"1. There are three new chronic conditions covered under CHAS – allergic rhinitis, chronic hepatitis B and gout. Can you tell us more about each condition?"

Answer:

Allergic Rhinitis

• What it is:

  Allergic rhinitis causes cold-like symptoms such as a runny nose, itchy eyes, congestion, sneezing and sinus pressure. But unlike a cold, allergic rhinitis isn't caused by a virus. It is caused by an allergic response to a harmless outdoor or indoor substance that the body identifies as harmful (allergen).

  Common allergens that can trigger hay fever symptoms include pollen, pet dander, and dust mites.



• Who it affects:

  It tends to run in families as the allergic gene is transmissible, and tends to occur as a group with other atopic conditions such as asthma, eczema and other allergies. Some people are allergic to certain pollen from flowers which are seasonal, but that is less common in Singapore, compared to temperate countries.

  It is estimated to affect about 5% of the population, but the percentage can be as high as 40% in children.



• How to manage it:

  They can control the allergen through:

  • Frequent cleaning
  • Soaking linens in hot water more than 65 degrees Celsius
  • Not having pets or carpets
  • Using oral antihistamines when necessary to help control symptoms
  • Using steroid nasal spray, as it is also very effective in controlling symptoms and has minimal systemic side effects

Gout

• What it is:

  Gout is a common and complex form of arthritis that can affect anyone. It's characterised by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints — most often in the big toe — and usually causes the patient to limp. Other joints such as the ankle or the knee can also be affected.

  It is caused by abnormal metabolism of purines which are found in certain food groups such as anchovies, fish, and other meats. It is measurable in the blood tests as high uric acid. However, high uric acid alone without any symptom of joint pains does not mean the individual has gout.



• Who it affects:

  It tends to occur in patients with concurrent metabolic illnesses such as being overweight, or having diabetes mellitus, dyslipidemia or high blood pressure. It can also occur by itself and is a rather common condition.

  It is estimated to affect about 5% of the population, but the percentage can be as high as 40% in children.



• How to manage it:

  They need to see a doctor immediately to get treatment for acute gout flares, and do regular blood tests to monitor their uric acid levels and kidney function, as both the condition and the treatment can affect the kidneys. They may be advised to take daily medication to lower their blood uric acid level to prevent further gout flares if they have more than two attacks in one year.

Chronic Hepatitis B

• What it is:

  Chronic Hepatitis B is caused by a virus which has not been cleared after 6 months of the initial infection. It stays in the body in dormant form, but can reactivate at a later date. It can also cause an increased risk of liver cancer.



• Who it affects:

  The virus is transmitted through bodily fluids, whether sexually, from mother to child or via needles, but as it is very common in Singapore, all children born here after 1984 are vaccinated against Hepatitis B. It is also common in the rest of Southeast Asia where vaccination rates may be less comprehensive.

  It remains common in individuals who were not vaccinated as they were born before 1984, and the dormant form may be undetected for many years, until a blood screening test for Hepatitis B is performed.



• How to manage it:

  They need six monthly liver enzyme monitoring to detect if the virus wakes from the dormant form to cause active liver inflammation. They would also need annual ultrasound of the liver with a blood test to screen for liver cancer. They may also be eligible to be treated with an antiviral.

"2. If a patient has a chronic condition, is it important to visit the doctor frequently?"

Answer:

Chronic conditions do not have reliable signs or symptoms, but lead to very serious complications if untreated. Therefore, patients need to be checked by the doctor, who is professionally trained to detect these complications before they become very severe and thus difficult to treat.

"3. If we have a chronic condition, should we stick to one doctor?"

Answer:

Sticking to one doctor will ensure continuity and comprehensiveness of care, as all the recommended testing and counselling for one chronic condition may span a few consultations. If we overload the patient with a lot of information in one session, it is proven to be less effective than bite-sized education over a longer period. Therefore, the doctor schedules the next appointment with the aim to continue optimising the patient's condition over time. Changing doctors would disrupt this flow of information from the professional to the patient, and usually leads to poorer understanding of the disease and hence poorer outcomes.

"4. How can a homebound/bedbound senior visit a GP? If he/she doesn’t visit a doctor face-to-face, will it affect the consultation and treatment?"

Answer:

It is recommended to have at least two face-to-face consultations per year so that the doctor can perform a physical assessment of the patient (e.g. heart auscultation or examining the patient's abdomen). Not performing these can miss the complications until they become severe and harder to treat. A homebound senior should call a house call doctor to visit at least twice a year.