title: The burden of segregated respiratory diseases in India and the quality of care in these patients: Results from the Asia-Pacific Burden of Respiratory Diseases study.
abstract: BACKGROUND
  Chronic respiratory diseases such as asthma, allergic rhinitis (AR), chronic obstructive pulmonary disease (COPD), and rhinosinusitis are becoming increasingly prevalent in the Asia-Pacific region. The Asia-Pacific Burden of Respiratory Diseases study examined the disease and economic burden of AR, asthma, COPD, and rhinosinusitis across the Asia-Pacific and more specifically India.
  
  
  OBJECTIVE
  To estimate the proportion of adults receiving care for asthma, AR, COPD, and rhinosinusitis and assess the economic burden, both direct and indirect of these chronic respiratory disease.
  
  
  METHODS
  Consecutive participants aged ≥18 years with a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Surveys comprising questions about respiratory disease symptoms, healthcare resource utilization, work productivity, and activity impairment were completed by treating physicians and participants during one study visit. Costs, indirect and direct, that contributed to treatment for each of the four respiratory diseases were calculated.
  
  
  RESULTS
  A total of 1000 patients were enrolled. Asthma was the most frequent primary diagnosis followed by AR, COPD, and rhinosinusitis. A total of 335 (33.5%) patients were diagnosed with combinations of the four respiratory diseases; the most frequently diagnosed combinations were asthma/AR and rhinosinusitis/AR. Cough or coughing up sputum was the primary reason for the current visit by patients diagnosed with asthma and COPD while AR patients reported a watery, runny nose, and sneezing; patients with rhinosinusitis primarily reported a colored nasal discharge. The mean annual cost per patient was US$637 (SD 806). The most significant driver of direct costs was medications. The biggest cost component was productivity loss.
  
  
  CONCLUSIONS
  Given the ongoing rapid urbanization of India, the frequency of respiratory diseases and their economic burden will continue to rise. Efforts are required to better understand the impact and devise strategies to appropriately allocate resources.
authors.affiliation: National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India.
authors.forename: Aloke Gopal
authors.initials: AG
authors.lastname: Ghoshal
authors.affiliation: St. John's Medical College Hospital, Bengaluru, Karnataka, India.
authors.forename: G D
authors.initials: GD
authors.lastname: Ravindran
authors.affiliation: Dr. Paras Gangwal's Clinic, New Delhi, India.
authors.forename: Paras
authors.initials: P
authors.lastname: Gangwal
authors.affiliation: Department of Medicine, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India.
authors.forename: Girish
authors.initials: G
authors.lastname: Rajadhyaksha
authors.affiliation: Department of Internal Medicine, National University Hospital, Seoul, South Korea.
authors.forename: Sang-Heon
authors.initials: SH
authors.lastname: Cho
authors.affiliation: Institute of Respiratory Medicine, Malaysia.
authors.forename: Abdul Razak Bin Abdul
authors.initials: AR
authors.lastname: Muttalif
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Horng-Chyuan
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Sanguansak
authors.initials: S
authors.lastname: Thanaviratananich
authors.affiliation: Center for Observational and Real-World Evidence (CORE), Merck and Co., Inc., New Jersey, USA.
authors.forename: Shalini
authors.initials: S
authors.lastname: Bagga
authors.affiliation: Center for Observational and Real-World Evidence (CORE), Merck and Co., Inc., New Jersey, USA.
authors.forename: Rab
authors.initials: R
authors.lastname: Faruqi
authors.affiliation: Center for Observational and Real-World Evidence (CORE), Merck and Co., Inc., New Jersey, USA.
authors.forename: Shiva
authors.initials: S
authors.lastname: Sajjan
authors.affiliation: Medical Affairs, MSD Pharmaceuticals, Mumbai, Maharashtra, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Shetty
authors.affiliation: Medical Affairs, MSD Pharmaceuticals, Mumbai, Maharashtra, India.
authors.forename: Raeesuddin
authors.initials: R
authors.lastname: Syed
authors.affiliation: Life Sciences, Optum, Sydney, NSW, Australia.
authors.forename: Kim K
authors.initials: KK
authors.lastname: Hamrosi
authors.affiliation: Department of Otolaryngology, National University of, Singapore.
authors.forename: De Yun
authors.initials: Y
authors.lastname: Wang
keywords: Economic cost; India; healthcare resource utilization; productivity; respiratory disease