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Allergic Rhinitis and Sinusitis in Asthma^*

Differential Effects on Symptoms and Pulmonary Function

^* From Pulmonary and Critical Care Medicine (Drs. Dixon, Kaminsky, and Irvin), University of Vermont, Burlington, VT; and Department of Medicine (Drs. Wise and Shade) and Bloomberg School of Public Health (Dr. Holbrook), Johns Hopkins University, Baltimore, MD.

Correspondence to: Anne E. Dixon, MD, FCCP, Pulmonary and Critical Care Medicine, Patrick 204, Fletcher Allen Health Care, 111 Colchester Ave, Burlington, VT 05401; e-mail: anne.dixon{at}vtmednet.org

Abstract

Background: Allergic rhinitis and sinusitis are frequently associated with asthma. The purpose of this study was to determine the impact of self-reported allergic rhinitis and sinusitis on lower airway disease in a large cohort of participants with well-characterized asthma.

Methods: A cohort study of participants in two trials of the American Lung Association-Asthma Clinical Research Centers: 2,031 asthmatics in the Safety of Inactivated Influenza Vaccine in Asthma in Adults and Children (SIIVA) trial and 488 asthmatics in the Effectiveness of Low Dose Theophylline as Add-on Treatment in Asthma (LODO) trial. At baseline, participants reported the presence of allergic rhinitis and sinusitis, and then lung function and asthma control were measured. During the trials, participants were monitored for asthma exacerbations.

Results: More than 70% of participants reported either allergic rhinitis or sinusitis. Sinusitis was more common in female patients (odds ratio, 1.46 [SIIVA]), those with gastroesophageal reflux disease (odds ratio, 2.21 [SIIVA]), and those of white race (odds ratio, 1.53 [SIIVA]). Similar associations were seen for allergic rhinitis. LODO participants with allergic rhinitis and sinusitis had increased asthma symptoms and a trend toward more sleep disturbance. Participants with allergic rhinitis had higher baseline lung function than those without allergic rhinitis measured by peak flow (91.2% vs 95.8% in the SIIVA trial). Participants with sinusitis had similar lung function to those without sinusitis. Participants with and without allergic rhinitis had similar exacerbation rates. In the LODO trial only, participants with sinusitis had increased asthma exacerbations (5.68 per patient per year vs 3.72 per patient per year).

Conclusion: Allergic rhinitis and sinusitis are associated with more severe asthmatic symptoms and, in patients with poorly controlled asthma, more exacerbations but are not associated with low lung function.

Key Words: allergic rhinitis • asthma • gastroesophageal reflux disease • pulmonary function tests • sinusitis

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