Comorbid Rhinitis Research Articles

Prevalencia y características de la rinitis en pacientes asmáticos de las consultas de Atención Primaria, Alergología y Neumología en España (Estudio AIR)

Background and objectives Rhinitis and asthma are linked by common epidemiological, clinical and inflammatory features. The objective of the AIR study was to understand the prevalence and characteristics of rhinitis in adult asthmatic patients who were seen in either primary or secondary care (Allergy or Pulmonology) in Spain. Patients and methods This was a prospective epidemiological study with the participation of 1,369 randomly selected physicians. Five thousand six hundred sixteen asthmatic patients older than 18 years of age were selected and the study was carried out between February-September 2006. Demographic data, rhinitis prevalence, pulmonary function, allergy tests and treatments were analyzed. Results Some 75% (N = 4,212) of the asthmatic patients presented with additional rhinitis and these were characterised as being both younger (41.3 vs 50.4 years; p < 0.0001) and with less severe asthma (FEV 1 = 86.6 vs 79.3%, p < 0.0001) than asthmatic patients without rhinitis. A positive correlation was found between asthma and rhinitis severity (p < 0.0001) whilst atopy was significantly associated with the presence of rhinitis (81 vs 48%; OR: 4.80; CI 95%: 4.2-5.5). The presence of co-morbid rhinitis was associated with a higher number of asthma exacerbations (p < 0.001). Conclusions Some 75% of our asthmatic patients had associated rhinitis and this association was more frequent in atopic subjects. There is a positive correlation between the severity of rhinitis and asthma and between the number of asthma exacerbations and the presence of rhinitis. These results support the main message of ARIA and GEMA recommendations regarding the integral management of airways to improve the control of asthma.

Rhinitis in children: Co-morbidities and phenotypes

Rhinitis and its co-morbidities affect quality of life; and in children, little is known. We therefore aimed to describe the co-morbidities and phenotypes of current rhinitis in 10-yr-old Norwegian children. We used information on rhinitis, asthma, allergic sensitization, anaphylaxis, and lung function tests from clinical examinations and structured parental interviews of 1019 children included in the birth cohort study, the Environment and Childhood Asthma Study, in Oslo. Current rhinitis was reported in 254 (25.0%) of the children, and 87.4% had at least one allergy-related co-morbidity of rhinitis, with conjunctivitis the most prevalent (75.6%). Overall, 11.8% of the children had conjunctivitis combined with current asthma and atopic eczema. Children with rhinitis were also more likely to have severe bronchial hyperresponsiveness (BHR) (PD(20) <or= 1 micromol methacholine) than children without rhinitis (17.5% and 5.8%, respectively, p < 0.001), as well as BHR (PD(20) <or= 8 micromol). The children with rhinitis and allergic sensitization (72.8%) had more frequently BHR, severe BHR, and conjunctivitis, but did not differ with respect to any other co-morbidity from children with rhinitis without allergic sensitization. Children with symptoms reported by exposure to both pollen and furry pets had more often asthma, wheeze, and BHR compared to the children who reported rhinitis symptoms only when exposed to pollen (91.9% of these had symptoms in spring/summer only). In conclusion, current rhinitis is closely associated with conjunctivitis, asthma, atopic eczema, and BHR in childhood. Conjunctivitis and BHR were most strongly linked to rhinitis with allergic sensitization.

Reduced basal salivary cortisol in children with asthma and allergic rhinitis

Reduced basal cortisol is reported in allergic disease. We investigated if basal salivary cortisol levels were reduced in children with asthma or allergic rhinitis, controlling for inhaled corticosteroids (ICS) use. Morning and evening saliva of asthmatic children aged 7-12 years (n = 50) and that of controls (n = 52) were sampled. A total of 19 asthmatics and four controls had allergic rhinitis. Healthy children were controls without rhinitis. Of all, 14 asthmatic children used low, and 12 used moderate or high doses of ICS. Cortisol was analysed by radioimmunoassay. Morning salivary cortisol median (95% CI) was lower in asthmatics (8.7 (7.1, 9.7)) compared with that in controls (10.4 (9.6, 11.8); p = 0.006), which was similar for evening cortisol levels. Regression analyses demonstrated that asthmatics using moderate or high doses of ICS had reduced morning salivary cortisol adjusted (for age and gender) odds ratio (aOR) (95% CI) (0.54 (0.37, 0.80); p = 0.002) and reduced evening cortisol aOR (0.09 (0.01, 0.6); p = 0.02) compared with that in healthy children. Asthmatics with rhinitis on no or low doses of ICS had reduced morning cortisol aOR (0.73 (0.56, 0.96); p = 0.02) compared with that in healthy children. Asthmatic children on moderate or high doses of inhaled corticosteroids had reduced salivary cortisol, but co-morbidity of asthma and rhinitis was also associated with reduced cortisol levels.

