Comorbidities and allergic rhinitis: Not just a runny nose
Authors of papers presented in this Supplement met in person at the 2011 Annual Meeting of the American College of Allergy, Asthma & Immunology to further discuss the clinical, social, and economic implications of the findings from the Nasal Allergy Survey Assessing Limitations (NASAL; www.nasalsurvey.com), a study sponsored by Teva Respiratory, LLC. This paper represents an edited transcript of their discussion.
Given the recent changes in US health care, how should the results of the NASAL 2010 survey be used to inform current practice? What about the role of other health care professionals and what are the cost implications of the survey findings?
Dr. Hadley: Firstly, it is important to note that there were improvements in the design of the NASAL 2010 survey compared to its 2006 predecessor. More importantly, although some of the 2010 information was a little bit different, we found that the majority of patients still suffer from their symptoms, and that the symptoms are predominant and bothersome. Allergic rhinitis bothers their sleep; it bothers their work and daily activities. In other words, we have not really seen any difference in achieving a reduction of the patients’ symptoms from 2006 to 2010.
Dr. Meltzer: Looking at this issue more globally, I think that the lack of change has a great deal to do with the public not understanding what “health” is. The World Health Organization (WHO) definition of health is there should be no problems with physical, social, emotional, or mental well-being. Individuals often do not appreciate how healthy they could be, and thus do not have a reference point. The NASAL survey clearly shows that most nasal allergy sufferers are not aware of an appropriate respiratory health goal and, further, they are not cognizant of the magnitude of their disease due to their allergic rhinitis. I believe the patients are not the only ones who are unaware; I think many clinicians are also not aware of the extent of their patients’ morbidity. A current problem is that there is not enough assumption of responsibility; patients are not taking enough responsibility for their health, clinicians are not adequately managing these patients, and—despite the suggested health care reforms—there does not appear to be in the foreseeable future a system that is going to alter these conditions.
Dr. Stoloff: For example, many family physicians only ask the question “How are you (with respect to this topic)?” and patients often say they are fine, and that’s the end of the dialogue. But consequences of this type of discussion are that costs of health care continue due to the lack of health. So the person misses work or the person’s job performance is less than it would be because they don’t recognize what their health could be if they were properly treated. As far as they’re concerned, this situation has been going on year after year, and it is only when they are really bad that they know they should be somewhat better. Even then, most people do not fully appreciate what is achievable because no one in the health care system has ever told them, “You should be able to sleep through the night and wake up feeling well. You should be able to go to work. You should be able to participate in athletic, recreational venues to be healthy.” No one has brought that up, and as long as this situation continues, the cost for the patient, his or her family, and health care will continue to increase.
Dr. Hadley: One of the things that I see as an otolaryngologist is that there is also often a missed diagnosis. Everybody who comes in to see me tells me: “Doctor, I have ‘sinus’.” I think most of them are simply unaware of that fact that their nasal congestion plays a role in developing their sinus symptoms. So there is general unawareness of the importance of treating nasal allergies in the lay public, as well as in primary care physicians who have to deal with these patients. Going to issues of cost, I think that patients are seeing the economy go down, and this means that they don’t want to spend a lot of money on their health care. They have a lot of other worries, and I think this is playing a role in how we have to deal with our patients.