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ICAR - Control and Burden of Asthma and Rhinitis

  • Main research unit: Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde (CINTESIS/FM/UP)
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  • Researchers
    • André Miguel Afonso de Sousa Moreira
    • José Luís Dias Delgado
    • António Apolinário Bugalho de Almeida
    • Luís Filipe Ribeiro de Azevedo
    • Tiago António Queirós Jacinto
    • Mário Augusto Sanches Morais de Almeida
    • António Jaime Botelho Correia de Sousa
    • Luís Miguel Vieira de Araújo
  • Fellows
    • Ivânia Martins Gonçalves
    • Rita Pinho Pereira da Silva
  • Start date: 01.03.2012 | End date: 28.02.2013
  • Financing: € 149,755.00 (FCT)

Project description: Accurate data on the burden of chronic diseases is needed to set up evidence-based health policies. Asthma and rhinitis are highly prevalent respiratory diseases, causing substantial social and personal burden. Asthma and rhinitis are intrinsically related to each other. Frequently, they are co­morbidities in the same patient and the outcomes of one disease are influenced by the status of the other. However, the degree of this influence is poorly known.

During 2010, we've conducted two cross-sectional, telephone national surveys that assessed the prevalence (Portuguese Asthma Prevalence Survey PAPS) and the control (Portuguese Asthma Control Survey PACS) of asthma and rhinitis. Before these surveys there was no country-wide data on prevalence or about the control of asthma in Portugal. The PACS was commissioned by the Portuguese Health Directorate within the Portuguese program for the control of asthma. Of the 6003 interviews completed in PAPS, 559 participants with self-reported current asthma, 648 with self-reported current rhinitis without asthma and 753 individuals without respiratory symptoms were interviewed in PACS. The main questionnaires used were the GAZLEN survey and in CARAT (Control of Allergic Rhinitis and Asthma Test). The GAZLEN survey has been used in many European countries in the last few years.
However, no study has validated this instrument. CARAT was developed and validated by our group and was recently proposed as a first tool to implement ARIA guidelines in primary care. In spite of thorough evaluated in patients from secondary care, it has not been assessed in patients from the general population.

We propose an additional study that will apply a comprehensive set of diagnostic tests and clinical assessment to a sub-sample of participants in the PACS study. The effect of asthma, rhinitis and their control on personal and social burden will be studied comparing patients with current asthma and/or rhinitis and individuals with no respiratory symptoms. The aims of this project are: 1) to validate the survey instruments used PAPS and PACS, with clinical and objective tests and 2) to compare the disease burden of different groups of participants assessing the effect of i) the diseases and ii) its control. It will be an observational cross-sectional study which will include 750 individuals of all ages, divided in 4 groups: 1) Patients with a self-reported diagnosis of asthma alone (n=150), 2) Patients with a self-reported diagnosis of rhinitis alone (n=150), 3) Patients with a self-reported diagnosis of asthma and rhinitis (n=150) and 4) Patients with no history of respiratory symptoms or diseases (n=300). Sample size calculations were based on the comparison of quality of life measured by WHOQOL-BREF in patients with different diagnosis. Data collection includes anthropometric measurements, lung function & inflammation tests, allergy tests, a structured clinical interview and standardized questionnaires. Research assistants performing the evaluations will be blinded to the subject classification in PAPS and PACS and to the results of the questionnaires administered, namely the GA2LEN survey instrument and CARAT` The data collection will be organized with the local Public Health delegate and will take place as close as possible to the participants' communities at a local health unit or in the surrounding area, in order to minimize dropouts.

This study will provide novel data on the burden of high-prevalence diseases, in light of the presence of asthma or rhinitis alone or together and of the control status of the diseases. This data will contribute to better estimates of the effects of health policies aiming to improve disease control and will aid the development of new policies addressing asthma and rhinitis together.

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