Allergic rhinitis and other comorbidities associated with asthma control in Thailand

Thitiwat Sriprasart; Narongkorn Saiphoklang; Theerasuk Kawamatawong; Watchara Boonsawat; Wat Mitthamsiri; Naricha Chirakalwasan; Chirawat Chiewchalermsri; Athipat Athipongarporn; Harutai Kamalaporn; Kumpol Kornthatchapong; Manaphol Kulpraneet; Mongkhon Sompornrattanaphan; Nittha Oer-Areemitr; Ticha Rerkpattanapipat; Santi Silairatana; Sarita Thawanaphong; Thanate Gaensan; Ketsupar Jirakran; Orapan Poachanukoon

doi:10.3389/fmed.2023.1308390

Allergic rhinitis and other comorbidities associated with asthma control in Thailand

Front Med (Lausanne). 2024 Jan 11:10:1308390. doi: 10.3389/fmed.2023.1308390. eCollection 2023.

Authors

Thitiwat Sriprasart¹, Narongkorn Saiphoklang², Theerasuk Kawamatawong³, Watchara Boonsawat⁴, Wat Mitthamsiri⁵, Naricha Chirakalwasan^{1

6}, Chirawat Chiewchalermsri⁷, Athipat Athipongarporn⁸, Harutai Kamalaporn⁹, Kumpol Kornthatchapong¹⁰, Manaphol Kulpraneet¹¹, Mongkhon Sompornrattanaphan¹², Nittha Oer-Areemitr¹³, Ticha Rerkpattanapipat¹⁴, Santi Silairatana¹⁵, Sarita Thawanaphong¹, Thanate Gaensan¹⁶, Ketsupar Jirakran¹⁷, Orapan Poachanukoon¹⁸

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
² Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
³ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁴ Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
⁵ Allergy and Clinical Immunology Division, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand.
⁶ Excellence Center for Sleep Disorders, Thai Red Cross Society, Bangkok, Thailand.
⁷ Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand.
⁸ Department of Pediatrics, Phra Nakhon Si Ayutthaya Hospital, Phra Nakhon Si Ayutthaya, Thailand.
⁹ Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
¹⁰ Department of Emergency Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
¹¹ Division of Pulmonary and Critical Care, Department of Medicine, Srinakarinwirot University, Bangkok, Thailand.
¹² Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹³ Division of Pulmonary and Critical Care Medicine, Ekachai Hospital, Samut Sakhon, Thailand.
¹⁴ Allergy Immunology and Rheumatology Division, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
¹⁵ Division of Pulmonary Medicine and Pulmonary Critical Care, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
¹⁶ Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
¹⁷ Center of Excellence for Maximizing Children's Developmental Potential, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
¹⁸ Center of Excellence for Allergy, Asthma and Pulmonary Diseases, Thammasat University, Pathum Thani, Thailand.

Abstract

Background: Asthma and allergic rhinitis (AR) can coexist and cause disabilities. This study aimed to assess the association between AR, asthma control, asthma-related quality of life, and other comorbidities.

Methods: A cross-sectional study was conducted in adults with asthma in six hospitals in Thailand. The outcomes were association of asthma control assessed by the asthma control test (ACT), AR, and asthma comorbidities. Not-well-controlled asthma was defined as ACT scores ≤22. The severity of AR was determined by visual analog scale (VAS). Severe AR was defined as VAS ≥5. Asthma-related quality of life (AQLQ), comorbidities, and total IgE were recorded.

Results: A total of 682 asthmatic patients were included. Median (IQR) age was 58.0 (47.0-64.0) years. 69.9% were female. Not-well-controlled asthma was present in 44.7%. The prevalence of AR was 86.1%. Moderate/severe persistent AR was diagnosed in 21.7% and severe AR was diagnosed in 30.2% of the patients. Inhaled corticosteroid-containing regimens were prescribed in 97.7% of patients. Intranasal corticosteroid and antihistamine were prescribed in 65.7 and 31.7%, respectively. Patients with not-well-controlled asthma had higher body mass index, VAS scores, proportions of pollution exposure, aeroallergen sensitization, severe AR, nasal polyp, urticaria, food allergy, gastroesophageal reflux disease, depression and anxiety, peptic ulcer, and asthma exacerbations, but younger age, lower AQLQ scores, and lower FEV₁. Correlation was found between AR severity and ACT (r = -0.461, p < 0.001), AQLQ (r = -0.512, p < 0.001), and total IgE (r = 0.246, p < 0.023). Multiple regression analysis revealed that ACT, AQLQ, and percentage of FEV₁/FVC were significantly associated with severe AR.

Conclusion: Allergic rhinitis is prevalent in Thai asthmatic patients. AR severity is associated with asthma control, quality of life, and pulmonary function. Comprehensive care is essential for patients with uncontrolled asthma, particularly when coexisting with conditions.

Keywords: ACT; IgE; Thailand; allergic rhinitis; asthma; asthma control test; comorbidities; quality of life.

Copyright © 2024 Sriprasart, Saiphoklang, Kawamatawong, Boonsawat, Mitthamsiri, Chirakalwasan, Chiewchalermsri, Athipongarporn, Kamalaporn, Kornthatchapong, Kulpraneet, Sompornrattanaphan, Oer-Areemitr, Rerkpattanapipat, Silairatana, Thawanaphong, Gaensan, Jirakran and Poachanukoon.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by Thammasat University Research Unit in Allergy and Respiratory Medicine, Thailand (grant number 67.04.2/0904) and Thai Asthma Council and Association (TAC), Thailand (grant number 341/2564).