title: Ongoing allergic rhinitis impairs asthma control by enhancing the lower airway inflammation.
abstract: BACKGROUND
  The relationship between allergic rhinitis and asthma is well accepted; however, little is known about the mechanism that underlies the interactions between the upper and lower airways.
  
  
  OBJECTIVE
  To investigate the symptomatic and inflammatory linkages between allergic rhinitis and asthma in patients with atopy.
  
  
  METHODS
  We enrolled 520 patients with asthma who were taking inhaled corticosteroids, and examined them by using the Asthma Control Questionnaire, spirometry, exhaled nitric oxide fraction (FENO), visual analog scale for nasal symptoms, allergic rhinitis questionnaire, and serum specific IgE (study 1). The symptomatic and inflammatory marker responses to nasal corticosteroids in patients with incompletely controlled asthma (Asthma Control Questionnaire > 0.75) and moderate-to-severe persistent allergic rhinitis were also observed (study 2).
  
  
  RESULTS
  A total of 348 patients (66.9%) had atopy and allergic rhinitis. There was a striking difference in the proportion of patients with incomplete asthma control, depending on the presence as well as the activity of rhinitis (no rhinitis, 11.0%; mild intermittent, 20.4%; moderate-to-severe intermittent, 44.6%; mild persistent, 53.1%; moderate-to-severe persistent, 65.7%). The FENO levels were increased with the activity of rhinitis, and the nasal visual analog scale was positively correlated with the FENO levels (r = 0.31; P < .0001). The additive treatment with nasal corticosteroids improved the nasal visual analog scale, Asthma Control Questionnaire, and FENO levels, and the changes in these variables were correlated with each other in all parameters (all P < .001).
  
  
  CONCLUSIONS
  This observational study of patients with atopy indicates that the ongoing allergic rhinitis is related to worsening of asthma by enhancing the lower airway inflammation.
authors.affiliation: Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Asako
authors.initials: A
authors.lastname: Oka
authors.affiliation: Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan. Electronic address: kazmatsu@wakayama-med.ac.jp.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Matsunaga
authors.affiliation: Kamei Respiratory Clinic, Takamatsu, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kamei
authors.affiliation: Minami Tokushima Clinic, Komatsushima, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Tsunahiko
authors.initials: T
authors.lastname: Hirano
authors.affiliation: Division of Respiratory Medicine, Naga Hospital, Kinokawa, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hayata
authors.affiliation: Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Akamatsu
authors.affiliation: Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kikuchi
authors.affiliation: Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Hiramatsu
authors.affiliation: Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Ichikawa
authors.affiliation: Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Nakanishi
authors.affiliation: Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Minakata
authors.affiliation: Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yamamoto
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy*; D001944:Breath Tests; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000032:analysis; D011446:Prospective Studies; D065631:Rhinitis, Allergic; D012221:Rhinitis, Allergic, Perennial / Q000150:complications*; D064232:Visual Analog Scale
chemical_list: D000305:Adrenal Cortex Hormones; D009569:Nitric Oxide
keywords: Airflow limitation; Airway inflammation; Atopy; Exhaled nitric oxide; Inhaled corticosteroids; Nasal corticosteroids