0 Control of Allergic Rhinitis and Asthma Test (CARAT): dissemination and applications in primary care

Online first

Discussion Paper

Control of Allergic Rhinitis and Asthma Test (CARAT): dissemination and applications in primary care

Pedro Azevedo¹, Jaime Correia de Sousa², Jean Bousquet³, António Bugalho-Almeida⁴, Stefano R Del Giacco⁵, Pascal Demoly⁶, Tari Haahtela⁷, Tiago Jacinto⁸, Vanessa Garcia-Larsen⁹, Thys van der Molen¹⁰, Mário Morais-Almeida¹¹, Luis Nogueira-Silva¹², Ana M Pereira¹³, Miguel Román Rodríguez¹⁴, Bárbara G Silva¹⁵, Ioanna G Tsiligianni¹⁶, Hakan Yaman¹⁷, Barbara Yawn¹⁸, ^*João A Fonseca¹⁹, in collaboration with the WHO Collaborative Center for Asthma and Rhinitis, Montpellier

Abstract
Asthma frequently occurs in association with allergic rhinitis and a combined management approach has been suggested. The Control of Allergic Rhinitis and Asthma Test (CARAT) is the first questionnaire to assess control of both diseases concurrently. However, to have an impact on healthcare it needs to be disseminated and adopted. In this paper we discuss the dissemination of CARAT in different countries and its possible applications in primary care. At present, the adaptation of CARAT for use in different languages and cultures is being led by volunteer researchers and clinicians in 15 countries. Website and smartphone applications have been developed, and a free open model of distribution was adopted to contribute to the dissemination of CARAT. Examples of dissemination activities include distribution of leaflets and posters, educational sessions on the use of the questionnaire in the follow-up of patients, development of clinical studies, collaborations with professional organisations and health authorities, and the inclusion of CARAT in clinical guidelines. The adoption of innovations is an important challenge in healthcare today, and research on the degree of success of dissemination strategies using suitable methods and metrics is much needed. We propose that CARAT can be used in a range of settings and circumstances in primary care for clinical, research and audit purposes, within the overall aim of increasing awareness of the level of disease control and strengthening the partnership between patients and doctors in the management of asthma and rhinitis. 

Cite as: Azevedo P, Correia de Sousa J, Bousquet J, Bugalho-Almeida A, Del Giacco SR, Demoly P, Haahtela T, Jacinto T, Garcia-Larsen V, van der Molen T, Morais-Almeida M, Nogueira-Silva L, Pereira AM, Rodríguez MR, Silva BG, Tsiligianni IG, Yaman H, Yawn B, Fonseca JA, in collaboration with the WHO Collaborative Center for Asthma and Rhinitis, Montpellier. Control of Allergic Rhinitis and Asthma Test (CARAT): dissemination and applications in primary care. Prim Care Respir J 2013; Available from: URL: http://dx.doi.org/10.4104/pcrj.2013.00012

Keywords
Asthma, rhinitis, control, questionnaire, dissemination, cultural adaptation

* Corresponding author. João A Fonseca Tel: +351914767661 Fax: +351914767661 Email:fonseca.ja@gmail.com

	View full text as PDF document
	Right click on this DOI link and copy link/shortcut to cite this article (What is a DOI link?)
	Export to bibliographic software or plain text
	Post to CiteULike
	Email this article to friend/s or colleague/s

Original Article  Open Access

 |  | Full Text    |    Asia Pac Allergy. 2013 Jan;3(1):42-49. English. Published online 2013 Jan 22.  http://dx.doi.org/10.5415/apallergy.2013.3.1.42  Copyright © 2013. Asia Pacific Association of Allergy, Asthma and Clinical Immunology. Asthma in Mexican school-age children is not associated with passive smoking or obesity Martín Bedolla-Barajas,1 Ana T. Barrera-Zepeda,2 Juan B. López-Zaldo,3 and Jaime Morales-Romero4 1Allergy and Clinical Immunology Service, Division of Internal Medicine, The “Dr. Juan I. Menchaca” Civil Hospital of Guadalajara, University of Guadalajara, Guadalajara, Jalisco 44340, Mexico. 2The Hospital Regional of Ciudad Guzman, Ministry of Health, Ciudad Guzman, Jalisco 49120, Mexico. 3Medical Intern, Southern Region University Center, University of Guadalajara, Ciudad Guzman, Jalisco 49000, Mexico. 4The Public Health Institute, University of Veracruz, Xalapa, Veracruz 91190, Mexico.  Correspondence: Martín Bedolla-Barajas. 2330-301 Eulogio Parra, Col. Las Américas, Guadalajara, Jalisco 44650, México. Tel: +52-33-33-42-89-16, Fax: +52-33-33-42-89-16, Email: drmbedbar@gmail.com  Received February 07, 2012; Accepted December 26, 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Educational & Teaching Material  Open Access

