Allergic Rhinitis: Effects on Quality of Life and Co-morbid Conditions

Size: px
Start display at page:

Download "Allergic Rhinitis: Effects on Quality of Life and Co-morbid Conditions"

Transcription

1 Disclosures : Effects on Quality of Life and Co-morbid Conditions Nycomed Pharmaceutical Sepracor Pharmaceutical Michael S. Blaiss, MD Clinical Professor of Pediatrics and Medicine University of Tennessee Health Science Center Memphis, Tennessee Objectives Be familiar with bothersome symptoms, impaired work productivity and quality of life with allergic rhinitis Understand the role of sleep impairment in allergic rhinitis Learn to recognize the co-morbidities of allergic rhinitis, such as conjunctivitis, sinusitis, increased respiratory infections, and asthma Case Report JD is a 26 year old male who presents to my office with a history each spring of developing sneezing, nasal itching, and rhinorrhea. This spring, his symptoms are getting worse. For the first time he also stated that his eyes were watering and itching and noted the whites of his eyes getting red and puffy. He is experiencing headaches and pain in the sinuses Case Report (cont.) He states that it has been hard to function at work as a computer programmer. Staring at the computer terminal has been difficult. He also reports having trouble falling to sleep and staying asleep all night. He likes to jog in the morning, but now he notices that he is coughing and wheezing which makes it difficult to do his normal 5K run. Case Report (cont.) Review of Symptoms he denies ear problems; he has been told that he snores during the spring Past History He had had nasal symptoms each spring since first grade; mild eczema which he outgrew at the age of 8 Family History Mother with asthma, brother with allergic rhinitis Environmental History-Lives in house with wall to wall carpeting; no pets; no basement Non-smoker; does not live with any smokers

2 JD s Physical Examination Eyes Conjunctiva injected and swollen with increased eye tearing and lid swelling Nose Turbinates very pale and swollen bilaterally with profuse serous drainage Ears Normal Throat Purulent post nasal drip Chest Rare wheeze on forced expiration Skin Clear Evaluation Allergy skin prick tests: Positive to oak and pecan tree pollen CT scan sinuses: bilateral air fluid levels in the maxillary sinuses Spirometry: FEV 1 85% of predicted with a 15% improvement in FEV 1 after bronchodilator Consequences Symptom bother Mood changes Impaired quality of life Impaired work/school productivity Sleep disturbances Co-morbidities Conjunctivitis Rhinosinusitis Respiratory infections Asthma Consequences Symptom bother Mood changes Impaired quality of life Impaired work/school productivity Sleep disturbances Co-morbidities Conjunctivitis Rhinosinusitis Respiratory infections Asthma Nasal Symptoms Are Bothersome: How Bothersome are Symptoms: All AILA Countries Allergies in America at Q21. When you have nasal allergy attacks, how bothersome are the following symptoms usually: extremely bothersome, moderately bothersome, slightly bothersome, or not bothersome? Base: Had symptom at least a few days a week

3 and Daily Life Q 31. During allergy season, would you say the condition impacted your daily life.? N=2,500 Allergies in America at 14 Patient Feelings During Allergy Season: Symptoms Experienced Frequently Impact on Mood: Patients with complaint (%) Tiredness Irritability Nervousness/ Sadness/ anxiety depression SAR + PAR PAR SAR Poor hearing Sickness Other None a Germany, France, Italy, Spain and the United Kingdom. Q32. During allergy season, how often did you feel (ITEM) frequently, sometimes, rarely, or never? N=1088 Canonica et al. Allergy. 2007;62(suppl 85):17. Impact on Quality of Life: Impact on Quality of Life: QoL Score Control (n=116) PAR (n=111) * * * * * * * * Global RQLQ Score P < 0.01 P < 0.01 Physical function Energy/ fatigue General health Social function Role limitations (physical) Role limitations (emotional) Mental health Pain Mild intermittent (n=84) Moderate-severe intermittent (n=874) Mild persistent (n=64) Moderate-severe persistent (n=1092) *P vs healthy controls. Bousquet et al. J Allergy Clin Immunol. 1994;94:182. Bousquet et al. J Allergy Clin Immunol. 2006;117:

4 Impact on Work/School Productivity: WPAI Impairment Score P < 0.01 P < 0.01 P < 0.01 Loss of work productivity (n=1397) Loss of school productivity (n=379) 19 Bousquet et al. J Allergy Clin Immunol. 2006;117: Nasal Allergies Interfere With Sleep Recent Allergy Interference: All AILA Countries Difficulty in getting to sleep 12% 32% Allergy No allergy Waking up during the night 8% 26% Lack of a good night s sleep 12% 29% Q34. How troubled have you been by each of these symptoms during the last week as a result of your nasal symptoms? On a scale of 1 to 7, where 1 means not at all troubled and 7 means extremely troubled, how much trouble have nasal allergies caused in? N = 1088 Impact on Sleep Complaints: Impact on Sleep Disorders: Subjects with complaint (%) AR patients (n=591) Controls (n=502) * * * * * * Subjects with complaint (%) AR patients (n=591) Controls (n=502) * * * * Difficulty falling asleep *P<0.001 vs controls. Nocturnal awakening Leger et al. Arch Intern Med. 2006;166:1744. Early Non-restorative awakening sleep Lack of sleep Snoring *P vs controls. Insomnia Leger et al. Arch Intern Med. 2006;166:1744. Severe insomnia Sleep apnea syndrome Hypersomnia

5 Ocular Allergy Symptoms Consequences Symptom bother Mood changes Impaired quality of life Impaired work/school productivity Sleep disturbances Co-morbidities Conjunctivitis Rhinosinusitis Respiratory infections Asthma Redness Itching Tearing 26 Ocular vs. Nasal Symptoms: Frequency Ocular vs. Nasal Complaints: How Bothersome? Percent of patients Percent of patients N = 2,500 N = 2,500 Allergies in America survey, 2006 Allergies in America survey, 2006 Epidemiologic Association Between Allergic Rhinitis and Conjunctivitis Prevalence of Concomitant Conditions Experienced in the Previous Week by AR Sufferers 30 % of Conjunctivitis Allergic Comorbidity Patients No other allergic manifestations 6 Asthma 1 Allergic rhinitis 66 Atopic eczema 0 Urticaria-angioedema 0.4 More than 1 allergic disease 27 Bonini S. Chibret Int J Ophthalmol. 1987;5:12. Reporting of concomitant conditions were similar between adults and children with AR, with the exception of heartburn/gerd, which was reported nearly 5-fold more frequently in adults than in children *Multiple answers were permitted.

