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Frequency and severity of allergic rhinitis in patients with asthma.

Magnan A, Meunier JP, Saugnac C, Gasteau J, Neukirch F. Frequency and impact of allergic rhinitis in asthma patients in everyday general medical practice: a French observational cross-sectional study. Allergy 2008;63:292298. Allergic rhinitis (AR) and asthma are inflammatory conditions which frequently co-exist. The importance of this coexistence has been highlighted in the updated 2008 Allergic Rhinitis in Asthma (ARIA) guidelines, and, most recently, by a new French study investigating the frequency and severity of allergic rhinitis in patients with asthma. Magnan and colleagues undertook a cross-sectional observational study in a French adult (18-60 years) population with clinician-diagnosed asthma. GPs were asked to include 10 consecutive patients with asthma. Data collection was in two phases. In the first phase, GPs assessed the control of asthma using the Asthma Control Questionnaire (ACQ) and used the Rhinitis Questionnaire and ARIA guidelines to diagnose and classify the severity of allergic rhinitis. AR was diagnosed when the patient indicated they had at least one of a list of four typical symptoms of rhinitis; each patient was then classified as having ‘intermittent’ or ‘persistent’ and ‘mild’ or ‘moderate/severe’ rhinitis. In the second phase, GPs asked the first three patients with a confirmed AR diagnosis to complete the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). This study yielded 14,703 first phase and 4,335 second phase questionnaires; data from both phases were available on 4,251 patients. About 45% of patients with asthma were classified as having intermittent disease, ~50% with mild or moderate persistent asthma, and only 4% as having severe persistent asthma. The frequency of AR in patients with asthma in this study was 55.2% (95%CI: 54.4-56.0). Key findings are that AR is most common in patients with more severe asthma (p<0.001), and that in a sub-population aged 18-45 years severity of AR is strongly related to the severity of asthma (p<0.001). The frequency of AR was equivalent in patients with intermittent or persistent asthma (55.3% vs. 55.1%, p=0.810); however, the frequency of moderate/severe AR was significantly higher in patients with persistent compared with intermittent asthma (51.0% vs. 39.6%, p<0.001). Whilst there are some important limitations in relation to the design, analysis and reporting of this cross-sectional study, the underlying message – namely that allergic rhinitis is most likely to occur in those with severe asthma and is furthermore likely to be severe in such patients – is of considerable practical importance to primary care providers as this should enable risk stratification and identification of those at highest risk of poor outcomes.