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

Figures & data

Table 1 Patient Demographics and Characteristics Overall and by Patient-Reported Rhinitis

	Overall (N=4274)	Patient-Reported Rhinitis		p value*
		No (n=1393)	Yes (n=2881)
Age in years, mean (SD)	50.7 (14.3)	52.3 (14.0)	50.0 (14.4)	<0.001^a
Gender, n (%)
Female	2600 (60.8)	809 (58.1)	1791 (62.2)	0.01^b
Male	1674 (39.2)	584 (41.9)	1090 (37.8)
BMI (kg/m^2) category, n (%)
Underweight (BMI ≤18.49)	56 (1.3)	15 (1.1)	41 (1.4)	0.001^b
Normal (BMI 18.5–24.99)	1293 (30.3)	371 (26.6)	922 (32.0)
Overweight (BMI 25–29.99)	1509 (35.3)	498 (35.8)	1011 (35.1)
Obese (BMI ≥30)	1416 (33.1)	509 (36.5)	907 (31.5)
Smoking history, n (%)
Never smoked	2364 (55.3)	808 (58.0)	1556 (54.0)	0.002^b
Past smoker	1357 (31.8)	393 (28.2)	964 (33.5)
Current smoker	553 (12.9)	192 (13.8)	361 (12.5)
Comorbidities^c, n (%), known	(n=3622)	(n=1273)	(n=2385)
Rhinitis	1228 (33.9)	241 (19.5)	987 (41.4)	<0.001^b
Eczema	696 (19.2)	230 (18.6)	466 (19.5)	0.2^b
GORD	480 (13.3)	150 (12.1)	330 (13.8)	0.1^b
Asthma symptom control (GINA-defined)^d, n (%)
Controlled	1296 (30.3)	442 (31.7)	854 (29.6)	<0.001^b
Partially controlled	1912 (44.7)	658 (47.3)	1254 (43.5)
Uncontrolled	1066 (25.0)	293 (21.0)	773 (26.9)
Perceived control^e, n (%), known
Well controlled	2582 (60.4)	905 (65.0)	1677 (58.2)	<0.001^b
Not well controlled	1692 (39.6)	488 (35.0)	1204 (41.8)

Notes: p value* No rhinitis symptoms versus rhinitis symptoms. ^aP value from independent samples t-test. ^bP value from chi-square test for independence. ^cDoctor diagnosed comorbidities. ^dIn the 7 days before an iHARP asthma review. ^eIn the 4 weeks before an iHARP asthma review.

Abbreviations: BMI, body mass index (kg/m²); GINA, Global Initiative for Asthma; GORD, gastroesophageal reflux disease; SD, standard deviation.

Figure 1 Incidence of diagnosed and undiagnosed rhinitis among patients reporting rhinitis symptoms (N=2881).

Figure 2 Asthma symptom control status in patients with mild (N=1829) and moderate-severe rhinitis (N=1052).

Table 2 Indicators of Asthma Symptoms and Exacerbations Overall and by Patient-Reported Rhinitis

	Overall (N=4274)	Patient-Reported Rhinitis		p value*
		No (n=1393)	Yes (n=2881)
Asthma symptoms^a
Daytime symptoms, n (%)
None	2045 (47.8)	772 (55.4)	1273 (44.2)	<0.001^b
1–2 days	956 (22.4)	284 (20.4)	672 (23.3)
≥3 days	1273 (29.8)	337 (24.2)	936 (32.5)
Activity limitations due to asthma, n (%)
None	3167 (74.1)	1109 (79.6)	2058 (71.4)	<0.001^b
≥1 day	1107 (25.9)	284 (20.4)	823 (28.6)
Night-time awakening, n (%)
None	3186 (74.5)	1150 (82.6)	2036 (70.7)	<0.001^b
≥1 day	1088 (25.5)	243 (17.4)	845 (29.3)
Reliever needed for symptoms, n (%)
None	2210 (51.7)	736 (52.8)	1474 (51.2)	0.6^b
1–2 times	733 (17.2)	230 (16.5)	503 (17.5)
≥3 times	1331 (31.1)	427 (30.7)	904 (31.4)
Highest number of puffs of reliever inhaler taken in 1 day^cd, n (%)
0–4	3773 (88.3)	1260 (90.5)	2513 (87.2)	0.002^b
5–12 or more	501 (11.7)	133 (9.5)	368 (12.8)
Acute exacerbations^e, n (%)
Oral steroid use for worsening asthma
None	2735 (64.0)	972 (69.8)	1763 (61.2)	<0.001^b
≥1	1539 (36.0)	421 (30.2)	1118 (38.8)
Emergency department visit due to asthma
None	3882 (90.9)	1286 (92.4)	2596 (90.2)	<0.001^b
≥1 visit	389 (9.1)	106 (7.6)	283 (9.8)
Hospitalisation due to asthma
None	4090 (95.7)	1335 (95.8)	2755 (95.7)	0.8^b
≥1 stay	182 (4.3)	58 (4.2)	124 (4.3)
Days absent from work/education due to asthma (n=3617)
None	3099 (85.7)	1113 (90.0)	1986 (83.4%)	<0.001^b
≥1 day	5118 (14.3)	124 (10.0)	394 (16.6%)

Notes: p value* No rhinitis symptoms versus rhinitis symptoms. ^aIn the 7 days before an iHARP asthma review. ^bp value from chi-square test. ^cIn the 4 weeks before an iHARP asthma review. ^dHighest number of puffs of reliever inhaler use, in response to the question: “In the past 4 weeks, what was the highest number of puffs in 1 day you took of the reliever inhaler?” with response options 1–4 puffs, 5–12 puffs and >12 puffs. ^eIn the12 months before an iHARP asthma review.