6 Acute Rhinosinusitis Is More Common in Patients With AR AR Increases the Risk for and Duration of Respiratory Infections in Children Patients with Acute Rhinosinusitis (%) P=0.09 AR (n=54) Controls (n=82) P<0.001 Total RI (number) P= RI Duration (days) P=0.009 Total population (N=136) Subjects 25 years of age (n=35) Allergic children (n=46) Non-allergic children (n=71) Allergic children (n=46) Non-allergic children (n=71) Ulanovski et al. Am J Rhinol. 2008;22:122. Ciprandi et al. Pediatr Allergy Immunol. 2006;17: AR Increases the Risk for and Duration of Respiratory Infections in Adults Prevalence of Asthma in Adults and Children With AR 34 Diagnosed with asthma Asthma symptoms in past 12 months RI Rate (episodes) * RI Duration (median, days) * 23 7 AR Patients (n=202) Controls (n=422) AR Patients (n=202) Controls (n=422) *P< Cirillo et al. Allergy. 2007;62: More children than adults with AR have been diagnosed with asthma or had asthma symptoms in the past 12 months Prevalence of Asthma in Children With and Without AR 35 Tasmanian Asthma Study 36 Diagnosed with asthma Asthma symptoms in past 12 months Associations between childhood AR and asthma incidence from preadolescence to middle age and asthma persistence to middle age Data from 1968, 1974, and 2004 survey of the Tasmanian Asthma Study Children with AR have a > 3-fold increased incidence of asthma diagnosis and asthma symptoms than children without AR Burgess JA, Walters EH, et al. J Allergy Clin Immunol. 2007;120:863-9.

7 Asthma in Different Life Stages After the Age of 7 Years, Dependent on Childhood Allergic Rhinitis 37 European Community Respiratory Health Survey 38 Childhood allergic rhinitis vs Never allergic rhinitis Age (y) at asthma onset* >7-12, preadolescence >12-20, adolescence >20-44, adult life (n=156) (n=124) (n=607) Homogeneity test, P value HR (95% CI) HR (95% CI) HR (95% CI) 7.12 ( ), P< ( ), P< ( ), P<0.001 < Longitudinal population-based study in 14 primary Western European countries Frequency of asthma development in 6461 participants from yrs old over 8.8 years Incident asthma was defined as reporting ever having asthma confirmed by a physician Atopy by positive prick skin test HR = hazard ratio. * There were 27 persons of the 2108 with a history of asthma ever for whom no age at onset of asthma could be determined and 1194 with asthma onset by age 7 years. Additionally adjusted for socioeconomic status, current smoking, and passive smoking at age 44 years. Shaabab R, Zureik M, et al. Lancet. 2008;372: Cumulative Incidence Rate of Asthma Positive Skin Test and AR Increase the Risk for New Asthma at 23-Year Follow-Up Control Atopy, no rhinitis Non-allergic rhinitis Allergic rhinitis Number at risk Control Atopy, no rhinitis Non-allergic rhinitis Allergic rhinitis Patients Developing New Asthma (%) P<0.001 Allergy skin test Positive Negative P<0.002 Allergic rhinitis Cumulative incidence of asthma by year of follow-up in 3161 individuals in the control group, 704 who had atopy alone, 1377 who had non-allergic rhinitis, and 1217 who had allergic rhinitis. Settipane et al. Allergy Proc. 1994;15:21. Summary Allergic rhinitis can impose multiple burdens on patients Symptom bother Mood changes Impaired quality of life Impaired work/school productivity Sleep disturbances Co-morbidities Treating the underlying pathophysiologic inflammation is the appropriate approach to relieve the symptoms and reduce the risk of consequences and co-morbidities in patients with upper respiratory disease

Derriford Hospital. Peninsula Medical School

Derriford Hospital. Peninsula Medical School Asthma and Allergic Rhinitis iti What is the Connection? Hisham Khalil Consultant ENT Surgeon Clinical Senior Lecturer, PMS Clinical Sub-Dean GP Evening 25 June 2008 Plymouth Derriford Hospital Peninsula

More information

PREPARATION FOR ALLERGY TESTING *** Please read this information at least one week before your upcoming visit.

PREPARATION FOR ALLERGY TESTING *** Please read this information at least one week before your upcoming visit. PREPARATION FOR ALLERGY TESTING *** Please read this information at least one week before your upcoming visit. In order to obtain valid and useful skin testing results, you will need to stop the use of

More information

(pedi) Patient Name: date of birth:

(pedi) Patient Name: date of birth: (pedi) Patient Name: date of birth:_ Date: I am being seen on: a) self referral _ b) physician referral from Dr. Please share the main reasons for your office visit today (check all those that apply):

More information

New Patient Questionnaire

New Patient Questionnaire - - Toda y 's Date: Primary Care Provider's Name: Was a consultation recommended? Primary Clinic: Referring provider's name (if different): Please answer the following questions to facilitate the diagnosis

More information

Does rhinitis. lead to asthma? Does sneezing lead to wheezing? What allergic patients should know about the link between allergic rhinitis and asthma

Does rhinitis. lead to asthma? Does sneezing lead to wheezing? What allergic patients should know about the link between allergic rhinitis and asthma Does rhinitis lead to asthma? Does sneezing lead to wheezing? What allergic patients should know about the link between allergic rhinitis and asthma For a better management of allergies in Europe Allergy

More information

NEW PATIENT INTAKE FORM

NEW PATIENT INTAKE FORM NEW PATIENT INTAKE FORM NAME: DOB: SEX: MALE FEMALE ADDRESS: ZIP CODE: PHONE #: - - WORK#: - - PHARMACY: PHARMACY #: - - WOULD YOU BE INTERESTED IN HAVING ACCESS TO YOUR MEDICAL RECORDS ONLINE? YES / NO

