The Burden of Self-Reported Rhinitis and Associated Risk for Exacerbations with Moderate-Severe Asthma in Primary Care Patients (original) (raw)

Self reported rhinitis is a significant problem for patients with asthma

Primary care respiratory journal : journal of the General Practice Airways Group, 2005

There is increasing interest in the possibility that rhinitis and asthma are intricately interlinked. The aim of this baseline audit was to investigate the prevalence and characteristics of rhinitis symptoms in a large-scale UK primary care-based survey of patients with asthma. A questionnaire about the presence/absence and type of nasal symptoms, seasonal variations, and trigger factors was developed and piloted. This was then distributed among approximately 10,500 patients with clinician-diagnosed asthma via a national database of practice nurses. We achieved a response from 7,129 patients (68%). Of these, 76% (n=5,420) had symptoms indicative of rhinitis as shown by the presence of more than one of the following: nasal blockage; runny nose; sneezing; and itchy eyes, ears or palate. 58% reported predominantly seasonal symptoms and 42% predominantly perennial symptoms. Sneezing was reported in a significantly greater proportion of patients with seasonal (66%) than perennial (58%) s...

Survey on the impact of comorbid allergic rhinitis in patients with asthma

BMC Pulmonary Medicine, 2006

Background: Allergic rhinitis (AR) and asthma are inflammatory conditions of the airways that often occur concomitantly. This global survey was undertaken to understand patient perspectives regarding symptoms, treatments, and the impact on their well-being of comorbid AR and asthma.

Prevalence and impact of rhinitis in asthma. SACRA, a cross-sectional nation-wide study in Japan

Allergy, 2011

Background: Asthma and rhinitis are common co-morbidities everywhere in the world but nation-wide studies assessing rhinitis in asthmatics using questionnaires based on guidelines are not available. Objective: To assess the prevalence, classification, and severity of rhinitis using the Allergic Rhinitis and its Impact on Asthma (ARIA) criteria in Japanese patients with diagnosed and treated asthma. Methods: The study was performed from March to August 2009. Patients in physicians' waiting rooms, or physicians themselves, filled out questionnaires on rhinitis and asthma based on ARIA and Global Initiative for Asthma (GINA) diagnostic guides. The patients answered questions on the severity of the diseases and a Visual Analog Scale. Their physicians made the diagnosis of rhinitis. Results: In this study, 1910 physicians enrolled 29 518 asthmatics; 15 051 (51.0%) questionnaires were administered by physician, and 26 680 (90.4%) patients were evaluable. Self-and physician-administered questionnaires gave similar results. Rhinitis was diagnosed in 68.5% of patients with self-administered questionnaires and 66.2% with physician-administered questionnaires. In this study, 994 (7.6%) patients with self-administered and 561 (5.2%) patients with physician-administered questionnaires indicated rhinitis symptoms on the questionnaires without a physician's diagnosis of rhinitis. Most patients with the physician's diagnosis of rhinitis had moderate/severe rhinitis. Asthma control was significantly impaired in patients with a physician's diagnosis of rhinitis for all GINA clinical criteria except exacerbations. There were significantly more patients with uncontrolled asthma as defined by GINA in those with a physician's diagnosis of rhinitis (25.4% and 29.7%) by comparison with those without rhinitis (18.0% and 22.8%). Conclusion: Rhinitis is common in asthma and impairs asthma control.

Allergic rhinitis and asthma comorbidity: ARIA classification of rhinitis does not correlate with the prevalence of asthma

Clinical & Experimental Allergy, 2007

Allergic rhinitis and asthma comorbidity is supported by both the similar underlying pathogenesis and immunologic mechanisms. The aim of this study was to verify whether the characteristics of rhinitis classified according to the new Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines correlate with the prevalence of asthma. From 1 March to 30 June 2002, a multi-centre cross-sectional study was conducted by 154 allergists chosen from throughout Italy. Duration, severity of rhinitis (according to the ARIA classification) and the type of allergic sensitizations were compared with the prevalence of asthma. One thousand three hundred and twenty-one consecutive rhinitis-allergic patients aged 18 years or older were enrolled for the study. The majority of patients, 1060 (80.24%), were on medication at the time of their specialist visit. Mild intermittent rhinitis was diagnosed in 7.7% of patients, moderate/severe intermittent in 17.1%, mild persistent in 11.6%, and moderate/severe persistent in 63.6%. The prevalence of asthma was 48% in patients with mild intermittent rhinitis, 49.6% in moderate-severe intermittent rhinitis, 36.6% in mild persistent rhinitis and 47.5% in moderate severe persistent patients. No correlation between the ARIA categories of rhinitis and the prevalence of asthma was found. A multivariate analysis, after adjustment for age, sex, type of sensitization, level of severity and duration of rhinitis classified according to the ARIA guidelines, demonstrated that age, over 41 years [risk ratio (RR) 1.260, 95% confidence interval (CI) 1.072-1.482] and especially over 51 years (RR 1.460, 95% CI 1.237-1.723), sensitization to indoor allergens (mite and cat), (RR 1.203, 95% CI 1.060-1.366), and polysensitization (RR 1.178, 95% CI 1.004-1.383) are significant risk factors for asthma. In allergic rhinitis (AR) patients referred to a specialist, the features of AR as defined by the ARIA classification are not able to predict the presence of asthma, therefore all such patients should be assessed for asthma.

