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Data Collection Form


An observational survey to analyze management of allergic rhinitis

(To be filled only by physician)


  1. As per your clinical practice, what is the approximate number of patients newly diagnosed with allergic rhinitis every month? *

  2. What are the signs & symptoms observed in patients with Allergic Rhinitis? (Please tick all the applicable options) *
  3. What are the patient profiles which you consider while choosing the specific antihistamine in your patients with Allergic Rhinitis? (Tick all applicable) *

    4. Please Specify

  4. What is the approximate percentage of patients having comorbidities in patients with allergic rhinitis, as per observation in your practice? (Please fill the approximate percentage) *
    5. Name Percentage (%)

    %

  5. What are the common comorbidities observed in patients with allergic rhinitis? (Please tick all the applicable options) *
  6. What is the approximate percentage of patients with allergic rhinitis requiring Leukotriene receptor antagonist + antihistamine combination, as per your practice? *

  7. What is the average duration of treatment with Leukotriene receptor antagonist + antihistamine combination in patients with allergic rhinitis, as per your practice? *

  8. Probable reason for choosing specific Leukotriene receptor antagonist (LTRA) + antihistamine combination as your preferred combination based on below mentioned parameters in patients with allergic rhinitis? *

  9. If patients are shifted from existing Anti-Histamine to other Anti-Histamine, what are the reasons for shifting to new Anti-Histamine (Please tick all the applicable options) *
  10. Any other medication/formulation prescribed concomitantly with Leukotriene receptor antagonist + antihistamine combination in Allergic rhinitis patients? *

  11. How would you rate the role of Leukotriene receptor antagonist + antihistamine combination for patients with allergic rhinitis as per the disease severity? *
    12. Parameter Strongly recommended Recommended Neutral
  12. Which symptom is expected to improve the most with LTRA + Anti-Histamines combination? (Please tick all the applicable options) *
  13. What is the approximate percentage of patients with severe allergic rhinitis, where Leukotriene receptor antagonist is advised, as per your practice? *

  14. What is the approximate break up of patients on the below specific therapies in patients with allergic rhinitis, as observed in your practice? *
    15. Percentage

    %

    %

    %

    %

    %

    %

  15. How would you rate the role of Anti-Histamines for patients with allergic rhinitis in addition to below mentioned medications? *
    16. Parameter Strongly recommended Recommended Neutral
  16. How would you rate the role of LTRA + Anti-Histamines combination in patients with Allergic rhinitis in terms of improvement for below symptoms? *
    17. Parameter Strongly recommended Recommended Neutral
  17. How would you rate the role of Leukotriene-receptor antagonists in patients with Allergic rhinitis in terms of improvement for below symptoms? *
    18. Parameter Strongly recommended Recommended Neutral
  18. How would you rate the role of LTRA + Anti-Histamines combination for patients with allergic rhinitis as per the type of patients? *
    19. Strongly recommended Recommended Neutral
  19. Do you consider taste as an advantage of flavored tablets over regular tablets in patients with allergic rhinitis? *

  20. Would you prefer to advise Oro-dispersible Tablets dosage forms for better patient compliance in patients with allergic rhinitis? *

  21. What is the frequency of follow up of allergic rhinitis patients? *

  22. Which is your preferred Antihistamines in addition to Montelukast in terms of efficacy & safety in allergic rhinitis patients? (Tick at the appropriate option) *
  23. What is the approximate percentage of patients with allergic rhinitis have asthma co-morbidity, as observed in your practice? *

  24. Approximately for which duration of therapy is LTRA + Anti-Histamines combination advised in your patients with allergic rhinitis having concomitant asthma? *

  25. What is the approximate percentage of patients with allergic rhinitis having cardio-vascular co-morbidity, as observed in your practice? *

  26. Which is your preferred Antihistamines in patients with allergic rhinitis with cardio-vascular co-morbidity, in your clinical practice? (Tick the appropriate feedback) *
  27. What is the approximate percentage of patients with allergic rhinitis having COPD co-morbidity, as observed in your practice? *

  28. What criteria’s do you use for choosing a LTRA + Anti-Histamines agents in your patient with COPD? *

  29. Which is your preferred Antihistamines in terms of efficacy & safety in allergic rhinitis patients with below comorbid conditions/ specific patient profiles? *
    30. Hepatic impairment Elderly Renal impairment
  30. Do you observe any challenges in terms of adherence with LTRA + Anti-Histamines combination in patients with allergic rhinitis, as per observations in your clinical practice? (Tick the appropriate feedback) *