More information

Dr ARIF AHMED M.D.(Paed.), D.Ch., M.D.(USA), European Board (EACCI) Certified in Allergy & Immunology

Dr ARIF AHMED M.D.(Paed.), D.Ch., M.D.(USA), European Board (EACCI) Certified in Allergy & Immunology Case Based Approach to Allergic Unified Airway Diseases Dr ARIF AHMED M.D.(Paed.), D.Ch., M.D.(USA), European Board (EACCI) Certified in Allergy & Immunology Recent Advances in Pediatrics 23: Hot Topics

More information

Allina Health United Lung and Sleep Clinic

Allina Health United Lung and Sleep Clinic Medical History Form Date Allina Health United Lung and Sleep Clinic Name Last First MI Date of birth What lung problem do you want us to help you with: Who is your primary care provider? Social History

More information

NEW PATIENT HISTORY. Patient s Name: Primary Care or Referring Physician:

NEW PATIENT HISTORY. Patient s Name: Primary Care or Referring Physician: Patient s Name: NEW PATIENT HISTORY Last First Middle Age: Primary Care or Referring Physician: Name How do you hear about our office? Referred by physician: (name): Referred by family or friend Facebook

More information

ALIGN ACUPUNCTURE AND HERBS LLC Rebekah V. Michaels MAOM, Diplomate OM, Lic Ac

ALIGN ACUPUNCTURE AND HERBS LLC Rebekah V. Michaels MAOM, Diplomate OM, Lic Ac ALIGN ACUPUNCTURE AND HERBS LLC Rebekah V. Michaels MAOM, Diplomate OM, Lic Ac. 617-835-2512 Patient Information and Health History Date: Name: Date of Birth: Street: City: State: Zip: Phone: (H) (W) )

More information

Pediatric Allergies in America: A Landmark Survey of Nasal Allergy Sufferers

Pediatric Allergies in America: A Landmark Survey of Nasal Allergy Sufferers Pediatric Allergies in America: A Landmark Survey of Nasal Allergy Sufferers EXECUTIVE SUMMARY Prepared for Nycomed Conducted by Schulman, Ronca and Bucuvalas, Inc. May 8, 2007 Supported by: Study Design

More information

List your current allergy/asthma medications, including over-the-counter medications: Medication Dose How Often?

List your current allergy/asthma medications, including over-the-counter medications: Medication Dose How Often? NEW PATIENT HISTORY Patient s Name: Last First Middle Age: Primary Care or Referring Physician: Name Address Please check Yes or No: Symptoms Eye Symptoms Cough? Itching? Wheeze? Watering? Tight Chest?

More information

Telephone Number Home: Work: Cell:

Telephone Number Home: Work: Cell: Page 1 of 7 Patient Name: DOB: Date: Address: Occupation: Telephone Number Home: Work: Cell: Emergency Contact: Relation: Telephone: Address: Referring Physician: Address: Telephone: ***ALL PATIENTS MUST

More information

PATIENT QUESTIONNAIRE Boise Location 7272 W. Potomac Drive Boise, ID (208)

PATIENT QUESTIONNAIRE Boise Location 7272 W. Potomac Drive Boise, ID (208) PATIENT QUESTIONNAIRE Boise Location 7272 W. Potomac Drive Boise, ID 83704 (208)884-2922 ***Questionnaire MUST be completed PRIOR to arrival for appointment*** Today s Date / / / / Last First MI DOB Referring

More information

Jeffrey M. Davidson, M.D. Certified by the Board of Allergy and Immunology Clinical Professor, University of California San Francisco

Jeffrey M. Davidson, M.D. Certified by the Board of Allergy and Immunology Clinical Professor, University of California San Francisco 180 Montgomery Street, Suite 2370 San Francisco, CA 94104 Tel: (415) 433-6673 Fax: (415) 433.6063 www.mydrd.com Jeffrey M. Davidson, M.D. Certified by the Board of Allergy and Immunology Clinical Professor,

More information

3002 Seminar. Problem-Based Learning: Evaluating and Managing the Patient with Recurrent Infections DO NOTE TURN THE PAGES UNTIL INSTRUCTED TO DO SO!

3002 Seminar. Problem-Based Learning: Evaluating and Managing the Patient with Recurrent Infections DO NOTE TURN THE PAGES UNTIL INSTRUCTED TO DO SO! 3002 Seminar Problem-Based Learning: Evaluating and Managing the Patient with Recurrent Infections DO NOTE TURN THE PAGES UNTIL INSTRUCTED TO DO SO! Discussion leaders: Kenneth Paris, MD Richard L. Wasserman,

More information

1960 FP CENTER FOR SLEEP DISORDERS

1960 FP CENTER FOR SLEEP DISORDERS 1960 FP CENTER FOR SLEEP DISORDERS Sleep Questionnaire Name: Date: Date of Birth: / / Age: Gender: Height: Weight: lbs. Referring Physician: Occupation: Please give a brief description of your sleep problem

More information

New Patient Information & Consents

New Patient Information & Consents New Patient Information & Consents Name: DOB: SSN: Gender: Address: City: State: Zip: Home #: Cell #: Other#: Employment Status: Occupation: Email Address: Marital Status: S M D W How did you hear about

More information

SCREENING AND PREVENTION

SCREENING AND PREVENTION These protocols are designed to implement standard guidelines, based on the best evidence, that provide a consistent clinical experience for AHC II Integrated Clinical Delivery Network patients and allow

More information

Pediatric Sleep History

Pediatric Sleep History Fax 423-431-2983 Pediatric Sleep History Patient/ Child s Name: Date of Birth: Parent Name: Last 4 of Social Security No: Gender: Male Female Height: Weight: Age: Race: Street Address: City: State: Zip:

More information

Sleep Center. Have you had a previous sleep study? Yes No If so, when and where? Name of facility Address

Sleep Center. Have you had a previous sleep study? Yes No If so, when and where? Name of facility Address Patient Label For office use only Appt date: Clinician: Sleep Center Main Campus Highlands Ranch Location 1400 Jackson Street 8671 S. Quebec St., Ste 120 Denver, CO 80206 Highlands Ranch, CO 80130 Leading

More information

Room # Critical Care & Pulmonary Consultants, P.C.

