ABSTRACT
BACKGROUND: Allergic rhinitis (AR) represents a major challenge in primary care. The Allergic Rhinitis and its Impact on Asthma (ARIA) group proposed a new classification for AR and developed evidence-based guidelines for the management of this disease. We conducted this study to further characterize the classes of AR described by ARIA, and to evaluate whether the management of AR in general practice is in accordance with the ARIA guidelines. METHODS: During the pollen season of 2003, 95 Belgian general practitioners (GPs) enrolled 804 patients who presented with symptoms of AR. For each patient, a questionnaire comprising the clinical presentation and management was completed. RESULTS: In 64% of the patients, AR was classified as intermittent and in 36% as persistent. Persistent rhinitis caused more discomfort than intermittent rhinitis. Only 50% of the patients had ever undergone allergy testing. Among them, 51% were allergic to both seasonal and perennial allergens. Eighty-two per cent of the persistent rhinitics were allergic to at least one seasonal allergen and 72% of the intermittent rhinitics to at least one perennial allergen. When compared strictly with the ARIA recommendations, 49% of the patients with mild and/or intermittent AR were overtreated, whereas about 30% of those with moderate/severe persistent rhinitis were undertreated. CONCLUSION: This study confirms that the previous classification of AR into 'seasonal' and 'perennial' is not satisfactory and that intermittent and persistent AR are not equivalent to seasonal and perennial AR respectively. Furthermore, persistent rhinitis has been shown to be a distinct disease entity. Further efforts are required to disseminate and implement evidence-based diagnostic and treatment guidelines for AR in primary care practice.
Subject(s)
Allergens , Pollen , Rhinitis, Allergic, Perennial/classification , Rhinitis, Allergic, Seasonal/classification , Seasons , Adult , Belgium , Family Practice , Female , Guideline Adherence , Humans , Male , Practice Guidelines as Topic , Rhinitis, Allergic, Perennial/diagnosis , Rhinitis, Allergic, Perennial/drug therapy , Rhinitis, Allergic, Seasonal/diagnosis , Rhinitis, Allergic, Seasonal/drug therapyABSTRACT
Rendu-Osler-Weber disease or hereditary hemorrhagic telangiectasia (HHT) is a multisystem autosomal dominant hereditary disorder. The disorder is manifested by multiple dysplasia of blood vessels of the skin and mucous membranes. This results in recurrent and sometimes severe bleeding, of which epistaxis is the most common. Cardial, pulmonary and cerebral manifestations can be responsible for complications. A patient is presented with Rendu-Osler-Weber disease followed by a review of literature.
Subject(s)
Telangiectasia, Hereditary Hemorrhagic/genetics , Aged , Aged, 80 and over , Epistaxis/etiology , Female , Humans , Mutation , Patient Care Team , Prognosis , Telangiectasia, Hereditary Hemorrhagic/diagnosis , Telangiectasia, Hereditary Hemorrhagic/therapyABSTRACT
An 81-year-old woman suffered from bleeding of the tongue due to vascular malformations accompanying Rendu-Osler-Weber disease.
Subject(s)
Arteriovenous Malformations/diagnosis , Telangiectasia, Hereditary Hemorrhagic/diagnosis , Aged , Aged, 80 and over , Arteriovenous Malformations/genetics , Female , Humans , Laser Therapy , Tongue/abnormalities , Tongue/blood supplyABSTRACT
In the workplace, employees need to be protected from the health threats of exposure to environmental tobacco smoke. There is a significant cost to employers associated with employee smoking at work, yet the uptake and development of a well-defined policy on smoking are not widespread, and few policies tackle the issue through promotion of smoking cessation. Such an approach could not only reduce costs associated with smoking at work, but also have a direct impact on public health. GlaxoSmithKline has implemented a voluntary programme of smoking cessation support for its employees in the UK. The 10 week programme offers a series of one-to-one support sessions with a trained occupational health adviser, as well as access to nicotine replacement therapy patches. At 12 months (n = 123), 25 participants (20%) were non-smokers, of whom 19 (15%) stated that they had not smoked at all for the 12 month period. The other six (5%) had relapsed, but had since tried again and quit successfully. An additional three (2%) classed themselves as non-smokers but still smoked occasionally. Fifty-two per cent of participants stated that regular face-to-face contact and monitoring of progress were particularly useful in helping them to stop smoking. This provides compelling support for the active promotion and support of smoking cessation among employees.
