Comorbid asthma worsens quality of life among patients with allergic rhinitis
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Patients with allergic rhinitis and comorbid asthma had poorer health-related quality of life and symptom control than patients who had allergic rhinitis alone, according to a study published in Clinical and Translational Allergy.
These findings indicate the need for comprehensive approaches to managing allergic rhinitis with comorbid conditions, Subhabrata Moitra, PhD, MSc, FRSPH, postdoctoral fellow in the division of pulmonary medicine and member of the Alberta Respiratory Centre, University of Alberta, and colleagues wrote.
“Allergic rhinitis is often a common comorbid condition in patients with asthma, and this dual disease condition can lead to a poorer control and health-related quality of life in patients with dual symptoms,” Moitra told Healio.
Although this has been well known from previous studies, Moitra continued, the reverse case of asthma as a comorbidity among patients with allergic rhinitis is a different scenario.
“There were no previous reports comparing the control and health-related quality of life in allergic rhinitis patients with and without comorbid asthma,” Moitra said. “We wanted to investigate asthma-rhinitis comorbidity and rhinitis control according to presence or absence of asthma at the population level, as previous results are mostly from patients.”
Study design, results
Conducted by the Desbrest Institute of Epidemiology and Public Health, the study involved 643 adults (38.9% men; mean age, 44.1 years) from Austria, France and Italy with allergic rhinitis assessed with the RHINASTHMA questionnaire — for which higher scores indicate lower health-related quality of life on a scale of 0 to 100 — and the 10-item Control of Allergic Rhinitis/Asthma Test (CARAT), for which higher scores in a range of 0 to 30 indicate better disease control.
Seventy-eight percent of the participants had comorbid asthma, 54% had moderate-severe intermittent allergic rhinitis and 34% had moderate-severe persistent allergic rhinitis.
Overall median total scores included 76 (interquartile range [IQR], 53-91) for RHINASTHMA and 18 (IQR, 14-22) for CARAT.
Participants with allergic rhinitis and asthma had significantly higher total RHINASTHMA scores (84 vs. 48.5) as well as significantly lower total CARAT scores (16.5 vs. 23) than those who only had allergic rhinitis, with similar trends seen on subdomain scores of each the tests.
Multivariable analysis revealed a significant association between allergic rhinitis with comorbid asthma and poorer quality of life based on total RHINASTHMA score (regression coefficient [beta], 022; 95% CI, 0.19-0.25), with a more pronounced effect among patients with severe persistent asthma (beta, 0.25; 95% CI, 0.22-0.29) and less so for those with mild persistent asthma (beta, 0.15; 95% CI, 0.1-0.2).
Also, patients with allergic rhinitis and comorbid asthma had poorer control of their symptoms than patients who only had allergic rhinitis based on total CARAT score (beta,–0.2; 95% CI, –0.25 to –0.15), with poorest control again seen among patients with severe persistent asthma (beta, –0.25; 95% CI, –0.31 to –0.19) and slightly less impact among those with mild persistent asthma (beta, –0.06; 95% CI, –0.14 to 0.03).
The researchers also found a marginally higher association between allergic rhinitis and asthma and total RHINASTHMA scores among participants without obesity (beta, 0.23; 95% CI, 0.19-0.26) compared with those with obesity (beta, 0.16; 95% CI, 0.07-0.25).
Moitra called this finding surprising, as the researchers expected these results to trend in the opposite direction. Unfortunately, Moitra said, the researchers could not investigate this relationship further since they did not have that much granularity in the data.
“As quality of life is driven by a multitude of factors of different personal, social and environmental levels, we suppose there could be many other factors beyond disease etiology that might have driven the association towards that direction,” he said. “For example, environmental factors, diet, physical activity, etc.”
Conclusions, next steps
These results emphasize the need for a comprehensive approach to managing allergic rhinitis with a comorbid condition, with such strategies enabling the reduction of the global burden of these diseases, according to the researchers.
Meanwhile, it is important for doctors to consider how comorbidity is common among patients with allergies and that it can remain undiagnosed or overlooked.
“Patients with multimorbidity suffer more than those with only one condition. The doctors must be vigilant to investigate that too,” Moitra said.
Doctors also need to consider occupational and environmental exposures, Moitra continued, as its quite common for exposure to workplace hazards to cause rhinitis and asthma and, sometimes, aggravate pre-existing asthma symptoms.
“Removal or avoidance of those hazards could be extremely helpful for the patients to regain control over their symptoms and improve their quality of life,” he said.
The researchers plan on continuing their work in this area.
“We have just launched the EU-funded Urbanome study in 10 European cities in nine European countries, in which we will study asthma-rhinitis comorbidity and their control,” Moitra said.
For more information:
Subhabrata Moitra, PhD, MSc, FRSPH, can be reached at subhabrata2207@gmail.com.