Room # Critical Care & Pulmonary Consultants, P.C. Room # Critical Care & Pulmonary Consultants, P.C. Health History You have been scheduled for an appointment with Critical Care and Pulmonary Consultants, P.C. This health history will help us facilitate

More information

Comprehensive Allergy and Asthma Care Center. New Patient Questionnaire. Patient Name: Age: DOB: Sex: M F

Comprehensive Allergy and Asthma Care Center. New Patient Questionnaire. Patient Name: Age: DOB: Sex: M F Comprehensive Allergy and Asthma Care Center New Patient Questionnaire Patient Name: Age: DOB: Sex: M F Primary Physician (Name, Address and Phone Number): Do you want the allergy consultation note sent

More information

New Patient Sleep Intake

New Patient Sleep Intake New Patient Sleep Intake Name: Date of Birth: Primary Care Physician: Date of Visit: Referring Physician and/or Other Physicians: Retail Pharmacy: Mail Order Pharmacy: Address: Mail Order Phone #: Phone

More information

An Update on Allergic Rhinitis. Mike Levin Division of Asthma and Allergy Department of Paediatrics University of Cape Town Red Cross Hospital

An Update on Allergic Rhinitis. Mike Levin Division of Asthma and Allergy Department of Paediatrics University of Cape Town Red Cross Hospital An Update on Allergic Rhinitis Mike Levin Division of Asthma and Allergy Department of Paediatrics University of Cape Town Red Cross Hospital Allergic Rhinitis Common condition with increasing prevalence

More information

Patient (Parent) Questionnaire Patient s Name: DOB: Date: Referred By: Primary Care Physician:

Patient (Parent) Questionnaire Patient s Name: DOB: Date: Referred By: Primary Care Physician: Dr. Bina Joseph Patient (Parent) Questionnaire Patient s Name: DOB: Date: Referred By: Primary Care Physician: Describe each problem that has led you to seek this allergy evaluation: 1. 2. 3. 4. Drug Allergies:

More information

Pediatric Allergy Allergy Related Testing

Pediatric Allergy Allergy Related Testing Pediatric Allergy Allergy Related Testing 1 Allergies are reactions that are usually caused by an overactive immune system. These reactions can occur in a variety of organs in the body, resulting in conditions

More information

SLEEP QUESTIONNAIRE. Name: Home Telephone. Address: Work Telephone: Marital Status: Date of Birth: Age: Sex: Height: Weight: Pharmacy & Phone #:

SLEEP QUESTIONNAIRE. Name: Home Telephone. Address: Work Telephone: Marital Status: Date of Birth: Age: Sex: Height: Weight: Pharmacy & Phone #: q JHMCE q JHS q SMEH SLEEP QUESTIONNAIRE 1. DEMOGRAPHIC DATA Name: Home Telephone Address: Work Telephone: Marital Status: Date of Birth: Age: Sex: Height: Weight: 2. PHYSICIAN INFORMATION Name of Primary

More information

The Impact of Hay Fever - a survey by Allergy UK PART 1

The Impact of Hay Fever - a survey by Allergy UK PART 1 The Impact of Hay Fever - a survey by Allergy UK PART 1 Supported and funded by HayMax April 2016 Foreword The role of Allergy UK, is to support the needs and concerns of those with allergies and intolerances.

More information

VCU CENTER FOR SLEEP MEDICINE NEW PATIENT QUESTIONNAIRE

VCU CENTER FOR SLEEP MEDICINE NEW PATIENT QUESTIONNAIRE VCU CENTER FOR SLEEP MEDICINE NEW PATIENT QUESTIONNAIRE Name:_ DOB: MR#: Date: Sex: Age: Height: Referring physician: Primary care physician: What is your primary sleep problem? Please explain any strange

More information

allergic rhinitis 3C47E65837E D1B E Allergic Rhinitis 1 / 6

allergic rhinitis 3C47E65837E D1B E Allergic Rhinitis 1 / 6 Allergic Rhinitis 1 / 6 2 / 6 3 / 6 Allergic Rhinitis Allergic rhinitis is a diagnosis associated with a group of symptoms affecting the nose. These symptoms occur when you breathe in something you are

More information

Introduction. Methods. Results 12/7/2012. Immunotherapy in the Pediatric Population

Introduction. Methods. Results 12/7/2012. Immunotherapy in the Pediatric Population 12/7/212 Introduction Immunotherapy in the Pediatric Population Michael S. Blaiss, MD Clinical Professor of Pediatrics and Medicine University of Tennessee Health Science Center Memphis, Tennessee Allergen

More information

SLEEP QUESTIONNAIRE. Please briefly describe your sleep or sleep problem:

SLEEP QUESTIONNAIRE. Please briefly describe your sleep or sleep problem: SLEEP QUESTIONNAIRE Your answers to the following questions will help us to obtain a better understanding of your sleep problems. Please answer every question to the best of your ability. It is helpful

More information

Baptist Health Floyd 1850 State Street New Albany, IN Sleep Disorders Center Lung & Sleep Specialists. Date of Birth: Age:

Baptist Health Floyd 1850 State Street New Albany, IN Sleep Disorders Center Lung & Sleep Specialists. Date of Birth: Age: Page 1 of 7 GENERAL INFORMATION Name: Date of Birth: Age: Social Security #: Sex: Height: Weight: Address: City: State: Zip: Home Phone: Cell Phone: Work Phone: Employer s Name: Marital Status: Married

More information

Path2220 INTRODUCTION TO HUMAN DISEASE ALLERGY. Dr. Erika Bosio

Path2220 INTRODUCTION TO HUMAN DISEASE ALLERGY. Dr. Erika Bosio Path2220 INTRODUCTION TO HUMAN DISEASE ALLERGY Dr. Erika Bosio Research Fellow Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research University of Western Australia

More information

Asthma and Vocal Cord Dysfunction

Asthma and Vocal Cord Dysfunction Asthma and Vocal Cord Dysfunction Amy L. Marks DO, FACOP Pediatric Allergy and Immunology Assistant Professor of Pediatrics Oakland University William Beaumont School of Medicine Objectives: Understanding

