Frequency and impact of allergic rhinitis in asthma patients in everyday general medical practice: a French observational cross-sectional study.

BACKGROUND: Allergic rhinitis (AR) and asthma are inflammatory conditions of the airways that often occur concomitantly. This observational, cross-sectional, national study was undertaken to describe the frequency and severity of AR in asthmatic patients. The impact of AR on the quality of life and the therapeutic management of patients in everyday general medical practice were also assessed. METHODS: From April to October 2005, 1906 French general practitioners (GP) participated in the study. Each physician had to fill out a questionnaire (including the Juniper Asthma Control Questionnaire and a Rhinitis Questionnaire) for up to 10 consecutive adult asthmatic patients. The first three patients with a confirmed diagnosis of AR (Allergic Rhinitis and its Impact on Asthma classification) were asked to complete the Juniper Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS: A total of 14,703 patient questionnaires and 4335 auto-questionnaires were analysed. Patients presented with intermittent (45%), mild (25%), moderate (25%) and severe (4%) persistent asthma. The frequency of AR in asthmatic patients was 55.2% (CI: 95%, 54.4-56.0%). Allergic rhinitis was mild for 54% and moderate/severe for 46% of patients. The frequency and severity of AR increased with the severity of asthma (P < 0.001). Moreover, AR was associated with worse asthma control whatever be the severity of asthma (P < 0.001). The global RQLQ scores of AR patients worsened with the severity of asthma (P < 0.001). Prescription of anti-asthma treatments significantly increased with the severity of AR. The majority of AR patients (81%) were treated for rhinitis. CONCLUSIONS: This survey suggested that AR was associated with more severe asthma, more difficulty to control asthma and substantial impairment of quality of life. The high frequency of AR in asthma patients requires that these conditions should be recognized and managed by GP.

[Schnyder's crystalline dystrophy. I. Study of a case by light and electron microscopy]. / Dystrophie cristalline de Schnyder. I. Etude d'un cas en microscopie optique et en ultrastructure.

Bilateral penetrating keratoplasties were performed in a case of Schnyder's crystalline stromal dystrophy and the buttons were examined by light and electron microscopy. Staining for lipids was negative probably because they had been dissolved during the dehydrating stage of the embedding process. In electron microscopy the deposits were highly suggestive of lipids. These deposits appeared as electron-lucent spaces, either empty and of regular geometrical form suggestive of cholesterol crystals, or smaller, rounded, and containing relative electron-lucent material also believed to be lipids. The crystals randomly accumulated in the superficial stroma, in Bowman's layer and in some basal epithelial cells, and the rounded spaces could be seen in all the layers of the stroma. Bowman's layer exhibited many disruptions. The endothelium and Descemet's membrane were unaffected. Our findings are compared with previous histological and electron microscopical reports.

[Schnyder's crystalline dystrophy. II. Association with genu valgum]. / Dystrophie cristalline de Schnyder. II. Association à un genu valgum.

The present study describes a family in which Schnyder's crystalline stromal dystrophy coexisted with genu valgum. One member, a woman, exhibited only the corneal dystrophy. She underwent a bilateral corneal graft and the buttons studied by light and electron microscopy were described in another report. Her daughter exhibited only genu valgum and her son had both disorders. It is to our knowledge the fourth report on the combination of Schnyder's dystrophy and genu valgum in the same family. The significance of this association and other associations like hyperlipoproteinaemia and xanthelasma are discussed.