 |  | Full Text    |    Asia Pac Allergy. 2013 Jan;3(1):59-69. English. Published online 2013 Jan 22.  http://dx.doi.org/10.5415/apallergy.2013.3.1.59  Copyright © 2013. Asia Pacific Association of Allergy, Asthma and Clinical Immunology. Diagnosis of food allergies: the impact of oral food challenge testing Komei Ito Department of Allergy, Aichi Children’s Health and Medical Center, Aichi 474-8710, Japan.  Correspondence: Komei Ito. Department of Allergy, Aichi Children’s Health and Medical Center, 1-2 Osakada, Morioka, Obu-city, Aichi 474-8710, Japan. Tel: +81-562-43-0500, Fax: +81-562-43-0513, Email:koumei_itoh@mx.achmc.pref.aichi.jp  Received December 13, 2012; Accepted December 16, 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Editorial  Open Access

 |  | Full Text    |    Asia Pac Allergy. 2013 Jan;3(1):1-2. English. Published online 2013 Jan 30.  http://dx.doi.org/10.5415/apallergy.2013.3.1.1  Copyright © 2013. Asia Pacific Association of Allergy, Asthma and Clinical Immunology. Allergies in Asia: are we facing an allergy epidemic? Meera Thalayasingam,1 and Bee Wah Lee1,2 1Department of Paediatrics, Khoo Teck Puat National University Children’s Medical Institute, National University Hospital, Singapore 119228, Singapore. 2Department of Paediatrics, National University of Singapore, Singapore 119228, Singapore.  Correspondence: Bee Wah Lee. Division of Allergy and Immunology, Department of Paediatrics, National University Hospital, Level 12, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore. Fax: +65-67797486, Tel: +65-67724411, Email: bee_wah_lee@nuhs.edu.sg  Received January 10, 2013. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Research

Sputum mediator profiling and relationship to airway wall geometry imaging in severe asthma

Dhananjay Desai, Sumit Gupta, Salman Siddiqui, Amisha Singapuri, William Monteiro, James Entwisle, Sudha Visvanathan, Harsukh Parmar, Radhika Kajekar and Christopher C Brightling

• 
  
  
  

For all author emails, please log on.

Respiratory Research 2013, 14:17 doi:10.1186/1465-9921-14-17

Published: 11 February 2013

Abstract (provisional)

Background

Severe asthma is a heterogeneous disease and the relationship between airway inflammation and airway remodelling is poorly understood. We sought to define sputum mediator profiles in severe asthmatics categorised by CT-determined airway geometry and sputum differential cell counts.

Methods

In a single centre cross-sectional observational study we recruited 59 subjects with severe asthma that underwent sputum induction and thoracic CT. Quantitative CT analysis of the apical segment of the right upper lobe (RB1) was performed. Forty-one mediators in sputum samples were measured of which 21 mediators that were assessable in >50% of samples were included in the analyses.

Results

Independent of airway geometry, sputum MMP9 and IL-1beta were elevated in those groups with a high sputum neutrophil count while sputum ICAM was elevated in those subjects with a low sputum neutrophil count. In contrast, sputum CCL11, IL-1alpha and fibrinogen were different in groups stratified by both sputum neutrophil count and airway geometry. Sputum CCL11 concentration was elevated in subjects with a low sputum neutrophil count and high luminal and total RB1 area, whereas sputum IL1alpha was increased in subjects with a high sputum neutrophil count and low total RB1 area. Sputum fibrinogen was elevated in those subjects with RB1 luminal narrowing and in those subjects with neutrophilic inflammation without luminal narrowing.

