ArticlesRhinitis and onset of asthma: a longitudinal population-based study
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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