Allergic rhinitis and sinusitis in asthma: differential effects on symptoms and pulmonary function.
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).


CONCLUSIONS
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.
Dixon
Anne E
AE
Pulmonary and Critical Care Medicine, University of Vermont, Burlington, 05401, USA. anne.dixon@vtmednet.org
Kaminsky
David A
DA
Holbrook
Janet T
JT
Wise
Robert A
RA
Shade
David M
DM
Irvin
Charles G
CG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012129:Respiratory Function Tests; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D013806:Theophylline / Q000627:therapeutic use; D015164:Vaccines, Inactivated / Q000627:therapeutic use
D001993:Bronchodilator Agents; D007252:Influenza Vaccines; D015164:Vaccines, Inactivated; D013806:Theophylline