Unawareness and undertreatment of asthma: follow‐up in a different geographic area in Denmark

Early detection and treatment of asthma is important to minimize morbidity and healthcare costs. The objective of this study was to investigate asthma awareness and management in a western society. In a random sample of 10 400 subjects aged 14-44 years, 686 (6.6%) reported symptoms of asthma in a standardized screening questionnaire. All 686 were evaluated by respiratory specialists and diagnosed by history, symptoms, lung function tests, bronchial challenges and allergy testing. Of these 686 participants, 69 (10%) had asthma alone, 205 (30%) had rhinitis alone and 217 (32%) had both asthma and rhinitis; 195 (28%) had nonasthmatic respiratory reports. Awareness of asthma was found among 163 (57%) of the 286 asthmatics, and 204 (95%) had doctor-diagnosed rhinitis as well. In a multivariate regression analysis, comorbidity with rhinitis (beta = 0.489, P < 0.001), smoking (beta = -0.116, P < 0.01), doctor-diagnosed bronchitis (beta = 0.086, P < 0.05), and earlier emergency visits at hospital (beta = 0.147, P < 0.001) was significantly associated with awareness. A difference in awareness was found between those who had asthma and rhinitis (62.2%) and those who had asthma alone (40.6%) (P < 0.01). Inhaled corticosteroids (ICS) were used by 27% of those with asthma, including 12% who used both ICS and long-acting beta-agonist. More than half of the persons with asthma were aware of their disorder; and the awareness was more likely in those with comorbidity of rhinitis. In general, asthma management was inadequate.

Does asthma control correlate with quality of life related to upper and lower airways? A real life study

The goal of asthma therapy is to achieve an optimal level of disease control, but the relationship between asthma control, impact of comorbid rhinitis and health related quality of life (HRQoL) in real life remains unexplored. The aims of this real life study were to evaluate asthma control, the impact of asthma (with and without rhinitis) on HRQoL, the relationship between asthma control and HRQoL, and the role of rhinitis on asthma control and HRQoL. 122 asthma patients completed the Asthma Control Test, Rhinitis Symptoms score (T5SS) and RHINASTHMA. Asthma control was unsatisfactory (44.27% of uncontrolled patients), as well as HRQoL. Controlled patients controlled showed significantly lower scores in all the RHINASTHMA domains compared to uncontrolled. Irrespective of their level of control, patients with rhinitis symptoms showed worse HRQoL in Upper Airways (UA) (P < 0.0001), Lower Airways (LA) (P < 0.001), and Global Summary (GS) (P < 0.0001). In patients with symptomatic rhinitis, RHINASTHMA were lower in controlled asthma patients (UA P = 0.002; LA P < 0.0001; RAI P < 0.01; GS P < 0.0001). Asthma control was associated with lower T5SS score (P = 0.034). Asthma control in real life is unsatisfactory. Rhinitis and asthma influence each other in terms of control and HRQoL. The control of rhinitis in asthma patients can lead to an optimization of HRQoL related to the upper airways, while this phenomenon is not so evident in asthma. These results suggest to strengthen the ARIA recommendation that asthma patients must be evaluated for rhinitis and vice versa.

Occupational rhinitis and occupational asthma; one airway two diseases?

The concept of 'one airway, one disease' refers to the frequent comorbidity of asthma and rhinitis. However, only limited research has been done on this association for the diverse range of occupational respiratory sensitisers. The relative frequency of rhinitis was determined for the 15 respiratory sensitisers reported to cause at least 10 cases of rhinitis or asthma to The Health and Occupation Reporting (THOR) network between 1997 and 2006. Of 1408 cases, 1190 were sole diagnoses of asthma, 138 sole diagnoses of rhinitis and in 80 cases asthma coexisted with rhinitis. The six sensitisers for which rhinitis featured in over 15% of cases were all particulates and known to cause release of mast cell mediators, either directly or through IgE antibodies. Four of the other nine sensitisers often exist as vapours and only two have been consistently associated with IgE-mediated disease mechanisms. Particle size did not appear to correlate with the relative frequency of rhinitis. Despite its limitations this study would support the hypothesis that there are at least two mechanistic categories of respiratory sensitisation with rhinitis being relatively more common where the mechanism is IgE-mediated. Particulate nature may be another important factor to consider in future studies.