More information

Asthma COPD Overlap (ACO)

Asthma COPD Overlap (ACO) Asthma COPD Overlap (ACO) Dr Thomas Brown Consultant Respiratory Physician Thomas.Brown@porthosp.nhs.uk Dr Hitasha Rupani Consultant Respiratory Physician Hitasha.rupani@porthosp.nhs.uk What is Asthma

More information

1 I *********IF YOU ARE NOT ON ALLERGY SHOTS PLEASE SKIP THIS SECTION AND MOVE TO PAGE 2********* NAME: AGE: ---- ID (For Office Use Only):

1 I *********IF YOU ARE NOT ON ALLERGY SHOTS PLEASE SKIP THIS SECTION AND MOVE TO PAGE 2********* NAME: AGE: ---- ID (For Office Use Only): NAME: AGE: ---- Date of Appointment:. ID (For Office Use Only): RETURN VISIT Date of Visit: Main Reason for visit: Reevaluation Family Doctor: Symptoms worse _ New problem _ Yearly follow up _ Follow up/office

More information

The information you provide us will greatly help us provide the highest quality and most comprehensive care for you.

The information you provide us will greatly help us provide the highest quality and most comprehensive care for you. Rheumatology (circle location of appointment) 111 Hundertmark Rd. Suite 115N 560 S. Maple St. Suite 400 place patient label here Chaska, MN 55318 Waconia, MN 55387 952-361-2450 952-361-2450 The information

More information

ALLERGY CLINIC-PATIENT QUESTIONNAIRE NAME: DOB: TODAY S DATE:

ALLERGY CLINIC-PATIENT QUESTIONNAIRE NAME: DOB: TODAY S DATE: ALLERGY CLINIC-PATIENT QUESTIONNAIRE NAME: DOB: TODAY S DATE: A. Please check any of the following problems which you have had, and record when they started: Problem/Date of Onset sniffles nasal congestion

More information

Eczema: also called atopic dermatitis; a chronic, itchy, scaly rash not due to a particular substance exposure

Eczema: also called atopic dermatitis; a chronic, itchy, scaly rash not due to a particular substance exposure Allergy is a condition in which the immune system causes sneezing, itching, rashes, and wheezing, or sometimes even life-threatening allergic reactions. The more you know about allergies, the better prepared

More information

HealthPartners Care Coordination Clinical Care Planning and Resource Guide ASTHMA

HealthPartners Care Coordination Clinical Care Planning and Resource Guide ASTHMA The following evidence based guideline was used in developing this clinical care guide: National Institute of Health (NIH National Heart, Lung, and Blood Institute (NHLBI) and American Academy of Allergy,

More information

Allergy overload. Nip those springtime allergies in the bud

Allergy overload. Nip those springtime allergies in the bud Y Name: VIBE ACTIVITIES E A R Issue 199 Years Healthy Vibe Healthy Body Allergy Overload page 26 Allergy overload Nip those springtime allergies in the bud W inter s over... the jumpers and trackies go

More information

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease By: Dr. Fatima Makee AL-Hakak () University of kerbala College of nursing Out lines What is the? Overview Causes of Symptoms of What's the difference between and asthma?

More information

Symptom Review (page 1) Name Date

Symptom Review (page 1) Name Date v2.4, 2/13 JonathanTreasure.com Botanical Medicine & Cancer Herb Drug Interactions Herbalism 3.0 Symptom Review (page 1) Name Date INSTRUCTIONS Please read each section below carefully and, after each

More information

Online Data Supplement Primary Ciliary Dyskinesia: First Health-related Quality of Life Measures for Pediatric Patients

Online Data Supplement Primary Ciliary Dyskinesia: First Health-related Quality of Life Measures for Pediatric Patients Online Data Supplement Primary Ciliary Dyskinesia: First Health-related Quality of Life Measures for Pediatric Patients Sharon D Dell, Margaret W. Leigh, Jane S Lucas, Thomas W. Ferkol, Michael R. Knowles,

More information

Respiratory System Virology

Respiratory System Virology Respiratory System Virology Common Cold: Rhinitis. A benign self limited syndrome caused by several families of viruses. The most frequent acute illness in industrialized world. Mild URT illness involving:

More information

R. Masekela. Paediatric Pulmonologist and Allergist

R. Masekela. Paediatric Pulmonologist and Allergist R. Masekela Paediatric Pulmonologist and Allergist Outline Definitions i i Biomass fuels Atopy Respiratory tract Environmental tobacco smoke (ETS) Respiratory tract. HIV Atopy Traffic related air pollutants

More information

Creve Coeur Family Medicine, LLC

Creve Coeur Family Medicine, LLC Creve Coeur Family Medicine, LLC Patient Name: Date of Birth: Medication List Medication Name (Over the counter medications too) Strength/ Dose (mg) Number of pills per dose Number of times per day Personal

More information

Efficacy and safety of montelukast in adults with asthma and allergic rhinitis

Efficacy and safety of montelukast in adults with asthma and allergic rhinitis Respiratory Medicine (26), 1952 1959 Efficacy and safety of montelukast in adults with asthma and allergic rhinitis J.Chr. Virchow a,, C. Bachert b a Universität Rostock, Ernst-Heydemann-Str. 6, 1857 Rostock,

More information

9220 Haven Avenue, Suite 101 Rancho Cucamonga, CA Tel: (909) Fax: (909) ALLERGY HISTORY

9220 Haven Avenue, Suite 101 Rancho Cucamonga, CA Tel: (909) Fax: (909) ALLERGY HISTORY Name: Date of Birth: Date of Visit: Briefly describe the reason for your visit: How long have you had these problems? How frequently do you have them? NASAL SYMPTOMS ALLERGY HISTORY 1. I have the following

More information

Allergy/Immunology Questionnaire

Allergy/Immunology Questionnaire Anita Shvarts, M.D. 85 Seasons Lane Hiawassee, GA 30546 [p] 855.656.6673 [f] 877.811.4836 Allergy/Immunology Questionnaire Please take a moment to complete this form. It will help the practitioner better

More information

Ailléirge Péidiatraiceach. Pediatric Allergy 3/9/2018. Disclosures & Conflicts Of Interest

Ailléirge Péidiatraiceach. Pediatric Allergy 3/9/2018. Disclosures & Conflicts Of Interest Ailléirge Péidiatraiceach Michael Zacharisen, M.D. Allergy/Immunology Pediatric Allergy Michael Zacharisen, M.D. Allergy/Immunology Disclosures & Conflicts Of Interest Green Bay Packer fan I drive a Jeep

More information

ESSENTIAL STANDARD. 6.PCH.1 Understand wellness, disease prevention, and recognition of symptoms.

