Rhinitis and rhinosinusitis (R/RS) are frequently associated with asthma. Small cohort studies suggest that R/RS are associated with severe asthma, and can worsen asthma control. The purpose of the current study was to determine the impact of rhinitis and rhinosinusitis on disease in the lower airway in a large cohort of subjects with well-characterized asthma.
We studied data from subjects enrolled in two trials of the American Lung Association-Asthma Clinical Research Centers (“SIIVA” and “LoDo”). At baseline subjects reported the presence of rhinitis or sinusitis, and had measures of lung function and asthma control.
Data were available on a total of 2031 subjects in SIIVA and 488 subjects in the LoDo. Over 70% of subjects reported rhinitis or sinusitis. Disease was more common in females (Adjusted OR 1.3, CI 1.05-1.61, SIIVA), those with gastro-esophageal reflux disease (Adjusted OR 1.81, CI 1.39-2.35, SIIVA) and less common in those of non-white race (Adjusted OR 0.82, CI 0.74-0.91, SIIVA). In LoDo asthma symptoms as measured by the Asthma Symptom Utility Index were slightly worse in subjects with R/RS (0.67 versus 0.73, p=0.0008). However, there was no difference in asthma severity as measured by lung function tests in LoDo subjects whereas SIIVA subjects with R/RS actually had higher baseline lung function than those without R/RS (FEV1 87.5% versus 84.0 % and FVC 91.8% versus 88.8% predicted, p<0.05).
Rhinitis and rhinosinusitis are common in asthma. They affect symptoms, but do not adversely affect lung function. Future studies evaluating the impact of treating upper airway disease in asthma should carefully evaluate symptoms using validated questionnaires.
Disease of the nose and sinuses is a frequent co-morbidity in subjects with asthma and may contribute to more severe symptoms, but does not adversely affect asthma severity as measured by lung function.
Anne Dixon, None.