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

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

The relationship between asthma control and quality-of-life impairment due to chronic cough: a real-life study

The objective of asthma therapy is to achieve optimal disease control and quality-of-life (QoL) improvements. Good correlation is reported between a composite evaluation of asthma control (the Asthma Control Test [ACT]) and QoL, with emphasis on asthma as a frequent cause of chronic cough and worsening of QoL due to chronic cough. To investigate asthma control in real life and to evaluate chronic cough-related impairment of QoL in patients with different degrees of asthma control evaluated by the ACT. Outpatients awaiting physician visits for asthma evaluation were asked to complete the ACT, the Chronic Cough Impact Questionnaire (CCIQ), and a rhinitis symptom score (Total Symptom Score [TSS] 5). A total of 122 patients (mean [SD] age, 44 [15] years; age range, 15-75 years; 61.5% female) were enrolled in the study, of whom 74% reported rhinitis in conjunction with asthma. Overall asthma control was substantially less than optimal (ACT mean score, 14) in 44% of patients. Asthma control correlated to a limited degree with the CCIQ among the total sample. In patients with asthma alone, the correlation between the ACT and the CCIQ was much improved. In patients with comorbid rhinitis, only those with significant symptoms (as determined by the TSS5) reported using rhinitis treatment; among these, no significant correlation between the ACT and the CCIQ was found. Asthma control in real life is less than optimal in substantially few patients. The importance of cough in asthma is highlighted by good correlation between cough and the ACT score in patients without comorbid rhinitis. In patients with comorbid rhinitis, cough appears related more to rhinitis than to asthma control. The combined use of the ACT and the CCIQ may be useful to improve asthma management, especially among patients in whom cough remains a prominent symptom.

Asthma and allergic rhinitis co-morbidity: a cross-sectional questionnaire study on adolescents aged 13-14 years

There is scarce epidemiological population-based data on the prevalence of asthma and allergic rhinitis (AR) co-morbidity in adolescents. The aim was to verify asthma and AR prevalence rates in order to emphasise asthma/AR co-morbidity. Cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire in adolescents aged 13-14 years, chosen randomly from public schools in Belo Horizonte, Brazil. A total of 3262 students were identified, 3083 (47.3% males) of whom completed the questionnaire (response rate 94.7%). The prevalence of symptoms related to asthma and AR co-morbidity was 8.4% (95% CI, 8.09-10.25). Among asthmatic adolescents, symptoms of AR were reported in 46.5% (95% CI, 42.60-52.08%). There is a high prevalence of adolescent asthma and AR co-morbidity in this area of Brazil. This co-morbidity is an important health issue that requires strategic application of primary health care facilities to achieve adequate control of both asthma and allergic rhinitis.

Efficacy and safety of montelukast in adults with asthma and allergic rhinitis

Several clinical studies have confirmed the effectiveness of montelukast 10mg orally in adults with both asthma and allergic rhinitis. The objective of this phase IV study was to investigate the efficacy and safety of montelukast 10mg in adults with both asthma and allergic rhinitis in a real-life setting. Data from 5855 patients (mean age: 42.8+/-15.4 years) were collected and analyzed following treatment for 4-6 weeks. Efficacy was analyzed by comparing baseline values of: general, day- and night-time improvement in asthma symptoms, need for rescue medication or inhaled corticosteroids (ICSs), general and specific improvement in allergic rhinitis symptoms, reduction in rhinitis medication use, and general and specific quality of life (QoL) improvement with values collected at the end of the observation period of 4-6 weeks. Following treatment with 10mg montelukast 86.5% (n=4547) of patients reported a strong or marked improvement in day-time asthma symptoms and 88.5% (n=4367) reported improvement in night-time symptoms. A similarly high proportion of patients had a strong or marked improvement in all symptoms of allergic rhinitis (i.e. sneezing/itching (84%), rhinorrhea (81.7%), nasal congestion (79.3%), watery eyes (78.4%) and red or burning eyes (77.7%). The use of asthma and rhinitis medication was also reduced. 92.3% (n=5685) of all patients intended to continue montelukast therapy. Overall QoL was "very good" or "good" in 85.2% of patients (n=4991) and a "strong" or "marked" improvement in each of the four domains of sleep, work, everyday life and physical activity. Montelukast was well tolerated. Adverse drug reactions occurred in 14 out of 6158 patients. None of the adverse events was serious. Accordingly, montelukast 10mg is a safe and effective treatment for patients with both asthma and allergic rhinitis.

Utilisation of an Environmental Challenge Chamber (ECC) to Explore Allergen Induced Bronchial Hyperresponsiveness (BHR) in Mild Asthmatic Patients with Co-morbid Rhinitis

RATIONALE: The potential to explore nasal responses in patients using an ECC is precedented. Using patients with co-morbid disease, to explore BHR to AMP and nasal symptoms in a single challenge paradigm is attractive but unprecedented and needs validation.

