title: Severity of rhinitis and wheezing is strongly associated in preschoolers: A population-based study.
abstract: BACKGROUND
  In preschool children, no study assessed the relation between wheezing and rhinitis severity. Our aims were to estimate the prevalence of current wheezing (CW) in preschoolers and to study the association between CW and current rhinitis (CR), considering its severity/persistency.
  
  
  METHODS
  This is a cross-sectional, nationwide, population-based study including a representative sample of 5003 Portuguese children aged 3-5 years. Data were collected by a face-to-face interview with caregivers using an adapted ISAAC questionnaire. CW was defined as presence of ≥1 wheezing episode in the previous 12 months. Rhinitis severity/persistency was classified according to Allergic Rhinitis and its Impact on Asthma.
  
  
  RESULTS
  Current wheezing prevalence was 24.5% [95% CI 23.3-25.7]; 9.4% of the participants had ≥4 wheezing episodes in the previous year. Children with CR had an odds ratio (OR) of 4.0 [95% CI 3.4-4.5] for CW; it was highest for children with moderate-severe persistent rhinitis (11.5 [95% CI 8.1-16.3]), even after adjusting for possible confounders. Wheezers with CR reported more wheezing treatment use (p = 0.024) than those without CR. There was a trend for a higher number of wheezing episodes with more persistent and severe nasal disease - 48.4% of children with moderate-severe persistent rhinitis had >4 wheezing episodes vs. 28.9% in moderate-severe intermittent, 20.0% in mild persistent, 10.8% in mild intermittent, and 3.6% in those without CR; p < 0.001.
  
  
  CONCLUSIONS
  Current wheezing was present in almost 25% of preschool children and was strongly associated with rhinitis, especially moderate-severe persistent disease. Preschoolers with both CW and rhinitis seem to have a more severe phenotype, emphasizing the need for concurrent evaluation of nasal and bronchial symptoms even in small children.
authors.affiliation: Immunoallergy Department, CUF-Descobertas Hospital, Lisbon, Portugal.|Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.|Allergy Unit, CUF-Porto Hospital & Institute, Porto, Portugal.
authors.forename: Ana Margarida
authors.initials: AM
authors.lastname: Pereira
authors.affiliation: Immunoallergy Department, CUF-Descobertas Hospital, Lisbon, Portugal.|Portuguese Society of Allergy and Clinical Immunology, Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Lisbon, Portugal.
authors.forename: Mário
authors.initials: M
authors.lastname: Morais-Almeida
authors.affiliation: Immunoallergy Department, CUF-Descobertas Hospital, Lisbon, Portugal.|Allergy and Clinical Immunology Department, Centro Hospitalar S. João E.P.E., Porto, Portugal.
authors.forename: Natacha
authors.initials: N
authors.lastname: Santos
authors.affiliation: Portuguese Society of Allergy and Clinical Immunology, Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Lisbon, Portugal.|Algarve Immunoallergy Center, Portimão, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Nunes
authors.affiliation: Department of Allergy and Respiratory Diseases, University Hospital and INSERM, Montpellier, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Bousquet
authors.affiliation: Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.|Allergy Unit, CUF-Porto Hospital & Institute, Porto, Portugal.|Portuguese Society of Allergy and Clinical Immunology, Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Lisbon, Portugal.|CINTESIS - Center for Research in Health Technologies and Information Systems, Porto, Portugal.
authors.forename: João Almeida
authors.initials: JA
authors.lastname: Fonseca
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D011174:Portugal; D015995:Prevalence; D012135:Respiratory Sounds / Q000209:etiology*; D012220:Rhinitis / Q000150:complications / Q000175:diagnosis*; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: preschool child; prevalence; rhinitis; wheezing