Survey on the impact of comorbid allergic rhinitis in patients with asthma

Abstract

Background: Allergic rhinitis (AR) and asthma are inflammatory conditions of the airways that often occur concomitantly. This global survey was undertaken to understand patient perspectives regarding symptoms, treatments, and the impact on their well-being of comorbid AR and asthma.

Methods: Survey participants were adults with asthma (n = 813) and parents of children with asthma (n = 806) from four countries each in the Asia-Pacific region and Europe. Patients included in the survey also had self-reported, concomitant AR symptoms. Patients and parents were recruited by telephone interview or by direct interview.

Results: Most patients (73%) had pre-existing symptoms of AR when their asthma was first diagnosed. Shortness of breath (21%) was the most troublesome symptom for adults, and wheezing (17%) and coughing (17%) the most troublesome for children. Patients used different medications for treating asthma (most commonly short-acting beta-agonists and inhaled corticosteroids) and for treating AR (most commonly oral antihistamines). The concomitant presence of AR and asthma disrupted the ability to get a good night's sleep (79%), to participate in leisure and sports activities (75%), to concentrate at work or school (69% of adults, 73% of children), and to enjoy social activities (57% of adults, 51% of children). Most patients (79%) reported worsening asthma symptoms when AR symptoms flared up. Many (56%) avoided the outdoors during the allergy season because of worsening asthma symptoms. Many (60%) indicated difficulty in effectively treating both conditions, and 72% were concerned about using excessive medication. In general, respondents from the Asia-Pacific region reported more disruption of activities caused by symptoms and more concerns and difficulties with medications than did those from Europe. Differences between the two regions in medication use included more common use of inhaled corticosteroids in Europe and more common use of Chinese herbal remedies in the Asia-Pacific region.

Conclusion: Results of this survey suggest that comorbid asthma and AR substantially impact patient well-being and that the worsening of AR symptoms in patients with asthma can be associated with worsening asthma symptoms. These findings underscore the need for physicians who treat patients with asthma to evaluate treatment options for improving symptoms of both AR and asthma when present concomitantly.

Figure 1

Medications used for asthma. Medications used by region (a) and by age group (b). *P ≤ 0.05 for comparison between Europe and the Asia-Pacific region or between adults and children. SABA, short-acting β-agonist; LABA, long-acting β-agonist; ICS, inhaled corticosteroid; OCS, oral corticosteroids; LTRA, leukotriene receptor antagonist.

Figure 2

Medications used for allergic rhinitis. Medications used by region (a) and by age group (b). *P ≤ 0.05 for comparison between Europe and the Asia-Pacific region or between adults and children. CS, corticosteroid; LTRA, leukotriene receptor antagonist.

Figure 3

Impact on patient well-being. Frequency of symptoms and disruption of sleep and activities caused by comorbid asthma and allergic rhinitis, by region (a) and by age group (b). *P ≤ 0.05 for comparison between Europe and the Asia-Pacific region or between adults and children. For symptoms, a positive response was defined as symptoms occurring all of the time, a lot of the time, or some of the time. Disruption was defined as occurring a great deal, quite a lot, or a little bit.