The burden of allergic rhinitis and asthma

Therapeutic advances in respiratory disease, 2012

Asthma and allergic rhinitis are common health problems that cause major illness and disability worldwide. The prevalence of allergic rhinitis is estimated to range from 10% to 20% in the USA and Europe. Multiple factors contribute to the wide range of reported prevalence rates. These include type of prevalence rate reported (current or cumulative), study selection criteria, age of participants, differences in survey methods, varied geographic locations and socioeconomic status, any of which are significant enough to confound direct comparison between studies. There is no standard set of diagnostic criteria for allergic rhinitis. In most studies, the criteria for diagnosis are based on the subject's reporting, solely by questionnaire and rarely confirmed by skin testing. In addition, most studies focus on hay fever, leaving perennial allergic rhinitis underestimated. Sinus imaging is generally not performed and, therefore, rhinosinusitis not differentiated. Some investigators re...

Rhinitis symptoms and comorbidities in the United States: burden of rhinitis in America survey

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2008

To assess the burden of nasal symptoms in the United States (U.S.) and the comorbid conditions associated with nasal symptoms. A self-administered screening questionnaire and follow-up survey was sent to targeted households from a representative sample of 15,000 households in the U.S. Subjects with comorbid asthma completed the Asthma Control Test (ACT). Out of 7024 evaluable subjects who responded, 3831 subjects were classified as rhinitis "sufferers." Individuals with active rhinitis symptoms were 1.5 to 4.5 times more likely to suffer from comorbid conditions including asthma, conjunctivitis, otitis media, sinusitis, eczema, food and insect bite allergies, migraine, and depression. Almost half of all respondents with moderate or severe rhinitis symptoms and comorbid asthma had poorly controlled asthma as defined by an ACT score of < or =19. A strong relationship exists between rhinitis symptoms and various comorbidities, including asthma, in the U.S. population. Poor...

Treating allergic rhinitis in patients with comorbid asthma: The risk of asthma-related hospitalizations and emergency department visits

Journal of Allergy and Clinical Immunology, 2002

Background: Although asthma and allergic rhinitis commonly occur together, the nature of the association has yet to be determined. Treatments for one condition could potentially alleviate the coexisting condition. Objective: Patients with both allergic rhinitis and asthma were studied to test the hypothesis that treating allergic rhinitis reduces health care utilization for co-morbid asthma. Methods: A retrospective cohort study was carried out with 1994-1995 MarketScan claims data. The cohort was limited to patients with both allergic rhinitis and asthma, aged 12 to 60 years, who were continuously enrolled and had no evidence of chronic obstructive pulmonary disease. Allergic rhinitis treatment and asthma-related events (hospitalizations and emergency department visits) were identified. An incidence density ratio (IDR) associated with exposure to allergic rhinitis treatment was calculated. A multivariate Poisson regression was estimated, and the parameter estimates were transformed into IDRs for each explanatory variable. An allergic rhinitis treatment indicator was included in all regressions. Results: The study sample population consisted of 4944 patients with allergic asthma, approximately 73% of whom were treated for their allergic rhinitis. Asthma-related events occurred more often for the untreated group compared with the treated group, 6.6% compared with 1.3%. An IDR of 0.49 for the treatment group (P = .001) indicates that the risk of an asthma-related event for the treated group was about half that for the untreated group. Conclusion: In summary, those who were treated for allergic rhinitis have a significantly lower risk of subsequent asthmarelated events (emergency department visits or hospitalizations) than those who were not treated. (J Allergy Clin Immunol 2002;109:57-62.)

The impact of concomitant rhinitis on asthma-related quality of life and asthma control

Allergy, 2010

Background: Characterizing the interactions between the upper and lower airways is important for the management of asthma. This study aimed at assessing the specific impact of concomitant rhinitis on asthmarelated quality of life (QOL) and asthma control. Methods: A cross-sectional, observational survey was conducted among 1173 patients with asthma (aged 12-45) recruited by general practitioners and chest physicians. AR was defined by self-reported rhinitis symptoms and previously documented sensi-tization to inhalant allergens. The primary outcomes were (1) asthma control assessed by the Asthma Control Questionnaire (ACQ) and (2) asthma-specific QOL evaluated through the Mini Asthma Quality of Life Questionnaire (mAQLQ). Results: AR was present in 73.9% of the population with asthma and nonallergic rhinitis (NAR) in 13.6%. AR and NAR were associated with an increased risk of uncontrolled asthma (i.e. ACQ score > 1.5) with adjusted odds ratios (OR) of 2.00 (95% confidence interval [CI]: 1.35-2.97) and 1.77 (95%CI: 1.09-2.89), respectively. Multivariate linear regression analysis showed that AR and NAR had a modest, although significant, negative impact on the global mAQLQ score (beta coefficient:-0.293, standard error [SE]: 0.063 and beta coefficient:-0.221, SE: 0.080, P < 0.001, respectively), even after adjustment for the level of asthma control and demographic characteristics. Conclusion: This survey provides direct evidence that AR and NAR are associated with an incremental adverse impact on the disease-specific QOL of patients with asthma and the level of asthma control. Further investigations are required to determine whether appropriate treatment of rhinitis would efficiently reduce asthma morbidity.

