The Burden of Self-Reported Rhinitis and Associated Risk for Exacerbations with Moderate-Severe Asthma in Primary Care Patients

Vicky Kritikos; David Price; Alberto Papi; Antonio Infantino; Björn Ställberg; Dermot Ryan; Federico Lavorini; Henry Chrystyn; John Haughney; Karin Lisspers; Kevin Gruffydd-Jones; Miguel Román Rodríguez; Svein Høegh Henrichsen; Thys van der Molen; Victoria Carter; Sinthia Bosnic-Anticevich

doi:10.2147/JAA.S266204

The Burden of Self-Reported Rhinitis and Associated Risk for Exacerbations with Moderate-Severe Asthma in Primary Care Patients

J Asthma Allergy. 2020 Oct 6:13:415-428. doi: 10.2147/JAA.S266204. eCollection 2020.

Authors

Vicky Kritikos^{1

2}, David Price^{3

4

5}, Alberto Papi⁶, Antonio Infantino⁷, Björn Ställberg⁸, Dermot Ryan^{3

9}, Federico Lavorini¹⁰, Henry Chrystyn¹¹, John Haughney¹², Karin Lisspers⁸, Kevin Gruffydd-Jones¹³, Miguel Román Rodríguez¹⁴, Svein Høegh Henrichsen¹⁵, Thys van der Molen¹⁶, Victoria Carter^{3

4}, Sinthia Bosnic-Anticevich^{1

17

18}

Affiliations

¹ Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
² Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
³ Optimum Patient Care, Cambridge, UK.
⁴ Observational and Pragmatic Research Institute, Singapore, Singapore.
⁵ Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
⁶ Respiratory Medicine, University of Ferrara, Ferrara, Italy.
⁷ Special Interest Respiratory Area, Italian Interdisciplinary Society for Primary Care, Bari, Italy.
⁸ Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
⁹ Usher Institute, University of Edinburgh, Edinburgh, UK.
¹⁰ Department Experimental and Clinical Medicine, University of Florence, Florence, Italy.
¹¹ Inhalation Consultancy Ltd, Leeds, UK.
¹² NHS Greater Glasgow & Clyde R&D, Glasgow, UK.
¹³ Box Surgery, Box, UK.
¹⁴ Primary Care Respiratory Research Unit Instituto De Investigación Sanitaria De Baleares (IdISBa), Palma, Spain.
¹⁵ Department of Primary Health Care Services, Norwegian Directorate of Health, Oslo, Norway.
¹⁶ Department of Primary Care, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
¹⁷ Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
¹⁸ Central Sydney Local Area Health District, Sydney, NSW, Australia.

Abstract

Purpose: There is a dearth of research regarding the prevalence and nature of patient-reported rhinitis and its relationship with risk of asthma exacerbations. The aim of this study was to (i) determine the prevalence, severity and treatment of self-reported rhinitis symptoms among adults aged ≥18 years with asthma treated at Global Initiative for Asthma (GINA) Step 3 and above and (ii) compare the demographics, clinical characteristics, medication use, side-effects and healthcare practitioner review between patients who report rhinitis symptoms and those who do not and (iii) determine whether patient-reported rhinitis is associated with risk of asthma exacerbations in the total patient sample.

Patients and methods: This analysis used data from the iHARP (Initiative Helping Asthma in Real-life Patients) asthma review service - a cross-sectional observational study (2011 and 2014) in seven countries that captured data on patient demographics, rhinitis symptoms, asthma symptoms, indicators of exacerbations, medication use, oropharyngeal effects and side-effects, using practitioner- and patient-reported questionnaires. Comparisons between patients with and without rhinitis were tested. Univariate logistic regression was used to identify variables associated with risk of exacerbations for entry into multivariable logistic regression.

Results: This report contains data from 4274 patients: 67.4% (2881/4274) reported rhinitis symptoms and of which 65.7% (1894/2881) had not received a doctor diagnosis; 36.5% (1052/2881) had moderate-severe rhinitis, 12.4% (358/2881) had used intranasal corticosteroids and 19.8% (569/2881) oral antihistamines. Patients with coexisting moderate-severe rhinitis were more likely to have GINA-defined uncontrolled asthma than those with mild rhinitis or no rhinitis. Moderate-severe rhinitis was associated with 40% increased risk of asthma exacerbations (OR=1.40, 95% CI: 1.02-1.90).

Conclusion: This study identified a major gap in the diagnosis and management of rhinitis in a cohort of people with asthma treated at GINA Step 3 and above who are managed in general practice. It highlights the need for practitioners to identify, evaluate and optimally treat rhinitis in adults with asthma, which is a significant factor associated with exacerbation risk.

Keywords: asthma symptom control; comorbidities; oral steroids; preventer; reliever; side-effects.