Bias in observational study of the effectiveness of nasal corticosteroids in asthma

Suissa, Samy; Ernst, Pierre

doi:10.1016/j.jaci.2004.12.1118

Cited by 33 publications

(23 citation statements)

References 32 publications

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“…8 Developing allergic rhinitis in infancy is considered as a significant risk factor for developing asthma at a later age. 9 Both allergic rhinitis and asthma have common underling factors. Education programs when designed should have this in mind and should emphasis on combined treatment for both.…”

Section: Discussionmentioning

confidence: 99%

Knowledge, attitude and practice about allergic rhinitis in a rural population, Kancheepuram district, Tamil Nadu

Rajasekaran

Ghosh

2017

Int J Otorhinolaryngol Head Neck Surg

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INTRODUCTIONAllergic rhinitis is hypersensitivity of the nasal mucosa to allergens. It can be associated with hypersensitivity of the lower airways, atopic dermatitis and allergic conjunctivitis. Allergic rhinitis is becoming more common but still an underreported and under treated condition. The prevalence of allergic rhinitis is increasing with time. The worldwide prevalence of allergic rhinitis is about 10-30% in adults.1 Allergic rhinitis is a global health problem affecting social life, sleep, school and work with a significant economic impact. 2 The increase in allergic tendency is more probably because of decrease in rate of infections in childhood. 3The best treatment for allergic rhinitis is to find out the allergen and avoid it. Most of the time it is very difficult to identify the allergen. There exists a wide gap between knowledge, actual practice and the recommended practice leading to poor quality of life. Allergic rhinitis related knowledge includes understanding the cause, treatment options and prevention. A good attitude is reflected in a positive relationship with the doctor. 4 A good practice includes timely and appropriate management. 5Understanding the knowledge, attitude and practices of patients with allergic rhinitis will help us in treating the patients in a better way, thereby improving their quality of life.This study is aimed at identifying the knowledge, attitude and practice of the patient about allergic rhinitis and how knowledge and attitude reflects on their practices. METHODS Study place: Shri Sathya Sai Medical College andResearch Institute, Ammapettai, Kancheepuram district, Tamil Nadu. ABSTRACTBackground: Allergic rhinitis presents a global health problem. The lack of awareness about allergic rhinitis leads to poor adherence to management protocol. Methods: Our cross sectional study in 100 patients with allergic rhinitis was aimed at assessing the knowledge, attitude and practice about the disease. This was done using a questionnaire. Descriptive analysis was made in the three domains and expressed in percentage. Results: The knowledge about the cause and the treatment options was low. Most of the patients were worried about the long term side effects and dependence of the drugs used for treatment of allergic rhinitis. Most patients ignore the symptoms and do not seek medical advice. Conclusions: Improving the patient's knowledge and attitude through health education can improve practices among allergic rhinitis patients.

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Section: Discussionmentioning

confidence: 99%

Knowledge, attitude and practice about allergic rhinitis in a rural population, Kancheepuram district, Tamil Nadu

Rajasekaran

Ghosh

2017

Int J Otorhinolaryngol Head Neck Surg

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“…15,16 By contrast, a third observational study found no benefit of intranasal corticosteroids in preventing asthma-related hospitalisations. 30 Confounding by indication may be one possible explanation for this finding, whereby the true effect of intranasal corticosteroids is underestimated because treatments are not randomly assigned and it is the patients with more severe asthma who are prescribed intranasal corticosteroids. This difference was evident (although not statistically tested) in asthma-related parameters between the unmatched cohorts at baseline in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…30,31 Moreover, the study of outcomes over a full year after the index prescription minimised the influence of seasonal variations in symptoms. While we attempted to address all confounding factors, a limitation of this study, as with all observational studies, is the possibility of unrecognised confounding factors.…”

Section: Discussionmentioning

confidence: 99%

Observational study comparing intranasal mometasone furoate with oral antihistamines for rhinitis and asthma

Price

Kemp

Sims

et al. 2010

Primary Care Respiratory Journal

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Aims: Retrospective database study comparing upper and lower airway-related outcomes for patients with rhinitis and co-morbid asthma receiving mometasone furoate -an intranasal corticosteroid with low systemic bioavailability -or an oral antihistamine.Methods: 395 patients prescribed intranasal mometasone were matched on 10 demographic and respiratory-related criteria in a 1:2 ratio to 790 patients prescribed oral antihistamine. Asthma and rhinitis control were assessed over one year using predefined composite proxy measures.Results: Asthma control was achieved by 309/395 (78.2%) versus 580/790 (73.4%; p=0.071) patients in the mometasone and antihistamine cohorts, respectively. Rhinitis control was achieved by 293 (74.2%) versus 539 (68.2%; p=0.035), respectively. The adjusted odds ratios for antihistamines, relative to mometasone, were 0.71 (95% CI, 0.52-0.98) for achieving asthma control and 0.74 (95% CI, 0.56-0.97) for achieving rhinitis control. Conclusions:Patients with rhinitis and co-morbid asthma initiating rhinitis therapy achieved significantly better upper as well as lower airway outcomes with intranasal mometasone than with oral antihistamine.

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“…Time-related biases, such as immortal time bias, time window bias, and time lag bias, have been previously described in studies of diabetes treatment (10) and in other therapeutic areas (11)(12)(13)(14). These biases result from not properly classifying exposure during the followup of a cohort study or from measuring exposure over unequal time intervals in case-control studies, which can produce spurious risk reductions.…”

mentioning

confidence: 99%

Metformin and Cancer: Mounting Evidence Against an Association

Suissa

Azoulay

2014

Diabetes Care

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Bias in observational study of the effectiveness of nasal corticosteroids in asthma

Cited by 33 publications

References 32 publications

Knowledge, attitude and practice about allergic rhinitis in a rural population, Kancheepuram district, Tamil Nadu

Knowledge, attitude and practice about allergic rhinitis in a rural population, Kancheepuram district, Tamil Nadu

Observational study comparing intranasal mometasone furoate with oral antihistamines for rhinitis and asthma

Metformin and Cancer: Mounting Evidence Against an Association

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