Bhattacharyya Neil, Kepnes Lynn J
Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Am J Rhinol Allergy. 2013 Nov-Dec;27(6):479-81. doi: 10.2500/ajra.2013.27.3969.
Nasal polyps occur in a significant fraction of patients with chronic rhinosinusitis. However, patterns of medical management in nasal polyp cases are unknown. We sought to determine actual national estimates and contemporary prescribing patterns for ambulatory care visits with a diagnosis of nasal polyposis (NP).
The National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey 2004-2010 were accessed, extracting all adult office visits with a diagnosis of NP. Demographic, provider type, and medication classes prescribed were determined. National estimates for the number of ambulatory medical care visits along with medications prescribed by provider type (otolaryngologist versus nonotolaryngologist) were determined.
There were an estimated 442,024 ± 49,609 adult office visits annually with an NP diagnosis (54.8% men; mean age, 52.3 years); 64.6% of these visits were with otolaryngologists. Medication prescribing rates with a diagnosis of NP were nasal steroids (43.7%), oral steroids (26.9%), antibiotics (26.0%), and oral antihistamines (18.5%). Medication use rates for nasal steroids, oral steroids, oral antihistamines, and antibiotics were 36.3, 25.9, 15.3, and 22.2% for otolaryngology visits, respectively. Analogous medication use rates were 57.1, 28.8, 24.2, and 32.9% of nonotolaryngology visits, respectively. These differences by provider were not statistically significant (all, p ≥ 0.113).
Although nasal steroids are efficacious in NP, they are likely underprescribed. Oral steroids are also commonly prescribed for NP and should be considered a standard option in the treatment of NP.
鼻息肉在相当一部分慢性鼻 - 鼻窦炎患者中出现。然而,鼻息肉病例的药物治疗模式尚不清楚。我们试图确定全国范围内诊断为鼻息肉病(NP)的门诊就诊的实际估计数和当代处方模式。
查阅2004 - 2010年国家门诊医疗调查和国家医院门诊医疗调查,提取所有诊断为NP的成人门诊就诊记录。确定人口统计学、医疗服务提供者类型和所开药物类别。确定全国门诊医疗就诊次数的估计数以及按医疗服务提供者类型(耳鼻喉科医生与非耳鼻喉科医生)开出的药物。
每年估计有442,024 ± 49,609例诊断为NP的成人门诊就诊(男性占54.8%;平均年龄52.3岁);其中64.6%的就诊是由耳鼻喉科医生诊治。诊断为NP时的药物处方率为鼻用类固醇(43.7%)、口服类固醇(26.9%)、抗生素(26.0%)和口服抗组胺药(18.5%)。耳鼻喉科就诊时鼻用类固醇、口服类固醇、口服抗组胺药和抗生素的用药率分别为36.3%、25.9%、15.3%和22.2%。非耳鼻喉科就诊时类似药物的使用率分别为57.1%、28.8%、24.2%和32.9%。医疗服务提供者之间的这些差异无统计学意义(所有p≥0.113)。
尽管鼻用类固醇对NP有效,但可能处方不足。口服类固醇也常用于NP的治疗,应被视为NP治疗的标准选择。