A common language to assess allergic rhinitis control: results from a survey conducted during EAACI 2013 Congress (original) (raw)
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Assessment of disease control in allergic rhinitis
Clinical and Translational Allergy, 2013
The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative has had a significant impact, by raising awareness of allergic rhinitis (AR) and improving the diagnosis and treatment of AR sufferers. ARIA classifies the severity of AR as "mild" or "moderate/severe" on the basis of "yes"/"no" answers to four questions. This two-point classification has been criticized as providing little guidance on patient management; patients with "mild" AR are unlikely to consult a physician, whereas the group of patients with "moderate/severe" seen by specialists is heterogeneous. These perceived shortcomings have prompted attempts to improve the ARIA classification or, by analogy with the Global Initiative for Asthma (GINA), adopt approaches based on "disease control" in AR. Even though "disease severity", "disease control" and "responsiveness to treatment" are different (albeit related) metrics, they are not mutually exclusive. Currently, there is no single, accepted definition, but we propose that "disease control" in AR can combine (i) measurements of the severity and/or frequency of daily or nocturnal symptoms, (ii) impairments in social, physical, professional and educational activities, (iii) respiratory function monitoring and (iv) exacerbations (e.g. unscheduled medical consultations and rescue medication use). Although control-based classifications have a number of limitations (e.g. their dependence on treatment compliance and the patient's psychological status), these instruments could be used as an adjunct to the ARIA severity classification and regional practice parameters. Here, we assess the strengths and weaknesses of the current two-level ARIA classification, analyze published proposals for its modification and review the literature on instruments that measure AR control. We conclude that there is a need for research in which severity is compared with control in terms of their effects on patient management.
The Rhinitis Control Scoring System: Development and validation
American journal of rhinology & allergy, 2016
Allergic rhinitis is a common health problem that requires regular monitoring of symptoms to provide adequate treatment. There is a need to develop rhinitis control assessment tools that are meaningful and easy to interpret by both the patient and the practitioner. To develop a simple, easy-to-interpret instrument, the Rhinitis Control Scoring System (RCSS), for the assessment of rhinitis control, as a companion tool to the Asthma Control Scoring System previously validated. After a literature review and based on the Allergic Rhinitis and its Impact on Asthma guidelines, allergic rhinitis control parameters were identified. The draft items were subjected to cognitive debriefing regarding instructions, wordings, and response options. The second version of the draft was then pretested and modified according to the results. The final draft of the RCSS, based on the intensity and frequency of symptoms, was then pilot tested with 50 subjects who had allergic rhinitis for validation of so...
Journal of Allergy and Clinical Immunology, 2013
Background: The Rhinitis Control Assessment Test (RCAT) is a brief, patient-completed tool to evaluate rhinitis symptom control. Objective: We sought to test the reliability, validity, and responsiveness of RCAT and to estimate a cut-point score and minimal important difference (MID). Methods: A total of 402 patients 12 years of age and older with allergic or nonallergic rhinitis were enrolled in a noninterventional study. Patients completed the RCAT (6 items; score range, 6-30) and had Total Nasal Symptom Scores (TNSSs) measured at baseline and 2 weeks later. Physicians completed a global assessment of rhinitis symptom control (Physician's Global Assessment) and disease severity. Internal consistency, test-retest reliability, convergent validity, knowngroups validity, and responsiveness were evaluated. The MID was determined by using distribution-and anchor-based methods. Content validity of the RCAT was assessed in individual interviews with a separate group of 58 adult patients. Results: Internal consistency and test-retest reliability of RCAT scores were 0.77 and 0.78, respectively. Convergent validity correlation between RCAT and TNSS scores was 0.57, and that between RCAT and Physician's Global Assessment scores was 0.34. Mean RCAT scores differed significantly (P < .001) across patient groups, differing in TNSS (F 5 72.7), Physician's Global Assessment score (F 5 28.6), and disease severity (F 5 34.1) in the hypothesized direction. Results suggested a cut-point score of 21 or less can be used to identify patients who are experiencing rhinitis symptom control problems. The preliminary estimate of the MID was 3 points. Patients found RCAT items comprehensive, easy to understand, and relevant. Conclusion: The RCAT demonstrated adequate reliability, validity, and responsiveness and was deemed acceptable and appropriate by patients. This tool can facilitate the detection of rhinitis symptom control problems, and its brevity supports its usefulness in clinical care. (J Allergy Clin Immunol 2013;131:379-86.)
The Patient: Patient-Centered Outcomes Research, 2010
Background: Effective management of allergic rhinitis requires ongoing monitoring of its control. This article describes the qualitative phase of development of a patient-completed instrument, the Rhinitis Control Assessment Test (RCAT), designed to assist patients and providers in the detection of problems with rhinitis symptom control. Objective: To identify concepts to be measured and to develop initial questionnaire items to be tested further in the next phase of development. Methods: A literature review and input from patient focus groups were utilized to generate concepts to be measured in the draft questionnaire. The draft items were subjected to cognitive testing to ensure that the items were understood by patients and to eliminate ambiguity as well as to select an optimal recall period and meaningful response scales. Patients aged ‡18 years selfreporting a rhinitis diagnosis who had experienced rhinitis symptoms in the past 12 months were eligible for participation in the focus groups (n = 39) and the cognitive interviews (n = 23). Results: This qualitative process yielded a draft instrument with 26 items assessing five constructs of rhinitis symptom control: frequency and bothersomeness of nasal and non-nasal symptoms, symptom impact, activity interference, symptom control, and medication use. A five-point Likert response scale and a 1-week recall period for each item were adopted based on patient input.
Change in visual analog scale score in a pragmatic randomized cluster trial of allergic rhinitis
Journal of Allergy and Clinical Immunology, 2009
Background: Most patients with allergic rhinitis consult in primary care. A simple test is needed to evaluate globally the severity of allergic rhinitis to assess the efficacy of treatment. Objective: This study compared the responsiveness of visual analog scale (VAS) scores between baseline and treatment with the 2 gold-standard outcomes (symptom score and quality of life). Five hundred eighty-six subjects were included, all with allergic rhinitis caused by grass pollens and all seen in primary care. Methods: A randomized, multicenter, open-label parallel study was designed to compare 2 therapeutic strategies in patients with allergic rhinitis. The disease-specific Rhinoconjunctivitis Quality of Life Questionnaire total score, the symptom score, and the VAS score (0-10 cm) were all self-assessed by the patient before and after 2 weeks of treatment. Receiver operating characteristic curves and cost function were used to assess VAS cutoff scores and to distinguish between patients with no clinical improvement and patients with improvement in symptoms, quality of life, or both. Results: The optimal cutoff in VAS score change separating the patients without improvement from those with improvement is 0.30 cm. By using the cost of false-positive and false-negative results, a difference of more than 1 cm is significant. However, when patients show an improvement in both symptoms and Rhinoconjunctivitis Quality of Life Questionnaire scores, the median improvement on the VAS is 7 cm. Conclusions: A VAS, when used for a global evaluation of rhinitis, is highly responsive to change during the treatment of a large number of patients in a cluster randomized pragmatic trial. (J Allergy Clin Immunol 2009;123:1349-54.) FIG 3. ROC curves (left) and cost function (right) evaluating VAS score evolution depending on clinical improvement. 1, No clinical improvement versus a clinical improvement in RQLQ score, RTSS4, or both. 2, No clinical improvement or clinical improvement in RQLQ score or RTSS4 versus clinical improvement in both RQLQ score and RTSS4.