Rhinitis and asthma patient perspective (RAPP): clinical utility and predictive value.

Background: RhinAsthma Patient Perspective (RAPP) is the only validated tool for the assessment of health-related quality of life (HRQoL) related to asthma and rhinitis in individual patients. Objective: The aim of this study was to compare the HRQoL burden among countries and to explore the usefulness of RAPP as a complementary measure in disease management. Methods: In this post hoc analysis of the RAPP International Study, the enrolled population was clustered into patients with controlled rhinitis and controlled asthma (CA/CR), uncontrolled rhinitis and controlled asthma (CA/UR), controlled rhinitis and uncontrolled asthma (UA/CR), uncontrolled rhinitis and uncontrolled asthma (UA/UR). Results: 575 adult patients were recruited. Significant differences among countries were observed in the mean RAPP score (from 15.7 in Spain to 18.7 in the Philippines), even if the percentage of subjects with an optimal HRQoL (RAPP<15) was not significantly different. Compared to patients with AR and asthma disease control, those with UR/CA, CR/UA, and UR/UA had significantly higher RAPP scores (4.7, 5, and 9.8, respectively). The best cutoffs for detecting uncontrolled diseases were RAPP>=15 (Sensitivity= 75%, Specificity= 69%, AUC=0.78) for AR; RAPP>=16 (Sensitivity=78%, Specificity=76%, AUC=0.83) for asthma; and RAPP>=18 (Sensitivity=86%, Specificity=87%, AUC=0.92) for both AR and asthma. Conclusions: The present findings provide a better understanding of the individual burden of HRQoL related to asthma and rhinitis in daily practice. In addition, the RAPP estimates how much of the risk for uncontrolled disease depends on uncontrolled AR and asthma, allowing its use as a clinical support tool in clinical management.