Rhinitis associated with asthma is distinct from rhinitis alone: TARIA‐MeDALL hypothesis

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of “one-airway-one-disease,” coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the “Epithelial Barrier Hypothesis.” This review determined that the “one-airway-one-disease” concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme “allergic” (asthma) phenotype combining asthma, rhinitis, and conjunctivitis.info:eu-repo/semantics/publishedVersio

Evaluation de la prise en charge intégrée de l’otite moyenne chronique dans le système des soins de santé primaires à Kinshasa, République Démocratique du Congo: Assessment of integrated management of chronic otitis media in the primary health care system in Kinshasa, Democratic Republic of the Congo

Context and objective. Chronic Otitis Media (COM) is common with significant health and economic consequences. Health care workers play a key role in the management of this condition. This study aimed to assess the availability and adequacy of human and material resources for the management of COM in the primary health care system (PHC) in Kinshasa. Methods. In a crosssectional analytical study, four categories of human resources (community health relay, nurse, general practitioner, and medical specialist) providing PHC in Kinshasa were interviewed between July 2 and 21, 2020. Results. 218 health care providers participated. At the primary level, the availability of providers was observed, but their performance on basic care activities was poor among the Reco and IT interviewed. In multivariate logistic regression analysis, female gender, lack of training in PHC of the ear and lack of management materials were the factors independently associated with poor response among Reco while A1 and A2 education (awareness), lack of training in PHC of the ear andlack of equipment were the factors independently associated among IT. At the Reference GeneralHospital (RGH) level, the General Practitioners (GPs) interviewed showed a lack of a coherentand reliable referral system between the Health Center (HC) and the RGH as well as between theRGH and the specialist Center. At the tertiary level, 75% of the facilities had only medical treatment as the only treatment option due to lack of expertise (75%) and surgical equipment (87.5%) in surgical management according to the specialist doctors interviewed. Conclusion. Management of COM is not efficient in PHC in Kinshasa. Capacity building of health care providers on the management of COM is an urgent need in Kinshasa. Contexte & objectif. L’otite moyenne chronique (OMC) est une maladie très fréquente aux conséquences sanitaires et économiques importantes. Le personnel soignant joue un rôle primordial dans la prise en charge de cette pathologie. L’objectif de l’étude était d’évaluer la disponibilité et l’adéquation entre les ressources humaines et matérielles et les activités de prise en charge de l’OMC. Méthodes. Dans une étude transversale analytique, 4 catégories de ressources humaines (relais communautaire, infirmier titulaire, médecin généraliste et médecin spécialiste) prestant dans le système des soins de santé primaire (SSSP) de Kinshasa, ont été interviewés, entre les 2 et 21 juillet 2020. Résultats. 218 prestataires de soins ont participé. Au niveau primaire, une disponibilité des prestataires a été objectivée, mais leur performance sur les activités de prise en charge de base a été faible chez les interviewés. En analyse de régression logistique multivariée, le sexe féminin, le manque de formation en SSP de l’oreille et l’absence d’équipement de PEC ont été les facteurs associés de manière indépendante à une mauvaise réponse chez les Reco tandis que chez les IT, il s’agissait des niveaux d’étude A1 et A2, le manque de formation en SSP de l’oreille et l’absence d’équipement. Au niveau de l’HGR, les médecins généralistes interviewés ont montré un manque de référence et de contre-référence entre le CS et l’HGR ainsi qu’entre l’HGR et le centre spécialisé. Au niveau tertiaire, 75% des structures ne donnent que le traitement médical faute d’expertise (75%) et de matériel de chirurgie (87,5%) dans la prise en charge chirurgicale selon les médecins spécialistes interviewés. Conclusion. La prise en charge intégrée de l’OMC n’est pas optimale dans le SSSP à Kinshasa. Un renforcement des capacités des prestataires des soins sur la prise en charge de l’OMC est impérieux à Kinshasa

ARIA pharmacy 2018 "Allergic rhinitis care pathways for community pharmacy" AIRWAYS ICPs initiative (European Innovation Partnership on Active and Healthy Ageing, DG CONNECT and DG Sante) \nPOLLAR (Impact of Air POLLution on Asthma and Rhinitis)\nGARD Demonstration project

Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.Peer reviewe