Elsevier

The Lancet

Volume 372, Issue 9643, 20–26 September 2008, Pages 1049-1057
The Lancet

Articles
Rhinitis and onset of asthma: a longitudinal population-based study

https://doi.org/10.1016/S0140-6736(08)61446-4Get rights and content

Summary

Background

A close relation between asthma and allergic rhinitis has been reported by several epidemiological and clinical studies. However, the nature of this relation remains unclear. We used the follow-up data from the European Community Respiratory Health Survey to investigate the onset of asthma in patients with allergic and non-allergic rhinitis during an 8·8-year period.

Methods

We did a longitudinal population-based study, which included 29 centres (14 countries) mostly in western Europe. Frequency of asthma was studied in 6461 participants, aged 20–44 years, without asthma at baseline. Incident asthma was defined as reporting ever having had asthma confirmed by a physician between the two surveys. Atopy was defined as a positive skin-prick test to mites, cat, Alternaria, Cladosporium, grass, birch, Parietaria, olive, or ragweed. Participants were classified into four groups at baseline: controls (no atopy, no rhinitis; n=3163), atopy only (atopy, no rhinitis; n=704), non-allergic rhinitis (rhinitis, no atopy; n=1377), and allergic rhinitis (atopy+rhinitis; n=1217). Cox proportional hazards models were used to study asthma onset in the four groups.

Findings

The 8·8-year cumulative incidence of asthma was 2·2% (140 events), and was different in the four groups (1·1% (36), 1·9% (13), 3·1% (42), and 4·0% (49), respectively; p<0·0001). After controlling for country, sex, baseline age, body-mass index, forced expiratory volume in 1 s (FEV1), log total IgE, family history of asthma, and smoking, the adjusted relative risk for asthma was 1·63 (95% CI 0·82–3·24) for atopy only, 2·71 (1·64–4·46) for non-allergic rhinitis, and 3·53 (2·11–5·91) for allergic rhinitis. Only allergic rhinitis with sensitisation to mite was associated with increased risk of asthma independently of other allergens (2·79 [1·57–4·96]).

Interpretation

Rhinitis, even in the absence of atopy, is a powerful predictor of adult-onset asthma.

Funding

UCB Institute of Allergy and Agence Nationale de la Recherche.

Introduction

The prevalence of asthma has increased during the second half of the 20th century in children and adults in most countries.1 Although in the past 10 years the prevalence of asthma seems to have reached a plateau or even decreased slightly in some areas, it is still rising in many populations and remains high in developed countries.1, 2 Despite therapeutic progress, the morbidity and mortality of this chronic disease are substantial. Therefore, prevention of asthma through identification and management of risk factors and preclinical phases of the disease is a priority.1

Allergic rhinitis, a common chronic condition, has also become increasingly prevalent.2, 3 A close relation between asthma and allergic rhinitis has been reported by several epidemiological and clinical studies.4 According to cross-sectional studies,4 asthma and rhinitis often coexist and share common risk factors, including atopy, and might even be manifestations of the same disease.5 The few longitudinal studies that have addressed the temporal relation between rhinitis and asthma report that rhinitis often precedes the development of asthma, suggesting that it might be a risk factor for asthma.3, 6, 7, 8 However, comparison of the results of these studies is difficult because they did not use standardised methods, especially for the definitions of asthma and rhinitis.

Cross-sectional data from the European Community Respiratory Health Survey (ECRHS) have shown a positive association between rhinitis and asthma in both atopic and non-atopic adults.9 We used the follow-up data from this international population-based study to investigate the onset of asthma in patients with allergic and non-allergic rhinitis.

Section snippets

Study design

This analysis was based on the follow-up data from the ECRHS, which included 29 centres (14 countries) mostly in western European countries. The methods for ECRHS I and ECRHS II have been published elsewhere,10, 11 and further information is available from the study website. The study was approved by the appropriate ethics committee, and informed written consent was obtained from every participant.

Results

Of the 10 827 participants with complete data for atopy, rhinitis, and asthma at baseline, 7326 (67·4%) participated in the follow-up. 6461 were free of asthma at baseline and supplied full data for baseline atopy and rhinitis and for asthma at follow-up (figure 1). The mean follow-up time was 8·8 [SD 1·0] years. A comparison of baseline characteristics between participants and non-participants of the follow-up showed small but significant differences: non-participants were slightly younger

Discussion

In this study, adults were more likely to develop asthma if they had rhinitis at baseline. This association was seen for both non-allergic and allergic rhinitis and was present after accounting for country, sex, baseline age, body-mass index, FEV1, log total IgE, family history of asthma, respiratory infection in childhood, and smoking. The positive associations between rhinitis and asthma were seen in both men and women.

Asthma-like symptoms or BHR in patients with rhinitis could be indicative

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