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Manon Belhassen,1 Marjorie Bérard,1 Gilles Devouassoux,2 Faustine Dalon,1 Jean Bousquet,3,4 Eric Van Ganse1,2,5 1Pelyon, Pharmacoepidemiology Lyon, Lyon, France; 2Respiratory Medicine, Croix Rousse Hospital, Lyon, France; 3MACVIA-France, Fondation Partenariale FMC VIA-LR, Montpellier, France; 4INSERM U 1168, VIMA, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, France; 5Research on Health Care Performance RESHAPE, INSERM U1290, University Claude Bernard Lyon 1, Lyon, FranceCorrespondence: Eric Van Ganse, Respiratory Medicine, Croix Rousse Hospital, Lyon, France, Tel +33 472 071 730, Email eric.van-ganse@chu-lyon.frBackground: Appropriate use of effective treatments is required for satisfactory control of allergic symptoms. Coherent medical care -regular prescribing by the same Health Care Professionals- is a preliminary need.Objective: We investigated the numbers of distinct prescribers, the regularity of medical visits, and the agreement between prescriptions and associated dispensations in individual patients with perennial allergic rhinitis (PAR) and asthma.Methods: In primary care electronic health records (EHRs), a cohort of patients with PAR and asthma was identified. Individual EHRs were linked to corresponding claims recording all dispensations. Prescribing patterns were analyzed for the major treatment classes, and the dispensations linked to individual prescriptions were retrieved to compute the proportions of days covered (PDCs) for asthma and PAR therapy.Results: A total of 3654 patients were included, with 62% being female (mean age, 46.1 years). At inclusion, asthma control was not optimal in 51% of the patients and 48% had received oral corticosteroids. The mean interval between successive prescriptions varied between 93 (leukotriene receptor antagonists, LTRAs) and 103 (inhaled corticosteroids, ICS) days, and 97 (antihistamines, AHs) and 103 days (nasal corticosteroids, NCS). On average, individual prescriptions lead to 1.2, 1.5, 1.7 and 1.8 dispensations of ICS, ICS/Long-Acting Beta-Agonist (LABA) fixed-dose combinations, LABAs, and LTRAs, respectively, and to 1.3 and 1.6 dispensations of NCS and AHs, respectively. PDCs then varied between 37.8% for ICS and 58.6% for LTRAs, and between 39.7% for NCS and 50.4% for AHs. Care was nonetheless coherent, with > 90% of all dispensations related to prescriptions issued by single General Practitioners (GPs).Conclusion: Despite regular healthcare visits and medication prescriptions, allergic patients only partly and selectively refilled their treatments, preferring the less effective therapy, in a context of poor control of asthma symptoms.Keywords: asthma, rhinitis, care, control, therapy, adherence, misuse more...

Numerous studies indicate beneficial effects of glutamine (Gln) in many models of catabolic adult rats. No data were available for aged rats. The effects of oral L-Gln-enriched diet were tested in endotoxemic 24-mo old rats. First, rats received for 7 d (from d0 to d7) an oral diet supplemented with either L-Gln [1g/(kg. d)] or casein (Cas: isonitrogenous supply) prior to lipopolysaccharide (LPS) challenge. The rats were then killed after 24 h food deprivation (from d7 to d8). Endotoxemia induced a catabolic response as shown by muscle glutamine depletion, hyperphenylalaninemia, small bowel atrophy and impaired functionality and bacterial translocation. The Gln-enriched diet did not prevent muscle Gln depletion but significantly (P more...