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Table 1 Template of the questionnaire used

From: The patient with rhinitis in the pharmacy. A cross-sectional study in real life

  QUESTION POSSIBLE ANSWERS
1 Gender • M
• F
2 Age (years) • <20
• 21-40
• 41-60
• >60
3 Race • Caucasian
• Asian
• South American
• Arab
• Other………….
4 Which symptom mainly prompted you to go to the pharmacy? • Rhinitis (sneezing, runny nose, itchy nose, stuffy nose)
• Cough
• Conjunctivitis (burning eyes, itchy eyes, photophobia)
• Dyspnea (short breath)
5 How long before your visit to the pharmacy did the symptom appear? • < 5 days
• 5-10 days
• 11-30 days
• > 30 days
6 The problem was already diagnosed by a physician? • Yes
• No
7 Did you received a physician prescription for your symptoms? • Yes
• No
8 Which medications do you usually take?
(multiple answers allowed)
• Topical nasal decongestants
• Systemic antihistamines
• Topical antihistamines
• Topical steroids
• Systemic steroids
• Topical anticholinergics
• Topical Cromones
• Antibiotics
• Antileukotrienes
• If you can not specify the class, indicate commercial names
9 Do you use or have used complementary/alternative medicines (e.g. homeopathy, acupuncture, herbs) for your rhinitis/asthma? • Yes
• No
10 Do you use or have used allergy vaccines? • Yes
• No
If yes:
• Sublingual route
• Subcutaneous route
11 If for this problem you usually care alone, why do you? • It is a trivial problem
• It’s not worth to talk to the doctor
• The doctor underestimates
• Just consult the pharmacist
12 Do your symptoms affect your everyday life? • Not at all
• Moderately
• Heavily