ESSENTIAL STANDARD. 6.PCH.1 Understand wellness, disease prevention, and recognition of symptoms. PRE-TEST 1.What are the basic functions of the respiratory system? 2.Describe five symptoms of asthma. 3.How can asthma be controlled? 4.What are some common asthma triggers? ESSENTIAL STANDARD 6.PCH.1

More information

Allergic rhinitis in India: an overview

Allergic rhinitis in India: an overview International Journal of Otorhinolaryngology and Head and Neck Surgery Chandrika D. Int J Otorhinolaryngol Head Neck Surg. 217 Jan;3(1):1-6 http://www.ijorl.com pissn 244-929 eissn 244-937 Review Article

More information

Riley Sleep Evaluation Questionnaire

Riley Sleep Evaluation Questionnaire Directions Please answer each of the following questions by writing in or choosing the best answer. This will help us better understand your child and his or her sleep problems. Shade circles like Not

More information

ALLERGY & ASTHMA SPECIALISTS, P.C.

ALLERGY & ASTHMA SPECIALISTS, P.C. ALLERGY & ASTHMA SPECIALISTS, P.C. Leonard Silverstein, M.D. Ruth L.K. Gold, M.D. Health Questionnaire Jennifer A. Sherman, D.O. Niya Wanich, M.D Patient: D.O.B.: / / Age: Date: / / Height: Weight: Reason

More information

Medical History Form

Medical History Form Dr. Vivek U. Rao, M.D. 500 Adams Ave., Suite 300 Odessa, TX 79761 Phone: 432.333.3300 Fax: 432.339.3300 Medical History Form Patient Name: DOB: A. CHIEF COMPLAINT: Briefly describe your (or your child

More information

MEDICAL DATA SHEET For Patients 18 years of age and older

MEDICAL DATA SHEET For Patients 18 years of age and older MEDICAL DATA SHEET For Patients 18 years of age and older NAME: DATE: / / AGE: DOB: / / 1. What is the main reason you are seeking a physician s advice? 2. Please list all allergies: Drug Allergies: Other

More information

Allergic rhinitis and the united airway in asthma

Allergic rhinitis and the united airway in asthma Earn 3 CPD Points online Allergic rhinitis and the united airway in asthma Based on a presentation by Dr Todd Marr Director: Paediatric Allergy/ Immunology Gunderson Lutheran Medical Centre La Crosse,

More information

Sleep History Questionnaire

Sleep History Questionnaire Sleep History Questionnaire Name: DOB: Phone: Date of Consultation: Consultation is requested by: Primary care provider: _ Preferred pharmacy: Chief complaint: Please tell us why you are here: How long

More information

Allergic Rhinitis. What Does Allergic Rhinitis Mean? Published on: 9 Jul 2014

Allergic Rhinitis. What Does Allergic Rhinitis Mean? Published on: 9 Jul 2014 Published on: 9 Jul 2014 Allergic Rhinitis What Does Allergic Rhinitis Mean? Allergic rhinitis is the way doctors describe an allergy that affects the nose. What happens when you have an allergy? To understand

More information

Glossary of Asthma Terms

Glossary of Asthma Terms HealthyKidsExpress@bjc.org Asthma Words to Know Developed in partnership with Health Literacy Missouri Airways (Bronchi, Bronchial Tubes): The tubes in the lungs that let air in and out of the body. Airway

More information

Function of the Respiratory System. Exchange CO2 (on expiration) for O2 (on inspiration)

Function of the Respiratory System. Exchange CO2 (on expiration) for O2 (on inspiration) Function of the Respiratory System Exchange CO2 (on expiration) for O2 (on inspiration) Upper Respiratory Tract Includes: Nose Mouth Pharynx Larynx Function: Warms and humidifies the inspired air Filters

More information

Allergic Rhinitis and Its Impact on Ast. Rhinitis: A Risk Factor for Asthma? Ronald Dahl, Aarhus University Hospital, Denmark

Allergic Rhinitis and Its Impact on Ast. Rhinitis: A Risk Factor for Asthma? Ronald Dahl, Aarhus University Hospital, Denmark Allergic Rhinitis and Its Impact on Ast Rhinitis: A Risk Factor for Asthma? Ronald Dahl, Aarhus University Hospital, Denmark Rhinitis and asthma SIT-SLIT Evidence A SIT-SLIT Evidence A? SIT Evidence? Rhinitis

More information

PLEASE DO NOT WEAR FRAGRANCES

PLEASE DO NOT WEAR FRAGRANCES Patient s Name: City: State: Zip: Male Female Race: Ethnicity: Language 1st: 2nd: Home Phone: Work Phone: Cell Phone: Email: Occupation: Employer: City: State: Zip: Family Doctor/Pediatrician: City: State:

More information

Comprehensive History, Consult, and Evaluation Form

Comprehensive History, Consult, and Evaluation Form 1 Comprehensive History, Consult, and Evaluation Form 1.Patient Information: Today s Date: Mr. Ms. Miss Mrs. Dr. Name Age: Date of Birth: Male Female Address: City/State/Zip: Home Phone: Work Phone: Cell

More information

Nancy Davis, RRT, AE-C

Nancy Davis, RRT, AE-C Nancy Davis, RRT, AE-C Asthma Statistics 25.6 million Americans diagnosed with asthma 6.8 million are children 10.5 million missed school days per year 14.2 lost work days for adults Approximately 10%

More information

Your turbinates are responsible for cleaning and humidifying the. How to Treat Inflamed Turbinates. by. How to Stop Sneezing With Natural

