment with ICS+MON or hdICS was associated with lower rates of asthma control failure and fewer treatment changes than the ICS+LABA group. MON users also required fewer oral corticosteroids.

Asthma and allergy medication use and costs among pediatric primary care patients on asthma controller therapy.

As observational studies in children initiating GINA-Step 3 therapies are scarce, we evaluated outcomes and costs in a primary care cohort. Two-yr retrospective cohort study included French children (age: 6-14) continuously followed in BKL-Thalès database who received > or =2 consecutive prescriptions for GINA-Step 3 therapy (=addition of montelukast or other controllers ('other'), such as increasing inhaled-corticosteroid dose (hICS), adding long-acting beta agonist (LABA), or ICS + LABA). After matching on gender and propensity score, medication use [rescue (short-acting beta agonists), acute (antibiotics (AB), oral corticosteroids (OCS)), allergy (antihistamines, nasal steroids) and other respiratory] was estimated via mean number of prescriptions and mean cost (per child/per month), and cost trends. During 12-month follow-up, children adding montelukast (n = 71) vs. 'other' (n = 213) had similar asthma rescue/acute and allergy medication use. Subgroup with asthma and allergic rhinitis (A + AR) adding montelukast used less OCS and AB (p = 0.014). Two-yr cost trends suggest stable asthma/allergy medication use in montelukast group (0.83 euro) compared with increase in 'other' (5.39 euro), which was driven by nasal steroid use [0.32 euro ('other') vs. -0.04 euro (montelukast), p = 0.0013]. In subgroup with A + AR decline in asthma/allergy medication use in montelukast group (-0.47 euro) vs. increase in 'other' (11.05 euro), p = 0.015, was driven by differences in AB and OCS (p = 0.04) and nasal steroid use (p = 0.001). Concomitant asthma/allergy medication use was similar in children adding montelukast or 'other' controllers (hICS, LABA, ICS + LABA), while children with allergic rhinitis on montelukast used less AB. Concomitant medication costs after addition of montelukast remained stable, while 'other' group experienced increase, especially in children with concomitant allergic rhinitis.

Burden of concomitant allergic rhinitis in adults with asthma.

Asthma (A) and allergic rhinitis (AR) are common conditions with evidence of shared epidemiological and patho-physiological backgrounds. A systematic review of the literature in the last three decades was performed to summarize both the prevalence and the economic burden of concomitant AR in adult patients with asthma. The reported prevalence estimates of concomitant AR in patients with asthma in the United States and in Europe studies is in excess of 50%, with up to 100% prevalence reported in patients with allergic asthma. In these populations, asthma-related medical resource use, including asthma attacks, emergency room visits, physician visits, and prescription medication use, is higher among asthmatic patients with concomitant AR compared to those without AR. These patients also experience more frequent absence from work and decreased productivity. A low prevalence (6.2%) of comorbid AR in people with asthma has been reported in a single study from Asia. A combined treatment strategy as recommended by international guidelines may improve asthma outcomes in asthmatic patients with concomitant AR.

Quality of life during pollen season in patients with seasonal allergic rhinitis with or without asthma.

OBJECTIVES: We studied the evolution of generic and rhinoconjunctivitis-specific quality of life (QOL) during pollen season in patients with isolated seasonal allergic rhinitis (SAR) and those with asthma and concomitant SAR (AS+SAR). Generic QOL between groups was also compared at pollen peak. METHODS: A prospective cohort study was conducted in Southern France in 2002. Outpatients aged 18-60, regularly visiting respiratory physicians for SAR, were recruited before the grass (grass cohort) or ragweed pollination period (ragweed cohort). Before the pollination period (baseline) and at peak pollination, patients completed French versions of the Mini Rhinoconjuctivitis Quality of Life Questionnaire (Mini-RQLQ) and physical and mental Short Form-12 (SF-12) scores (PCS and MCS) to determine rhinoconjunctivitis and generic QOL. RESULTS: Totals of 83 and 52 patients were included in the SAR and AS+SAR groups, respectively (mean age=35.4; 56.4% females). Mini-RQLQ scores indicated slightly worse QOL in the A+SAR group at inclusion, which significantly deteriorated at the time of pollen peak, both in the SAR (p<0.0001) and AS+SAR groups (p=0.003). In univariate analysis, significantly higher SF-12 PCS (meaning better QOL) were observed at pollen peak in the SAR compared with the AS+SAR group (p=0.0008), while the difference for SF-12 MCS was more limited (p=0.05). Results were confirmed in multivariable analyses adjusting for gender, allergy medication use at pollen peak, cohort of inclusion (grass/ragweed) and comorbid conditions. CONCLUSIONS: Significant deterioration in rhinoconjunctivitis-specific QOL was observed through the pollination period in patients with SAR and AS+SAR. At pollen peak, AS+SAR patients experienced significantly worse physical functioning than patients with SAR alone.