Chronic non allergenic Rhinosinusitis accounts for 1/3 of visits to physicians offices.In many of our asthmatics, cough is the presenting symptom. This study is to evaluate benefits of daily nasal steroids and HT1 blockers in decreasing severity of bronchial inflamation, improvement of disease control and quality of life.
Study is a retrospective observational based on Blue Shield Puerto Rico expenditures of all services and medications paid in 2004 for the population of this study and the control patients. The subject were 358 patients referred to center because of refractioness to management. Control population consisted of 12,070 asthmatics treated by the neumologists in the community. Inclussion criteria were: an age of 12-70 years, presence of Rhinosinusitis, cough as prominent symptons, severe airway obstruction shown by spirometry and low peak flow (PEF)readings, prior visits to emergency department and or hospital admissions in 2003.Upon entry patients received instructions in the use of PEF and logging, nasal steroids, inhaled bronchial medication, emergency albuterol inhalations.The use of daily nasal steroids was continous for 4 weeks.
Asthma complex with Bronchial Obstruction decreased as evidenced by peak flow redings and controller medications and by dollars paid for them.The shift in cost occurs in favor use of nasal steroids and HT1 blockers .The emergency dept visits and admissions decreased to the lowest levels. In 2004 2 out of 176 ptswere admitted for 0.4% lower than in 2003that was 1 %.
The study showed dramatical improvement in severity of airway obstructions and symptoms complex with 88% less hpspital admissions and a dramatic decrease in the use and cost of controller medications. Use of daily nasal steroids is of great benefit in the majority of patients.
Daily nasal steroids and HT1 blockers should be part of the management of moderately severe and severe asthmatic. Study showed the benefit of this practice for patients and for the economy. This study may improved the asthma management.
Ramon Figueroa -Lebron, None.