Your turbinates are responsible for cleaning and humidifying the. How to Treat Inflamed Turbinates. by. How to Stop Sneezing With Natural 3-10-2017 Your turbinates are responsible for cleaning and humidifying the. How to Treat Inflamed Turbinates. by. How to Stop Sneezing With Natural Remedies. Natural remedy for swollen turbinates I assume

More information

Allergy overload. Nip those springtime allergies in the bud

Allergy overload. Nip those springtime allergies in the bud Y Name: VIBE ACTIVITIES E A R Issue 199 Years Healthy Vibe Healthy Body Allergy Overload page 26 Allergy overload Nip those springtime allergies in the bud W inter s over... the jumpers and trackies go

More information

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 21 July 2010

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 21 July 2010 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 21 July 2010 GRAZAX 75 000 SQ-T, oral lyophilisate B/30 (CIP: 378 011-6) B/100 (CIP code: 378 012-2) B/90 (CIP code:

More information

P R E S E N T S Dr. Mufa T. Ghadiali is skilled in all aspects of General Surgery. His General Surgery Services include: General Surgery Advanced Laparoscopic Surgery Surgical Oncology Gastrointestinal

More information

REDROCK MEDICAL GROUP INITIAL HISTORY AND PHYSICAL

REDROCK MEDICAL GROUP INITIAL HISTORY AND PHYSICAL REDROCK MEDICAL GROUP INITIAL HISTORY AND PHYSICAL NAME: BIRTH DATE: AGE: SEX: M F OCCUPATION: RACE: WHO REFERRED YOU TO OUR OFFICE? _ WHAT IS YOUR MAIN COMPLAINT? HOW LONG HAS THIS BEEN A PROBLEM? IS

More information

Diagnosis. you have asthma? Get the answers. Your Asthma Basics series: Asthma Basics #1. Diagnosis Triggers Medications Kids

Diagnosis. you have asthma? Get the answers. Your Asthma Basics series: Asthma Basics #1. Diagnosis Triggers Medications Kids Diagnosis Asthma Basics #1 Your Asthma Basics series: 1 2 3 Diagnosis Triggers Medications Kids Supported by unrestricted educational grants from: For more information from the Asthma Society of Canada:

More information

*521634* Sleep History Questionnaire. Name of primary care doctor:

*521634* Sleep History Questionnaire. Name of primary care doctor: *521634* Today s Date: Sleep History Questionnaire Appointment Date: Please answer the following questions before coming to your appointment. Please arrive 15 minutes early with this packet filled out.

More information

PATIENT DEMOGRAPHICS

PATIENT DEMOGRAPHICS PATIENT DEMOGRAPHICS NPSG CPAP CPAP Retitration Split Night PATIENT INFORMATION: Name: Last First Middle Initial Address: City: State: Zip: Social Security #: DOB: Gender: Age: Phone Number: Cell: Work:

More information

Allergies and the Primary Care Practice. Mark Gurley, MD, FAAOA

Allergies and the Primary Care Practice. Mark Gurley, MD, FAAOA Allergies and the Primary Care Practice Mark Gurley, MD, FAAOA Dr. Mark Gurley- Disclosure Neither I, nor an immediate family member (parent, sibling, spouse, partner, or child), has any financial relationship

More information

Allergy & Asthma Consultants, L.L.P. 720 W. 34 th Street Suite 200 Austin, Texas Office (512) Fax (512) PATIENT INFORMATION

Allergy & Asthma Consultants, L.L.P. 720 W. 34 th Street Suite 200 Austin, Texas Office (512) Fax (512) PATIENT INFORMATION 720 W. 34 th Street Suite 200 Austin, Texas 78705 Office (512) 454-5821 Fax (512) 459-9137 PATIENT INFORMATION MRN DR ENTERED VERIFIED Patient Information ( as it appears on insurance card) Last First

More information

Asthma By Mayo Clinic staff

Asthma By Mayo Clinic staff MayoClinic.com reprints This single copy is for your personal, noncommercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, use the reprints

More information

Frequent Ear Infections Past Present Have you had pressure equalization tubes? No Yes If yes, date(s): Ear Symptoms Past Present

Frequent Ear Infections Past Present Have you had pressure equalization tubes? No Yes If yes, date(s): Ear Symptoms Past Present BRIEFLY DESCRIBE THE REASON FOR THIS VISIT (what is your main concern or symptom?): CHECK SYMPTOMS YOU HAVE OR HAVE HAD: Nasal Symptoms Past Present Nasal congestion Runny nose Nasal discharge Postnasal

More information

Allergic Rhinitis. Dr. Sasan Dabiri. Otorhinolaryngologist Head & Neck Surgeon January 2011 Imam Hospital complex - Tehran

Allergic Rhinitis. Dr. Sasan Dabiri. Otorhinolaryngologist Head & Neck Surgeon January 2011 Imam Hospital complex - Tehran In the name of God Dr. Sasan Dabiri Otorhinolaryngologist Head & Neck Surgeon January 2011 Imam Hospital complex - Tehran Rhinitis Allergic Rhinitis Infectious Rhinitis Nonallergic Rhinitis Neoplastic

More information

Case approach in Asthma and COPD. Assoc.Prof.Sunee Lertsinudom BSc.Grad.Diplo.BCP. Department of Clinical pharmacy Khonkaen University

Case approach in Asthma and COPD. Assoc.Prof.Sunee Lertsinudom BSc.Grad.Diplo.BCP. Department of Clinical pharmacy Khonkaen University Case approach in Asthma and COPD Assoc.Prof.Sunee Lertsinudom BSc.Grad.Diplo.BCP. Department of Clinical pharmacy Khonkaen University Asthma Diagnosis History and patterns of symptoms Physical examination

More information

Allergic rhinitis is a frequent chronic disease that may. Persistent Allergic Rhinitis and the XPERT Study SYMPOSIUM REPORT SUPPLEMENT

Allergic rhinitis is a frequent chronic disease that may. Persistent Allergic Rhinitis and the XPERT Study SYMPOSIUM REPORT SUPPLEMENT SYMPOSIUM REPORT SUPPLEMENT Persistent Allergic Rhinitis and the XPERT Study Anthi Rogkakou, MD, Elisa Villa, MD, Valentina Garelli, MD, G. Walter Canonica, MD Abstract: Allergic rhinitis (AR) is a chronic