Table 3 Clinical and Behavioural Characteristics Overall and by Patient-Reported Rhinitis

	Overall (N=4274)	Patient-Reported Rhinitis		p value*
		No (n=1393)	Yes (n=2881)
Patient-reported prior inhaler review by HCP^a, n (%)	2221 (52.0)	791 (56.8)	1430 (49.7)	0.009^b
Preventer adherence, n (%)	(n=3761)	(n=1264)	(n=2497)
Take it every day	2081 (55.3)	805 (63.7)	1276 (51.0)	<0.001^b
Take it some days but others do not	994 (26.4)	261 (20.6)	733 (29.4)
Used to take it but now do not	235 (6.3)	66 (5.3)	169 (6.8)
Take it only when have symptoms	214 (5.7)	75 (5.9)	139 (5.6)
Never take it	237 (6.3)	57 (4.5)	180 (7.2)
Patient-reported side-effects^c, n (%)
≥1	1641 (38.4)	459 (33.0)	1182 (41.0)	<0.001^b
Patient-reported oropharyngeal effects^d, n (%) known	(n=3755)	(n=1264)	(n=2491)
≥1	1833 (48.6)	472 (37.3)	1361 (54.6)	<0.001^b
Patient-reported specialist review, n (%)
Never	534 (12.5)	158 (11.3)	376 (13.1)	0.001^b
More than a year ago	986 (23.1)	282 (20.2)	704 (24.4)
In the past year	2754 (64.4)	953 (68.4)	1801 (62.5)

Notes: p value* No rhinitis symptoms versus rhinitis symptoms. ^aIn the previous 12 months. ^bp value from chi-square test. ^cPatient-reported side-effects from preventer inhaler use, in response to the question: “Do you experience any of these side-effects from your preventer inhaler?” with “yes” or “no” responses for the following side-effects: continual sore mouth/throat; oral thrush; bruising; hoarse voice; abnormal weight gain and cough. Patients could indicate more than one side-effect. ^dPatient-reported oropharyngeal effects during the inspiration phase of preventer inhaler use, in response to the question: When you use your preventer inhaler, do you feel a sensation at the back of your throat?; do you sometimes feel a need to cough?; do you feel your medication is deposited at the back of your throat? With yes’ or “no” response options. Patients could indicate more than one oropharyngeal effect. In the 12 months before an iHARP asthma review.

Abbreviation: HCP, healthcare professional.

Table 4 Univariable Associations Between Patient Characteristics and Risk of Asthma Exacerbations

	Reference Category	Category	Odds Ratio (95% CI)	p value
Body mass index	Underweight/normal weight	Obese	1.31 (1.13–1.53)	0.001
Gastroesophageal diagnosis	No	Yes	1.46 (1.19–1.79)	< 0.001
Smoking status	Never smoker	Current smoker	1.74 (1.44–2.09)	< 0.001
GINA-defined asthma symptom control	Controlled/partially controlled	Uncontrolled	1.40 (1.22–1.61)	< 0.001
Rhinitis severity	No	Moderate-severe	1.74 (1.47–2.05)	< 0.001
Preventer adherence	Taken every day	Not taken every day	2.42 (2.10–2.78)	< 0.001
Highest number of puffs of reliever taken in 1 day^a	0–4	5–12 or more	1.40 (1.16–1.69)	< 0.001
Oropharyngeal effects during inspiration phase	0	≥ 1	1.42 (1.23–1.64)	< 0.001
Side-effects from preventer inhaler use	0	≥ 1	0.62 (0.54–0.70)	< 0.001
Respiratory specialist review	In the previous year	More than a year ago/never	0.71 (0.62–0.81)	< 0.001

Note: ^aIn the 4 weeks before an iHARP asthma review.

Abbreviation: GINA, Global Initiative for Asthma.

Table 5 Logistic Regression Predicting Likelihood of Asthma Exacerbations

	Reference Category	Category	B	Odds Ratio (95% CI)	p value
GINA-defined asthma symptom control	Controlled/partially controlled	Uncontrolled	0.98	2.67 (1.76–4.04)	<0.001
Preventer adherence	Taken every day	Not taken every day	0.67	1.96 (1.27–3.03)	0.002
Oropharyngeal effects during inspiration phase	0	≥ 1	0.66	1.93 (1.32–2.83)	0.001
Gastroesophageal reflux disease	No	Yes	0.61	1.83 (1.20–2.79)	0.005
Highest number of puffs of reliever taken in 1 day^a	0–4	5–12 or more	0.60	1.83 (1.18–2.82)	0.007
Side-effects from asthma therapy	0	≥ 1	0.60	1.82 (1.17–2.83)	0.008
Respiratory specialist review	In the previous year	More than a year ago/never	0.57	1.77 (1.30–2.41)	<0.001
Body Mass Index	Underweight/normal weight	Obese	0.45	1.57 (1.16–2.12)	0.003
Rhinitis severity	No	Moderate-severe	0.33	1.40 (1.02–1.90)	0.036
Smoking status	Never smoker	Current smoker	0.24	1.27 (0.89–1.83)	0.194
GINA-defined asthma symptom control*Oropharyngeal effects	Controlled/partially controlled	Uncontrolled	−0.64	0.53 (0.29–0.97)	0.040
	0	≥ 1
Preventer adherence*Side-effects from asthma therapy	Not taken every day	Taken every day	0.59	1.80 (1.01–3.25)	0.049
	≥ 1	0

Notes: *Interaction with. ^aIn the 4 weeks before an iHARP asthma review.

Abbreviation: GINA, Global Initiative for Asthma.