Multi-symptom asthma is closely related to nasal blockage, rhinorrhea and symptoms of chronic rhinosinusitis-evidence from the West Sweden Asthma Study

Jan Lötvall,Linda Ekerljung,Bo Lundbäck

doi:10.1186/1465-9921-11-163

Abstract

BackgroundWe have previously shown that approximately 25% of those with asthma in West Sweden have multiple asthma symptoms, which may describe a group of patients with more severe disease. Furthermore, asthma is associated with several co-morbid diseases, including rhinitis and chronic rhinosinusitis. The aim of this study was to determine whether multi-symptom asthma is related to signs of severe asthma, and to investigate the association between multi-symptom asthma and different symptoms of allergic and chronic rhinosinusitis.MethodsThis study analyzed data on asthma symptoms, rhinitis, and chronic rhinosinusitis from the 2008 West Sweden Asthma Study, which is an epidemiologically based study using the OLIN and GA2LEN respiratory and allergy focused questionnaires.ResultsMulti-symptom asthma was present in 2.1% of the general population. Subjects with multi-symptom asthma had more than double the risk of having night-time awakenings caused by asthma compared with those with fewer asthma symptoms (P < 0.001). The prevalence of allergic rhinitis was similar in the fewer- and multi-symptom asthma groups, but nasal blockage and rhinorrhea were significantly increased in those with multi- versus fewer-symptom asthma (odds ratio 2.21; 95% confidence interval 1.64-2.97, versus 1.49; 1.10-2.02, respectively). Having any, or one to four symptoms of chronic rhinosinusitis significantly increased the risk of having multi- versus fewer-symptom asthma (P < 0.01).ConclusionAn epidemiologically identified group of individuals with multiple asthma symptoms harbour to greater extent those with signs of severe asthma. The degree of rhinitis, described by the presence of symptoms of nasal blockage or rhinorrhea, as well as the presence of any or several signs of chronic rhinosinusitis, significantly increases the risk of having multi-symptom asthma.

Highlights

We have previously shown that approximately 25% of those with asthma in West Sweden have multiple asthma symptoms, which may describe a group of patients with more severe disease
The prevalence of reported nasal blockage and rhinorrhea was higher in the group with multi-symptom asthma compared with the fewer-symptom asthma group (Table 1)
We suggest that a large component of subjects have a more severe degree of asthma, as they reported much higher frequency of night-time awakenings due to asthma compared with non-asthma and fewer symptom asthma groups

Summary

Introduction

We have previously shown that approximately 25% of those with asthma in West Sweden have multiple asthma symptoms, which may describe a group of patients with more severe disease. Asthma is associated with several co-morbid diseases, including rhinitis and chronic rhinosinusitis. Studies that have recruited asthma patients from different clinical cohorts have shown that severity of nasal symptoms is associated with severity and difficulty to treat the asthma [9,11,12,13,14,15,16]. Despite these findings, no epidemiological studies have described the relationship between different nasal symptoms and asthma symptoms in a large random population sample. Multi-symptom asthma, identifiable by epidemiological means, has not been described previously

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