More information

Pediatric Sleep Questionnaire

Pediatric Sleep Questionnaire Pediatric Sleep Questionnaire Date Child's Name: Age Gender DOB Referring Physician: Primary Care Physician: Please answer fill out the following questionnaire regarding your child's sleep: What are your

More information

ASTHMA IN THE PEDIATRIC POPULATION

ASTHMA IN THE PEDIATRIC POPULATION ASTHMA IN THE PEDIATRIC POPULATION SEARCH Rotation 2 August 23, 2010 Objectives Define asthma as a chronic disease Discuss the morbidity of asthma in pediatrics Discuss a few things that a health center

More information

Managing and Treating Allergic Rhinitis in the Primary Care Setting

Managing and Treating Allergic Rhinitis in the Primary Care Setting University of Vermont ScholarWorks @ UVM Family Medicine Block Clerkship, Student Projects College of Medicine 2014 Managing and Treating Allergic Rhinitis in the Primary Care Setting Leah Novinger University

More information

Speaker Disclosure. Identification and Diagnosis of Asthma. Definition of Asthma. Objectives 11/9/2017

Speaker Disclosure. Identification and Diagnosis of Asthma. Definition of Asthma. Objectives 11/9/2017 Speaker Disclosure Identification and Diagnosis of Asthma Isabel L. Virella Lowell, MD, Associate Professor, Pulmonology and Sleep Medicine, University of Alabama at Birmingham Isabel Virella-Lowell, MD

More information

Littleton, CO Welcome Packet 8151 Southpark Lane, Suite 200 Littleton, CO 80120

Littleton, CO Welcome Packet 8151 Southpark Lane, Suite 200 Littleton, CO 80120 Littleton, CO Welcome Packet For any after-hours questions, please call (303) 956-5145 Dear Mountain Sleep Patient, You have been scheduled for a sleep study at 8151 Southpark Lane, Suite 200, Littleton,

More information

Tips on managing asthma in children

Tips on managing asthma in children Tips on managing asthma in children Dr Ranjan Suri Consultant in Respiratory Paediatrics Bupa Cromwell Hospital Clinics: Friday (pm) Asthma in Children Making the diagnosis Patterns of childhood asthma

More information

General Questionnaire

General Questionnaire General Questionnaire Name: Date: Address:_ Home Phone: Alternate number: Occupation: Age: Height: Weight: Weight 6 months ago: At age 20: At your heaviest: Referring Physician: Family Physician: 1. In

More information

Allergy Clinic of Iowa Advanced Allergy Therapeutics

Allergy Clinic of Iowa Advanced Allergy Therapeutics 1 Name: Address: City: State: Zip: Phone: Email: Date of Birth: Male Female Pregnant Yes No Trimester 1 2 3 SECTIONS: Please select the section(s) that apply to you and complete those sections only 1.

More information

Cough. It s Not All It s Hacked Up To Be. John Johnson, D.O. Allergy & Asthma Centers of Cape Cod Hospitalist, Cleveland Clinic Foundation

Cough. It s Not All It s Hacked Up To Be. John Johnson, D.O. Allergy & Asthma Centers of Cape Cod Hospitalist, Cleveland Clinic Foundation Cough It s Not All It s Hacked Up To Be John Johnson, D.O. Allergy & Asthma Centers of Cape Cod Hospitalist, Cleveland Clinic Foundation Agenda Review Differential for Cough Discussion on the management

More information

Presenter. Mona Sarfaty, MD, MPH, FAAFP Director, Program on Climate and Health Center for Climate Change Communication George Mason University

Presenter. Mona Sarfaty, MD, MPH, FAAFP Director, Program on Climate and Health Center for Climate Change Communication George Mason University Presenter Mona Sarfaty, MD, MPH, FAAFP Director, Program on Climate and Health Center for Climate Change Communication George Mason University Making the Connection: Climate Changes Allergies and Asthma

More information

SLEEP HISTORY QUESTIONNAIRE

SLEEP HISTORY QUESTIONNAIRE Date of birth: Today s date: Dear Patient: SLEEP HISTORY QUESTIONNAIRE Thank you for taking the time to fill out a sleep history questionnaire. This will help our healthcare team to provide the best possible

More information

The Increasing Importance of Allergies in Asthma Environmental Considerations

The Increasing Importance of Allergies in Asthma Environmental Considerations The Increasing Importance of Allergies in Asthma Environmental Considerations R. Robert Schellenberg, MD, FRCPC Professor and Head, Division of Allergy and Immunology, UBC Disclosures Medical Advisory

More information

Some Facts About Asthma

Some Facts About Asthma Some Facts About Asthma Contents What is asthma? Diagnosing asthma Asthma symptoms Asthma triggers Thanks What is asthma?? Asthma is a chronic lung-disease that inflames and narrows the airways (tubes

More information

Get Healthy Stay Healthy

Get Healthy Stay Healthy Asthma Management WHAT IS ASTHMA? Asthma causes swelling and inflammation in the breathing passages that lead to your lungs. When asthma flares up, the airways tighten and become narrower. This keeps the

More information

Integrative Consult Patient Background Form

Integrative Consult Patient Background Form Let Us Know More - So We Can Help Thank you for choosing to schedule an integrative medicine consultation with UC Health. To help us meet your needs during your visit, please take some time to sit in a

More information

Clinical Study Report SLO-AD-1 Final Version DATE: 09 December 2013

Clinical Study Report SLO-AD-1 Final Version DATE: 09 December 2013 1. Clinical Study Report RANDOMIZED, OPEN, PARALLEL GROUP, PHASE IIIB STUDY ON THE EVALUATION OF EFFICACY OF SPECIFIC SUBLINGUAL IMMUNOTHERAPY IN PAEDIATRIC PATIENTS WITH ATOPIC DERMATITIS, WITH OR WITHOUT

More information

PUGET SOUND ALLERGY, ASTHMA & IMMUNOLOGY

PUGET SOUND ALLERGY, ASTHMA & IMMUNOLOGY PUGET SOUND ALLERGY, ASTHMA & IMMUNOLOGY New Patient Questionnaire. Please answer all the questions as completely as possible. We appreciate your effort in helping us obtain current and complete information

More information