Epidemiology and burden of nasal congestion

Abstract

Nasal congestion, which may be described as fullness, obstruction, reduced airflow, or being "stuffed up," is a commonly encountered symptom in clinical practice. Systematic study of congestion has largely considered it as a component of a disease state. Conditions associated with congestion include nasal polyposis, obstructive sleep apnea, and anatomic variation; however, most information on the burden of congestion comes from studies of allergic rhinitis and rhinosinusitis, diseases of which congestion is the major symptom. Congestion can be caused by other rhinologic conditions, such as non-allergic rhinitis, viral or bacterial rhinitis, and vasomotor rhinitis. Allergic rhinitis affects as much as one quarter of the population worldwide and imposes a significant economic burden. Additionally, allergic rhinitis significantly impairs quality of life; congestion causes allergic rhinitis sufferers decreased daytime productivity at work or school and reduces night-time sleep time and quality. Annually, rhinosinusitis affects tens of millions of Americans and leads to approximately $6 billion in overall health care expenditures; it has been found to be one of the most costly physical conditions for US employers. Given the high prevalence and significant social and economic burden of nasal congestion, this symptom should be a key consideration in treating patients with rhinologic disease, and there continues to be a significant unmet medical need for effective treatment options for this condition.

Keywords: allergic rhinitis; congestion; epidemiology; obstruction; rhinosinusitis.

Figure 1

Top 10 most costly diseases to US employers in 1999. Reprinted with permission from Goetzel RZ, Hawkins K, Ozminkowski RJ, Wang S. The health and productivity cost burden of the “top 10” physical and mental health conditions affecting six large US employers in 1999. J Occup Environ Med. 2003;45(1):5–14. Copyright © 2003 Wolters Kluwer Health. Abbreviation: NEC, not elsewhere classified.

Figure 2

Most bothersome symptoms of nasal allergies. ^aP < 0.05 vs adults; ^bSmall base population (n = 69); ^cSmall base population (n = 68). Reprinted with permission from Shedden A. Impact of nasal congestion on quality of life and work productivity in allergic rhinitis: findings from a large online survey. Treat Respir Med. 2005;4(6):439–446. Copyright © 2005 Wolters Kluwer Health.

Figure 3

Allergy symptoms patients most want to prevent. ^aP < 0.05 vs adults; ^bSmall base population (n = 69); ^cSmall base population (n = 68). Reprinted with permission from Shedden A. Impact of nasal congestion on quality of life and work productivity in allergic rhinitis: findings from a large online survey. Treat Respir Med. 2005;4(6):439–446. Copyright © 2005 Wolters Kluwer Health.

Figure 4

Impact of nasal congestion on sleep. ^aP < 0.05 vs children. Reprinted with permission from Shedden A. Impact of nasal congestion on quality of life and work productivity in allergic rhinitis: findings from a large online survey. Treat Respir Med. 2005;4(6):439–446. Copyright © 2005 Wolters Kluwer Health.