title: Impact of rhinitis on asthma severity in school-age children.
abstract: BACKGROUND
  In a population-based sample of school-age children, we investigated factors associated with rhinitis, and differences between allergic and nonallergic rhinitis. Amongst children with asthma, we explored the association between rhinitis and asthma severity.
  
  
  METHODS
  Children participating in a birth cohort study (n = 906) were reviewed at age 8 years. Asthma was defined as at least two of the following three features: physician-diagnosed asthma, currently using asthma medication and current wheeze. We measured lung function (plethysmography and spirometry) and airway hyper-reactivity (AHR; methacholine challenge).
  
  
  RESULTS
  In the analysis adjusted for the presence of asthma, children with rhinitis had significantly higher AHR (P = 0.001). Maternal smoking and absence of breastfeeding were stronger predictors of nonallergic rhinitis, whereas current wheeze and eczema were stronger predictors of allergic rhinitis. Amongst asthmatics (n = 159), when compared to 76 children without rhinitis, those with rhinitis (n = 83) were 2.89-fold (95% CI 1.41-5.91) more likely to experience frequent attacks of wheezing, 3.44-fold (1.19-9.94) more likely to experience severe attacks of wheezing limiting speech, 10.14-fold (1.27-81.21) more likely to have frequent visits to their doctor because of asthma and nine-fold (1.11-72.83) more likely to miss school. Reported use of intranasal corticosteroids resulted in a numerically small, but consistent reduction in risk, rendering the associations between rhinitis and asthma severity nonsignificant.
  
  
  CONCLUSIONS
  We observed differences in risk factors and severity between allergic and nonallergic rhinitis. In children with asthma, rhinitis had adverse impact on asthma severity. The use of intranasal corticosteroids resulted in a small, but consistent reduction in the risk.
authors: Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester & University Hospital of South Manchester, Manchester, UK.
authors: M
authors: M
authors: Deliu
authors: D
authors: D
authors: Belgrave
authors: A
authors: A
authors: Simpson
authors: C S
authors: CS
authors: Murray
authors: G
authors: G
authors: Kerry
authors: A
authors: A
authors: Custovic
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D015415:Biomarkers; D002648:Child; D015331:Cohort Studies; D005500:Follow-Up Studies; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D010641:Phenotype; D011159:Population Surveillance; D015995:Prevalence; D012135:Respiratory Sounds; D012220:Rhinitis / Q000150:complications* / Q000188:drug therapy; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D006633:Histamine Antagonists
keywords: asthma severity; childhood asthma; childhood rhinitis