Chest
Volume 130, Issue 2, August 2006, Pages 429-435
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Original Research: ASTHMA
Allergic Rhinitis and Sinusitis in Asthma: Differential Effects on Symptoms and Pulmonary Function

https://doi.org/10.1378/chest.130.2.429Get rights and content

Background

Allergic rhinitis and sinusitis are frequently associated with asthma. The purpose of this study was to determine the impact of self-reported allergic rhinitis and sinusitis on lower airway disease in a large cohort of participants with well-characterized asthma.

Methods

A cohort study of participants in two trials of the American Lung Association-Asthma Clinical Research Centers: 2,031 asthmatics in the Safety of Inactivated Influenza Vaccine in Asthma in Adults and Children (SIIVA) trial and 488 asthmatics in the Effectiveness of Low Dose Theophylline as Add-on Treatment in Asthma (LODO) trial. At baseline, participants reported the presence of allergic rhinitis and sinusitis, and then lung function and asthma control were measured. During the trials, participants were monitored for asthma exacerbations.

Results

More than 70% of participants reported either allergic rhinitis or sinusitis. Sinusitis was more common in female patients (odds ratio, 1.46 [SIIVA]), those with gastroesophageal reflux disease (odds ratio, 2.21 [SIIVA]), and those of white race (odds ratio, 1.53 [SIIVA]). Similar associations were seen for allergic rhinitis. LODO participants with allergic rhinitis and sinusitis had increased asthma symptoms and a trend toward more sleep disturbance. Participants with allergic rhinitis had higher baseline lung function than those without allergic rhinitis measured by peak flow (91.2% vs 95.8% in the SIIVA trial). Participants with sinusitis had similar lung function to those without sinusitis. Participants with and without allergic rhinitis had similar exacerbation rates. In the LODO trial only, participants with sinusitis had increased asthma exacerbations (5.68 per patient per year vs 3.72 per patient per year).

Conclusion

Allergic rhinitis and sinusitis are associated with more severe asthmatic symptoms and, in patients with poorly controlled asthma, more exacerbations but are not associated with low lung function.

Section snippets

Participants

We evaluated baseline cross-sectional data obtained from two cohorts of patients enrolled in the ALA-ACRC Safety of Inactivated Influenza Vaccine in Asthma in Adults and Children (SIIVA) and Effectiveness of Low Dose Theophylline as Add-on Treatment in Asthma (LODO) trials. The primary results of the SIIVA trial have been published10; those of the LODO trial have been submitted for publication. In brief, the SIIVA trial was a multicenter, double-blind, placebo-controlled, crossover study to

Baseline Demographics

The SIIVA trial enrolled 2,031 participants (age range, 3 to 83 years). The distribution of race and age is shown in Table 1. The LODO trial enrolled 488 participants ≥ 15 years old; age and race distribution are shown in Table 1. The SIIVA cohort included significantly more children: 38% of the participants were < 20 years old, compared with 10% in the LODO trial.

Prevalence of Allergic Rhinitis and Sinusitis

Allergic rhinitis and sinusitis were the most common comorbidities reported in these participants; together, they affected 73% of

DISCUSSION

In our study, self-reported allergic rhinitis and sinusitis were very common in asthma. GERD, female gender, and white race were particularly associated with both allergic rhinitis and sinusitis. Both allergic rhinitis and sinusitis were associated with more severe symptoms in those with more severe asthma at baseline; in one cohort, sinusitis (but not allergic rhinitis) was associated with increased exacerbations. Participants with allergic rhinitis and sinusitis tended to have higher lung

REFERENCES (34)

  • FM de Benedictis et al.

    Rhinosinusitis and asthma: epiphenomenon or causal association?

    Chest

    (1999)
  • T Young et al.

    Nasal obstruction as a risk factor for sleep-disordered breathing: the University of Wisconsin Sleep and Respiratory Research Group

    J Allergy Clin Immunol

    (1997)
  • RA Nathan et al.

    Fluticasone propionate nasal spray is superior to montelukast for allergic rhinitis while neither affects overall asthma control

    Chest

    (2005)
  • J Corren et al.

    Changes in bronchial responsiveness following nasal provocation with allergen

    J Allergy Clin Immunol

    (1992)
  • J Bousquet et al.

    Allergic rhinitis: a disease remodeling the upper airways?

    J Allergy Clin Immunol

    (2004)
  • LJ Newman et al.

    Chronic sinusitis: relationship of computed tomographic findings to allergy, asthma, and eosinophilia

    JAMA

    (1994)
  • ME Ferrante et al.

    Prevalence of sinusitis in young asthmatics and its relation to bronchial asthma

    Mil Med

    (1998)
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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestjournal.org/misc/reprints.shtml)

    None of the authors have any conflicts of interest in the content of this article.

    Funding was provided by the American Lung Association and grant K23 RR019965.

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