Health-related quality of life in asthma measured by the World Health Organization brief questionnaire (WHO-BREF) and the effect of concomitant allergic rhinitis-A population-based study.

Abstract

The impact of allergic rhinitis (AR), a common comorbidity in asthma, on global quality of life (QoL) using generic QoL questionnaires has not been extensively evaluated. This was a cross-sectional population-based study among adults ≥18 years old. Generic QoL was measured using the World Health Organization (WHO) questionnaire (WHOQOL-BREF), and asthma control was assessed using the Asthma Control Test. Participants were categorized into four groups: Group 1 (No asthma, no AR), Group 2 (Asthma only), Group 3 (AR only) and Group 4 (Concomitant asthma and AR). The student t-test or the ANOVA was used for comparison between groups and based on the level of asthma control. Linear regression was used to assess the association between the level of asthma control and QoL scores, adjusted for age and sex. A p-value of less than 0.05 was considered significant for all associations. There were 9115 participants; 906 (9.9%) had asthma, and 1998 (21.9%) had AR. The lowest QoL scores were in the environment domain. Mean QoL scores were significantly lower in asthma compared to 'no asthma' and in AR compared to 'no AR'. Either asthma or rhinitis (Group 2 or 3) had significantly lower scores compared to no disease (Group 1) only in the environment domain, but the concomitant disease (Group 4) had lower scores across all categories and domains. Scores were significantly lower for uncontrolled asthma compared to controlled asthma and for 'concomitant asthma and AR' compared to 'asthma only'. Increasing age and uncontrolled asthma predicted worse health-related quality of life (HRQoL) consistently. Although asthma and AR negatively impact HRQoL independently, concomitant asthma and AR are worse. Uncontrolled asthma underpins poor QoL in asthma because QoL is not impaired in controlled disease. This underscores the need for recognition and treatment of AR in asthma and reinforces the benefits of achieving asthma control as a priority in asthma treatment.