Intranasal and inhaled fluticasone propionate for pollen‐induced rhinitis and asthma

Studies suggest that nasal treatment might influence lower airway symptoms and function in patients with comorbid rhinitis and asthma. We investigated the effect of intranasal, inhaled corticosteroid or the combination of both in patients with both pollen-induced rhinitis and asthma. A total of 262 patients were randomized to 6 weeks' treatment with intranasal fluticasone propionate (INFP) 200 microg o.d., inhaled fluticasone propionate (IHFP) 250 microg b.i.d., their combination, or intranasal or inhaled placebo, in a multicentre, double-blind, parallel-group study. Treatment was started 2 weeks prior to the pollen season and patients recorded their nasal and bronchial symptoms twice daily. Before and after 4 and 6 weeks' treatment, the patients were assessed for lung function, methacholine responsiveness, and induced sputum cell counts. Intranasal fluticasone propionate significantly increased the percentages of patients reporting no nasal blockage, sneezing, or rhinorrhoea during the pollen season, compared with IHFP or intranasal or inhaled placebo. In contrast, only IHFP significantly improved morning peak-flow, forced expiratory volume in 1 second (FEV1) and methacholine PD20, and the seasonal increase in the sputum eosinophils and methacholine responsiveness. In patients with pollen-induced rhinitis and asthma, the combination of intranasal and IHFP is needed to control the seasonal increase in nasal and asthmatic symptoms.

Persistent asthma and rhinitis co-morbidity and allergic sensitization in a sample of 317 Bulgarian patients

Rationale Since there is no data about persistent allergic and non-allergic asthma and rhinitis association as well as sensitization among Bulgarian patient population, we assessed this co-morbidity and the major allergen sensitization in our country. Methods A sample of 317 proven perennial asthma and/or rhinitis patients underwent skin prick testing (SPT) to house dust mites, cockroaches, moulds, dog, cat and pollens with commercially available allergen extracts (Allerbio). Results The majority of patients in our series 185 (58%) were atopic and had at least one positive skin test to major inhalant allergens. The mean age of the patients in allergic group was 34,8 (from 5 to 59) with 43%:56% men:women ratio versus 44,1 (from 6 to 79) in the non-allergic group with 30%:70% men:women ratio. In the allergic group 87% of asthmatics suffered from accompanying rhinitis versus 79% in the non-allergic group. A subgroup of 9 (5,3%) asthmatics had nasal polyps and aspirin sensitivity and 11 (6,5%) had only polyps as a concomitant disorder. Accompanying seasonal rhinoconjunctivitis proven with positive SPT to pollens was assessed in 55% of atopic patients. The sensitization to the inhalant allergens in the allergic group was as follows: D. pteronyssinus 60%, D. farinae 52%, dog 34%, cat 31%, Blatella germanica 26%, Periplaneta americana 22%, Alternaria mix 19%, Fusarium moniliforme 18%, Penicillium digihetum 10%. Conclusions Both persistent allergic rhinitis and non-allergic rhino(sinusitis) showed a frequent association with persistent asthma. Polysensitization was a characteristic feature for 82% of patient sample and house dust mites and pets were among the most common allergens causing sensitization.

Rhinasthma: a new specific QoL questionnaire for patients with rhinitis and asthma.

To date we have available specific instruments assessing health-related quality of life (HRQL) in rhinoconjunctivitis or in asthma, but not instruments evaluating rhinitis and asthma together, although they often coexist. The aim of our study was to develop and validate a specific quality of life (QoL) questionnaire for adult patients with rhinoconjunctivitis, asthma or both. A pool of 42 items covering the main symptoms and problems related to respiratory allergy, was generated based on literature review and clinical experience. The items were randomly listed and presented to 148 consecutive outpatients 46 suffering from asthma (age 32.9 +/- 14.3 years), 53 suffering from rhinoconjunctivitis (age 32.6 +/- 11.5 years) and 49 from asthma and rhinoconjunctivitis (age 35.6 +/- 12.2 years). The patients were asked to indicate which item they had directly experienced and for each of them, its importance on a four-point scale (1 = not important; 4 = very important). Twelve items were cancelled from the list, because of low importance or redundance. In the instrument validation phase, 104 patients (42 with rhinoconjunctivitis alone and 62 with asthma and rhinoconjunctivitis) were evaluated with the generic instrument SF-36 and the new questionnaire (RHINASTHMA). RHINASTHMA was able to differentiate patients with rhinitis from those with both rhinitis and asthma. In stable condition, RHINASTHMA showed good reliability. The factor analysis extracted three factors with a good reliability (0.93, 0.87, 0.76). RHINASTHMA is the first tool aimed at evaluating HRQL impairment in patients with rhinitis and/or asthma. It provides a short and simple assessment, and has overall psychometric properties. This is of relevance because of the frequent asthma-rhinitis comorbidity.