2015 ERS EVENTS

DATE: FRIDAY SEPTEMBER 25TH

VENUE: Wyndham Apollo Hotel, AmsterdamROOM: BoardroomTIME: 11:00AM-12.30PM

CHAIR: David Price, Professor of Primary Care Respiratory Medicine, The University of Aberdeen, Aberdeen, UK

ALLERGY WORKING GROUP UPDATE MEETING

Agenda

David Price, Professor of Primary Care Respiratory Medicine, The University of Aberdeen, Aberdeen, UK

Reminder of Barcelona Meeting Discussions

Research ideas discussed Nasal Hyper-Responsiveness: • Actions: Peter Hellings; • Participating collaborators: Sinthia Bosnic Anticevich; Alvaro Cruz; Pete Smith + others • Explore the role of NHR in uncontrolled allergic rhinitis. • Studies to be run in specialist care; primary care; pharmacy settings.

Urticaria concept: • Discussion Lead: Martin Church• Characterise current prescribing behavior for urticaria• Evaluate the real-life effectiveness of available (and prescribed) treatments.

Patient-centric outcomes• Discussion Lead: Fulvio & Walter• Introduce a patient-centered evaluation of effectiveness in AR management

o Ask the patient what they need/want from their treatment; o Use a VAS to assess attainment of that outcome

Near-patient testing for IgE• Evaluate the utility of continuous IgE monitoring & circulating IgE as biomarkers

Research actions proposedNasal Hyper-Responsiveness: • UK primary care data collection: add ~5 questions to the Optimum Patient

Care clinical service questionnaire so that data can be collected on: o Upper airway hyper responsivenesso Lower airway hyper responsiveness o Upper airway symptomso Lower airway symptomso Use of over-the-counter medicationso VAS to evaluate control.

• Australia pharmacy data collection: o Similar questions to be (potentially) integrated into Australian pharmacy study (with

ethics at the time of the previous meeting)

Urticaria concept: • Investigate number of patients with diagnosed urticaria in the OPC research

database to inform feasibility.

David Price: Professor of Primary Care Respiratory Medicine, The University of Aberdeen, UKDermot Ryan: Clinical Advisor to Optimum Patient Care; Honorary Fellow at the University of Edinburgh, UKSinthia Bosnic-Anticevich: Associate Professor and Principal Research Fellow, School of Medical Sciences, University of Sydney, Australia

Nasal & Bronchial Hyper-Reactivity New Data Collection Opportunities

Current OPC Questionnaire Questions (I)

Current OPC Questionnaire Data

Do you have any of these symptoms: itchy, runny, blocked nose or sneezing

when you don’t have a cold?

Do any of the following upset your asthma? Tick all that apply.

6,817

24,396

No

Yes

31,213

11,623

15,771

Cigarette Smoking

Allergies

15,913Strenuous Activity

19,964Colds

New OPC Questions (I)

  Nose Chest   Nose ChestSpring Time     Cooking Scent    

Summer     Cigarette Smoke    

Food     Paint Scent    

Pet Animals     Perfume    

Dust (house)     Emotions    

Grass     Physical Stress    

Trees Strong odors    

Cold Air Temperature changes

Fog Humidity changes

Which of the following upsets your nose and/or chest…?

GREEN evidence for allergy. ORANGE evidence for BHR.

RED evidence of NHR. Any positive answer regard as evidence in a binary analyses yes/no

Are your nasal symptoms always present? Yes No

Combine Nose & Chest/

Separate?

New OPC Questionnaire? (II)

How often do you consume fast food?

<1 a month 1-3 a month 1-2 x a week

3-4 x a week >5 x a week

How much fruit and/or soft drinks do you consume?

<1 a month 1-3 a month 1-2 x a week

3-4 x a week >5 x a week

Allergy Questionnaire?Evaluation of VAS scores for TNS and individual scores in AR during the last month (and/or during the

pollen season)

New OPC Questionnaire Questions (II)

• Data collection to begin Q1 2016

• Dietary questions:o Need for an allergy questionnaire?o Clinical reasoning for sending an allergy questionnaire?o Feasibility of implementation

• Possibility to integrate into Australian Pharmacy Study…?

