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An multicentric, observational retrospective, cross-sectional survey study to assess the Treatment pattern of Chronic Rhinosinusitis

(To be filled only by physician)

Demographic Data

Age(in Years) *

Gender *

Male Female

General Examination Findings

Weight (kgs) *

Heart Rate (beats/min) *

BP (mm Hg) *

Comorbidities if any *

Yes No

Comorbidities if any

Conditions³

YES or NO

Condition since how long

Years

Months

Urticaria*

Yes No

Anaemia*

Yes No

COPD*

Yes No

Asthma*

Yes No

Idiopathic angio-oedema*

Yes No

Atopic Dermatitis*

Yes No

Mention others if any

	Yes No
	Yes No

Treatment regimen *

Kindly tick the ongoing medications in this patient

No treatment
ICS
Phosphodiesterase inhibitors
Acebrophylline + N-Acetylcysteine
N- Acetylcysteine

Factors Influencing choice of therapy *

Kindly tick the appropriate reasons for prescribing drugs in these patients

Attributes*	Tick all the applicable appropriate attributes/ reasons for prescribing any drug*
Efficacy in terms of symptom control (Sneezing, Rhinotheca, Bloch nose, Sinuses and Headache)
Tolerability
Faster onset of action
Presence of Co-morbidities

Duration of therapy for therapy patients *

1 month 1-3 months 3-6 months 7-12 months

Other Class of Drug given along with above therapy *

Class of Drug

Generic Name

Dose

Duration

Inhaled corticosteroids (ICS)

H1 Anti-Histamines

N-Acetylcysteine

Leukotriene receptor antagonists (LTRA)

Acebrophylline + N-Acetylcysteine

Mention others if any