Allergic Rhinitis and Its Impact on Asthma Update (ARIA 2008)-Western and Asian-Pacific Perspective

… Pacific Journal of …, 2010

Allergic rhinitis is a global health problem. Over 600 million patients suffer from this disease worldwide. ARIA (Allergic Rhinitis and its Impact on Asthma), an evidence-based document, was produced and published in 2001 using an extensive review of the available literature. The ARIA 2008 update was recently published and covers tertiary prevention of allergy, pharmacologic treatments, and immunotherapy. Nonallergic rhinitis is still a controversial area and may pose some treatment problems. Another important aspect of the ARIA update is the comorbidity of allergic rhinitis, in particular, asthma. The recommendations of the 2008 ARIA Update, as in 2001, are that patients with allergic rhinitis, particularly if persistent, should be evaluated for asthma, patients with asthma should be evaluated for rhinitis, and an effective and safe combination strategy should be used to treat diseases of the upper and lower airways. Over the last few years, several studies performed in Spain report new data on the prevalence of allergic rhinitis, sensitivity to common aeroallergens, comorbidity of allergic rhinitis and asthma, and impact on quality of life. The studies reviewed in this manuscript confi rm-as do those from other developed countries-the enormous impact of the disease on society and health care in Spain.

Lack of control of severe asthma is associated with co-existence of moderate-to-severe rhinitis

Allergy, 2008

Asthma and rhinitis are related diseases, sharing similarities in many aspects. The hallmark of the airway inflammation in rhinitis and asthma is the Th 2 immune response. This is characterized by the modulation of the inflammatory process by Th 2 cytokines (1) and the presence of eosinophils in the mucosa of the airways (2). The prevalence of rhinitis among asthmatics is high, around 46-100%, and the prevalence of asthma among rhinitis patients is around 24-33% (3). This interrelationship is reinforced by studies that demonstrated increased bronchial hyper-responsiveness in patients with rhinitis exposed to nasal challenge (4) and exposed to environmental allergens (5). Similarly, segmental bronchial provocation induces nasal inflammation in patients with rhinitis (6). Recently, retrospective studies provided evidence for an increased severity of asthma in patients with associated rhinitis. Analyses of health administrative databases have shown the rate of hospital admissions and emergency room visits to be higher among asthmatic patients with rhinitis (7-9). Post hoc analysis of clinical trials also suggests that asthmatic patients with rhinitis have more severe asthma symptoms (10, 11). However, in some of these studies the prevalence of rhinitis was low, probably reflecting some degree of imprecision in the diagnostic criteria, and raising the possibility of bias on account of misclassification. Although the concept of impact of rhinitis on asthma is largely accepted (12), the studies that observed an association between rhinitis and parameters of increased asthma severity were not fully conclusive. The aim of this study is to evaluate whether rhinitis is a predictor for increased asthma severity, lower response to treatment and higher cost of treatment for asthma. Material and methods Patients Consecutive patients were screened on admission in ProAR, a public funded programme for control of asthma and rhinitis in Bahia, Brazil. For this study, the inclusion criteria were symptoms of severe asthma, according to GINA (13), and age over 12 years. The exclusion criteria were abnormal chest x-ray, a diagnosis of Background: Retrospective studies provide evidence that rhinitis is associated with more severe asthma. The aim of this study was to evaluate prospectively whether rhinitis is a predictor of increased asthma severity. Methods: Five hundred and fifty-seven patients with severe asthma were enrolled. During 1 year of follow-up, each patient was evaluated every 3 months with a record of emergency room visits and supply of topical corticosteroids for asthma and rhinitis. In the 1 year of follow-up visit, the patients were checked for rhinitis diagnosis, severity and answered questionnaires for asthma symptoms and quality of life. Results: Eighty-two (15%) patients had no rhinitis, 299 (54%) had mild rhinitis and 176 (31%) moderate/severe rhinitis. In logistic regression models, moderate/ severe rhinitis was a predictor for any emergency room visit in the follow-up period [3.83 (2.00-7.35)], for the presence of uncontrolled asthma after 1 year of follow-up [12.68 (1.73-92.85)], for <10% improvement of the airway obstruction [2.94 (1.48-5.85)] and <50% reduction in the number of emergency room visits [2.90 (1.02-8.26)] in the year of follow-up. It was also associated with a smaller chance of more than 90% reduction in the number of emergency room visits in the year of follow-up [0.27 (0.12-0.60)]. In a multivariate linear regression model, severity of rhinitis was positively correlated with a score of asthma severity and inversely correlated to an index of quality of life. Conclusions: In a population with severe asthma, moderate/severe rhinitis is a strong predictor for greater severity of asthma.