Australia Pharmacy Study• Aim:

o To determine the current status of AR management in primary care.o To determine the burden of AR on community pharmacy.o To identify management practices.o To identify facilitators and barriers to optimal AR management,

• Goal: To develop and pilot test a AR Clinical Management Pathway for community pharmacy based on the needs of patients and ARIA 2015 (which will be subsequently tested and integrated into future Integrated Care Pathways for AR.

• Patients/pharmacy customers:o N=200o People who either self-select a nasal-symptom related product or approach the pharmacist

• Data capture: People are asked about:o About the symptoms they are trying to treat

– Including nasal symptoms in recognition that ≥33% of people receive a formal diagnosis for AR or hay fever. Interested to evaluate degree of self-medication

o About the medication they have chosen– Why they have chosen it – What else they have tried in the past.

• Data collection by researcher rather than pharmacist as data collection is post interaction with the pharmacist and do not want to influence user/patient behaviour.

• Status:o Data collected for n=168 patients to dateo Completed 50 in depth interviews with patients. o Interviews with pharmacists and GPs still to be completed.o Psuedopatient visits to the pharmacy to validate our findings still to be carried out.

Group Discussion

Future Study Ideas

OPCRD Queries following Barcelona

UrticariaMartin Church• GPs describe urticaria as one of the most confusing and challenging conditions

they see.

• Little is known of how GPs currently manage urticarial, i.e. what drugs they prescribe.

• 90% of anti-histamine sensitive patients can be cured by the use of omalizumab, indicating the presence of an IgE-mediated component to the condition

• To improve management of urticaria, there is a need to:o Find out more about the condition (work is on-going at Martin’s centre in Berlin)o Evaluate the real-life prescribing patterns and associated comparative effectiveness. As

there are many genes involved, it is a condition best investigated via real-life studies

• Also of potential interests is exploring blood eosinophil count in patients with urticaria.

Rhinitis Personal Treatment Outcomes

Fulvio Braido & Walter Canonica

• Pragmatic survey o Age __________o Sex : M F  o Ongoing treatment

– Oral antihistamine– Nasal antihistamine– Oral Antihistamine + Decongestant– Nasal Decongestant– Oral decongestant– Nasal Antihistamine + Nasal Inhaled Steroid– Nasal Inhaled Steroid– Allergy specific immunotherapy– Antileukotrienes

Survey Questions• Which is the main aspect of your rhinitis, that you

need to be improved by the treatment?

• How much, the drugs that you are assuming for rhinitis, allow you to reach this outcome?

• Rhinitis is characterized by sneezing, rhinorrhea, nasal itching, nasal obstruction and itchy eyes.

Survey Questions• Please indicate in the scale reported below, how this symptoms

is bothering you,

Sneezing

Rhinorrhea

Nasal Itching

Nasal Obstruction

Itchy Eyes

Survey Questions• Questionnaires that should be filled in by

the patients:oRCAToT5SSo………

Burden of Allergic Disease

Dermot Ryan• Community pharmacy study• Patients attending a community pharmacy for

OTC preparations for allergic rhinitis.• Data collection via computer / iPad ± patient

incentive…?

Near patient testing for IgE

• Potential value of on-going IgE monitoring (via a “finger-pricker”).

• Barcelona comment / discussion:o There is a need to establish whether circulating IgE is a

biomarker – in urticaria and asthma there are data to suggest that IgE level and treatment effectiveness are unconnected.

o The interaction of diet and IgE could be interesting to explore. High blood sugar levels (binging & spikes in blood sugar) can result in the predictive antibodies being glycated (the reason that diabetics are prone to infections). It could be interesting to look at diet scores in patients that exhibit IgE response interesting.

Publication Ideas from Barcelona

Concept discussed

Closing the Era of Complex Assessment – moving towards simplified AR assessment

• Concepts:o Sharing information on available, simple assessment toolso There are a range of very useful tools available, but not all clinicians are aware of

themo Complex, 30-point questionnaires are of no practical utility in clinical practice o The Respiratory Allergy Prediction (RAP) is validated for daily use and is the only

tool validated for use in clinical practiceo There is a need for tool standardisation – some teams use 7-item scores for

allergic rhinitis, some use 5-item symptom scoreso “If you can’t fill in a questionnaire in a breath then it is too much.”o While there is a need for tools to be validated there should be a move towards use

of validated short tools rather than validated long questionnaires.