Polysensitisation in children with allergic rhinitis

  • There has been little previous research on polysensitisation in children with allergic rhinitis in primary care. On pg 155, de Bot et al. report on 784 Dutch children aged 6–18 years with either a doctor diagnosis of allergic rhinitis or documented regular use of allergic rhinitis medication. Nasal and eye symptom scores were recorded, and allergen-specific IgE to grass and birch pollens, house dust mite, cat dander, and household pets was measured. 89% were monosensitive (i.e. one positive specific-IgE test) and 69% were polysensitive (≥ 2 positive specific-IgE tests). There were no significant sex differences and no difference in eye or nasal symptom scores between the mono- and polysensitised children.

Patients who prefer once-daily controller treatment for asthma and COPD

  • What patient characteristics indicate a preference for once-daily controller treatment? Price et al. studied 3,371 asthma patients and 2,138 COPD patients (pg 161). 48.2% of the asthma patients and 44.7% of the COPD patients preferred a once-daily controller regimen. Preference for once-daily controller treatment for asthma was significantly associated with poor adherence, concerns about medication, and better disease control. For COPD, preference for once-daily treatment was significantly associated with a high self-perceived need for controller medication, and concerns about medication. In his linked editorial (pg 140), Horne considers the results and discusses their significance.

DOSE can predict changes in COPD health status

  • The DOSE index was developed and validated in primary care patients. A DOSE score of ≥4 (maximum of 8) is associated with an increased risk of hospitalisation, respiratory failure, and mortality (see http://dx.doi.org/ 10.4104/pcrj.2012.00054, published in last September's PCRJ). On pg 169, Rolink et al. report a prospective cohort study to examine whether DOSE can predict the risk of decline in health status in COPD patients. They compared the 2-year change in CCQ score in patients with a DOSE score of ≥4 versus those with a score of <4. Using three different analyses, a high DOSE score (>4) was a significant predictor of change in CCQ score after 2 years, particularly in primary care patients. The linked editorial by Sundh and colleagues (pg 142) puts the paper in context.

BOLD in Salzburg: underuse of spirometry in the diagnosis of COPD

  • With its rigorous use of diagnostic protocols using both questionnaires and spirometry, the Burden of Obstructive Lung Disease (BOLD) study has provided much needed data on the burden of COPD and variations in prevalence between different countries. The study by Lamprecht et al. (pg 195) from Salzburg, Austria, reports on how many people with a self-reported diagnosis of COPD had previous spirometry, and whether previous spirometry increased the likelihood of a correct COPD diagnosis. 1,258 participants provided complete BOLD questionnaire and spirometry data. Surprisingly, there was no difference in the likelihood of a correct COPD diagnosis between those subjects who reported spirometry in the last 12 months and those who didn't… In his linked editorial (pg 145), Marks discusses the evaluation of patients with lung disease in primary care.

Smoking prevalence in young women in Sweden: higher than expected

  • On pg 214, Wennergren et al. present further data from the West Sweden Asthma Study. Responders in the 16–25 year age group (n = 2,702; 1,548 women) provided data on smoking and smoking-related respiratory symptoms. Significantly more young women than men were active smokers [23.5% vs. 15.9%; P<0.001] or ex-smokers [7.2% vs. 4.1%; P=0.001]. Symptoms such as longstanding cough, sputum production, wheeze and chest tightness were much more common in smokers than in never-smokers, and (as expected) smoking significantly increased the risk of recurrent wheeze and sputum production. These are higher than expected prevalence figures for smoking and respiratory symptoms in young women…

Paul Stephenson and Aziz Sheikh