Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul 1;13(6):100132.
doi: 10.1016/j.waojou.2020.100132. eCollection 2020 Jun.

Prevalence and triggers of self-reported nasal hyperreactivity in adults with asthma

Jef Feijen  1 , Sven F Seys  2 , Brecht Steelant  2 , Dominique M A Bullens  2   3 , Lieven J Dupont  4 , Maria García-Cruz  5 , Alejandro Jimenez-Chobillón  5 , Désirée Larenas-Linnemann  6 , Laura Van Gerven  1 , Wytske J Fokkens  7 , Ioana Agache  8 , Peter W Hellings  1   2   7
Affiliations

Prevalence and triggers of self-reported nasal hyperreactivity in adults with asthma

Jef Feijen et al. World Allergy Organ J. .

Abstract

Background: Nasal hyperreactivity (NHR) is a common feature of various rhinitis subtypes and represents a novel phenotype of rhinitis. It is being reported in two-thirds of adult rhinitis patients irrespective of the atopic status. Data on the prevalence of NHR in patients with asthma are lacking, as well as the nature of evoking triggers.

Methods: Postal questionnaires were distributed to an unselected group of asthmatic patients in Leuven (Belgium, n = 190) and completed by 114 patients. In Mexico City (Mexico) and Brasov (Romania), respectively, 97 out of 110 and 80 out of 100 asthmatic patients attending the outpatient clinic completed the questionnaire. Non-asthmatic volunteers were recruited amongst university and hospital co-workers in Leuven (n = 53). The presence of self-reported NHR, the type of triggers evoking nasal and bronchial symptoms, medication use, self-reported allergy, and environmental factors were evaluated.

Results: Overall, 69% of asthma patients reported NHR, with 32% having more than 4 triggers evoking NHR. These triggers included mainly exposure to temperature and humidity changes, cigarette smoke, and strong odours. A higher prevalence of NHR was detected in allergic compared to non-allergic asthma patients (73% vs. 53% p < 0.01). The prevalence of NHR correlated with asthma severity, ranging from 63% (VAS ≤3) to 81% (VAS ≥7). BHR was found more frequently in patients with NHR compared to without NHR (89% vs. 53%, p < 0.0001).

Conclusion: NHR represents a clinical phenotype of upper airway disease affecting over two-thirds of asthma patients and correlates with asthma severity. Targeting NHR in patients with asthma is often overlooked and should be reinforced in the future to achieve better symptom control.

Keywords: AR, allergic rhinitis; Asthma; Atopy; BHR, bronchial hyperreactivity; Bronchial hyperreactivity; FEV1, forced expiratory volume in one second; NHR, nasal hyperreactivity; Nasal hyperreactivity; Symptom severity; VAS, visual analogue scale.

PubMed Disclaimer

Conflict of interest statement

All authors state they have no conflict of interest in relation to this study and the results described in the manuscript.

Figures

Fig. 1
Fig. 1
NHR in asthma patients and control. (A) Percentage of patients with asthma reporting NHR. (B) Percentage of patients reporting how many triggers are provoking NHR. (C) Provoking stimuli displayed in order of frequency. (D) Percentage of self-reported NHR in mild (VAS ≤ 3), moderate (between 3 and 7 cm) and severe sinonasal disease (VAS ≥ 7). (E) Prevalence of NHR in allergic vs. non-allergic asthma. (F) Prevalence of NHR in non-smoking vs. smoking. ∗∗∗∗; p < 0.0001, ∗∗∗∗; p < 0.0001, ∗∗∗; p < 0.001, ∗∗; p < 0.01 compared with control group. # # #; p < 0.001, # #; p < 0.01 compared with the Romanian cohort. NS; not significant
Fig. 2
Fig. 2
BHR in asthmatic patients and controls. (A) Percentage of patients with asthma reporting BHR. (B) Percentage of patients reporting how many triggers are provoking BHR. (C) Provoking stimuli displayed in order of frequency. (D) Percentage of self-reported BHR in mild (VAS ≤ 3), moderate (between 3 and 7 cm) and severe sinonasal disease (VAS ≥ 7). (E) Prevalence of BHR in allergic vs. non-allergic asthma. (F) Prevalence of BHR in non-smoking vs. smoking. ∗∗∗∗; p < 0.0001, ∗; p < 0.05 compared with control group. # #; p < 0.01 compared with the Romanian cohort. NS; not significant
Fig. 3
Fig. 3
Prevalence of BHR in patients with and without NHR. (A) Percentage of asthmatic patients with and without NHR reporting BHR. (B) Percentage of self-reported NHR in mild (VAS ≤3), moderate (between 3 and 7 cm) and severe asthma (VAS ≥ 7) ∗; p < 0.05
figs1
figs1
figs2
figs2
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Cockcroft D.W., Davis B.E. Mechanisms of airway hyperresponsiveness. J Allergy Clin Immunol. 2006;118(3):551–559. - PubMed
    1. Capro R.O., Casaburi R., Coates A., Enright P., Hankinson J. American thoracic society guidelines for methacholine and exercise challenge. Crit Care Med. 1999;10 - PubMed
    1. Coates A.L., Wanger J., Cockcroft D.W. ERS technical standard on bronchial challenge testing: general considerations and performance of methacholine challenge tests. Eur Respir J. 2017;49(5):1–17. - PubMed
    1. Van Gerven L., Steelant B., Hellings P.W. Nasal hyperreactivity in rhinitis: a diagnostic and therapeutic challenge. Allergy. 2018;2 - PubMed
    1. Segboer C.L., Holland C.T., Reinartz S.M. Nasal hyper-reactivity is a common feature in both allergic and nonallergic rhinitis. Allergy. 2013;68(11):1427–1434. - PubMed