Conclusions

We have demonstrated that sputum mediator profiling reveals a number of associations with airway geometry. Whether these findings reflect important biological phenotypes that might inform stratified medicine approaches requires further investigation.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

     Â

Services on Demand

Article

• pdf in English


• Article in xml format


• Article references


• 
  How to cite this article
  


• 
  Curriculum ScienTI
  
  
  
  
  


• Automatic translation

Indicators

Related links

Bookmark

• 
  
  Share on deliciousShare on googleShare on twitterShare on diggShare on citeulikeShare on connotea|More Sharing ServicesMore
  

  
  
  
  

---

• Permalink

Sao Paulo Medical Journal

Print version ISSN 1516-3180

Sao Paulo Med. J. vol.130 no.5 São Paulo  2012

http://dx.doi.org/10.1590/S1516-31802012000500005 

ORIGINAL ARTICLE

Autoimmune thyroid disease as a risk factor for angioedema in patients with chronic idiopathic urticaria: a case-control study

Doença autoimune da tireoide como um fator de risco para angioedema em pacientes com urticária crônica idiopática: um estudo caso-controle

Ruy Felippe Brito Gonçalves Missaka^I; Henrique Costa Penatti^I; Maria Regina Cavariani Silvares^II; Célia Regina Nogueira^III; Gláucia Maria Ferreira da Silva Mazeto^IV

^IUndergraduate Medical Student, Department of Internal Medicine, Botucatu Medical School, Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil
^IIMD, PhD. Professor of Dermatology, Department of Dermatology and Radiotherapy, Botucatu Medical School, Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil
^IIIMD, PhD. Professor of Endocrinology and Metabology, Department of Internal Medicine, Botucatu Medical School, Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil
^IVMD, PhD. Professor of Endocrinology and Metabology, Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil

Address for correspondence

---

ABSTRACT

CONTEXT AND OBJECTIVE: An association between chronic idiopathic urticaria (CIU) and autoimmune thyroid disease (ATD) has been reported. However, there have not been any reports on whether ATD raises the risk of angioedema, which is a more severe clinical presentation of CIU. Thus, the aim of the present study was to evaluate whether the risk of angioedema is increased in patients with CIU and ATD.
DESIGN AND SETTING: Case-control study including 115 patients with CIU at a tertiary public institution.
METHODS: The patients were evaluated with regard to occurrence of angioedema and presence of ATD, hypothyroidism or hyperthyroidism.
RESULTS: Angioedema was detected in 70 patients (60.9%). There were 22 cases (19.1%) of ATD, 19 (16.5%) of hypothyroidism and nine (7.8%) of hyperthyroidism. The risk among patients with ATD was 16.2 times greater than among those without this thyroid abnormality (confidence interval, CI = 2.07-126.86). The odds ratio for hypothyroidism was 4.6 (CI = 1.00-21.54) and, for hyperthyroidism, 3.3 (CI = 0.38-28.36).
CONCLUSIONS: Patients with CIU and ATD presented greater risk of angioedema, which reinforces the idea that a relationship exists between this allergic condition and thyroid autoimmunity. This finding could imply that such patients require specifically directed therapy.

Key words: Angioedema. Allergy and immunology. Autoimmunity. Hashimoto disease. Thyroiditis. Urticaria.

---

RESUMO

CONTEXTO E OBJETIVO: A associação de urticária crônica idiopática (UCI) com doença autoimune da tireoide (DAT) é relatada. Porém, não foram encontrados relatos se a DAT eleva o risco de angioedema, uma apresentação clínica mais grave da UCI. Assim, o objetivo do presente estudo foi avaliar se o risco de angioedema está aumentado em pacientes com UCI e DAT.
TIPO DE ESTUDO E LOCAL: Estudo caso-controle, incluindo 115 pacientes com UCI em uma instituição pública terciária.
MÉTODOS: Os pacientes foram avaliados quanto à ocorrência de angioedema e à presença de DAT, hiper ou hipotireoidismo.
RESULTADOS: Angioedema ocorreu em 70 pacientes (60,9%). Foram observados 22 (19,1%) casos de DAT, 19 (16,5%) de hipotireoidismo e 9 (7,8%) de hipertireoidismo. Os pacientes com DAT apresentaram risco 16,2 vezes maior de angioedema do que os sem a alteração tireoidiana (intervalo de confiança, IC = 2.07-126.86). Oodds ratio, para hipotireoidismo, foi de 4,6 (IC = 1.00-21.54) e para hipertireoidismo foi de 3,3 (IC = 0.38-28.36).
CONCLUSÕES: Pacientes com UCI e DAT apresentaram maior risco de angioedema, reforçando a ideia de existência de relação entre o quadro alérgico e autoimunidade tireoidiana. Este achado poderia implicar em um direcionamento terapêutico específico para tais pacientes.

Palavras-chave: Angioedema. Alergia e imunologia. Auto-imunidade. Doença de Hashimoto. Tireoidite. Urticária.

---