AB042. Allergy Working Group Update: the burden and management of rhinitis and rhinosinusitis in UK primary care

Background: Rhinitis and rhinosinusitis are diseases of the upper airways with a high prevalence and when they are chronic with a high quality of life burden on patients and costs for society. To date, data on the primary care burden of rhinitis and rhinosinusitis are limited as is knowledge of how primary care physicians currently manage these patients. This study aims to quantify the burden of CRS and characterize related management approaches in UK primary care.

Methods: Patients with diagnostic codes for rhinitis and rhinosinusitis were identified within the UK’s Optimum Patient Care Research Database (OPCRD), a respiratory enriched primary care database. Consultations over a 5-year period (latest for each patient) code for rhinitis and rhinosinusitis symptoms resulting in prescriptions for antibiotics, oral steroids and/or antihistamines were identified. Diagnostic codes were used to further categorize patients into acute/chronic rhinitis/rhinosinusitis and allergic/non allergic chronic rhinitis subgroups. Prescribed therapies were categorized as: antibiotics (all); steroids (oral, injectable, nasal) and antihistamines, nasal spray and eye drops and mapped across rhinitis/rhinosinusitis and allergic/non-allergic patient subgroups.

Results: A total of 685,429 patients were identified with rhinitis and rhinosinusitis diagnostic codes. Of these patients: 80,900 (5%) had a diagnostic code for acute rhinitis (common cold); 176,353 (26%) for acute rhinosinusitis; 65,610 (10%) for chronic rhinosinusitis; 306,030 (45%) for chronic allergic rhinitis; 4,747 (1%) for chronic non-allergic rhinitis and 51,790 (8%) undefined chronic rhinitis. A total of 1,664,068 consultations for rhinitis and rhinosinusitis symptoms were identified, of which 185,730 (27%) resulted in an antibiotic prescription, 5,597 (0.8%) in an oral steroid prescription and 1,898 (0.3%) in an antibiotic and oral steroid prescription. Drug prescribing varied markedly across diagnostic subgroups with antibiotic use highest among patients with acute rhinosinusitis (71%).

Conclusions: In the OPCRD, rhinosinusitis consultations make up 35% of primary care consultations for rhinitis and rhinosinusitis. Interestingly, almost three-quarters of patients (71%) consulting for acute rhinosinusitis and 58% of patients with chronic rhinosinusitis receive an antibiotic prescription.

Keywords: Rhinitis; rhinosinusitis; symptom; primary health care