The impact of concomitant allergic rhinitis on asthma control: a cross-sectional nationwide survey in China

Abstract

Objectives: Understanding the interactions between allergic rhinitis (AR) and asthma is important for asthma management. This study explored the clinical features of AR as a comorbidity in Chinese asthmatic patients and its impact on asthma control. Methods: This cross-sectional survey was conducted among 20 051 patients with asthma in an out-patient setting and covered all of the territories of China. The patients were interviewed face-to-face. A standardized questionnaire was completed by each patient. AR was defined according to the ARIA criteria. The level of asthma control was assessed by the Asthma Control Test. A score ≤19 indicated poorly controlled asthma. Results: AR was present in 69.9% of patients with asthma. Of them, 72.4% had intermittent symptoms, and 93.1% presented with moderate/severe symptoms. Cold air, irritant air and household mites were the most common triggers for AR. A higher percentage of patients with AR experienced poorly controlled asthma compared with those without AR (56.2% versus 51.5%, p < 0.001). AR was associated with an increased risk of poorly controlled asthma [odds ratio (OR): 1.21, p < 0.001]. Moderate/severe or persistent symptoms were associated with a higher risk of poorly controlled asthma than those with mild or intermittent symptoms (OR: 2.34 and 1.78, respectively, p < 0.001). In contrast, diagnosed AR (OR: 0.84, p < 0.001), being currently treated with medication (OR: 0.91, p = 0.004) and a prior skin prick test (OR: 0.90, p = 0.003) showed a significantly negative association with poorly controlled asthma. Conclusion: This study confirms that concomitant AR and asthma are highly prevalent in China and that AR is associated with poor asthma control.

• Allergic rhinitis
• asthma
• asthma control test
• comorbidity
• questionnaire

Acknowledgements

The authors would like to thank all the patients and investigators for their participation to achieve this study goal. The authors also thank Irene Jin and Iris Peng from Macrostat China for assistance in writing the manuscript and providing statistical considerations.

List of the principal researchers and the sites participated in this survey:

J Lin, China-Japan Friendship Hospital; W Xu, Peking Union Medical College Hospital; H Wang, Beijing Friendship Hospital; H Chen, The General Hospital of Beijing Military Region; H Zhu, Peking University Third Hospital; Y Sun, Beijing Tongren Hospital; W Wang, Beijing Chao-Yang Hospital; Y Ma, Beijing Shijitan Hospital; S Mu, Peking University People’s Hospital; Y Lin, Tianjin Chest Hospital; J Cao, Tianjin Medical University General Hospital; G Ge, The Second Hospital of Tianjin Medical University; F Ping, Hebei Province People's Hospital; J Ma, The Second Hospital of Hebei Medical University; A Lin, The Fifth People's Hospital of Datong; J Xu, The First Hospital of Shanxi Medical University; J Yang, The Third Affiliated Hospital of Inner Mongolia Medical College; H He, The First Affiliated Hospital of Baotou Medical College;X Fu, The First Affiliated Hospital of Inner Mongolia Medical College; M Jin, Zhongshan hospital, Fudan university; Hg Wan, Ruijin Hospital, Shanghai Jiao Tong University; Y Li, Renji Hospital, Shanghai Jiao Tong University; X Zhou, The First People's Hospital, Shanghai Jiao Tong University; C Shen, The Sixth People's Hospital, Shanghai Jiao Tong University; Q Xiu, Shanghai Changzhen Hospital; Y Liang, Shanghai East Hospital; X Yao, Jiangsu Province Hospital; J Dai, Nanjing Drum Tower Hospital; X Xin, Jinling hospital, Nanjing; S Sun, Zhongda Hospital, Southeast University; X Zhang, The First Affiliated Hospital of Soochow University; T Bian, Wuxi People's Hospital; J Zhou, The First Affiliated Hospital, Zhejiang University; H Shen, The Second Affiliated Hospital, Zhejiang University; K Ying, SIR RUN SHAW Hospital, Zhejiang University; Q Zhang, The First Hospital of Jiaxing; X Huang, Ningbo First Hospital; J Shen, Shaoxing People's Hospital; E Cui, Huzhou Central Hospital; D Rong, The Second Affiliated Hospital of Wenzhou Medical College; X Mei, Anhui Provincial Hospital; G Sun, The First Affiliated Hospital of Anhui Medical University; Y Chen, Fujian Provincial Hospital; Q Lin, The First Affiliated Hospital of Fujian Medical University; G Lai, Fuzhou General Hospital, Nanjing Military Region; S Jiang, Shandong Provincial Hospital; Y Yang, Jinan Central Hospital, Shandong University; F Gao, Affiliated Hospital of Weifang Medical University; H Ji, Yantai Yuhuangding Hospital; H Jiang, The Affiliated Hospital, Qingdao University; X Liu, Tongji hospital, Huazhong University of Science and Technology; H Li, Wuhan Union Hospital; X Wu, Hubei General Hospital; C Hu, Xiangya Hospital, Central-South University; P Chen, The Second Xiangya Hospital of Central South University; W Li, Hunan Provincial People's Hospital; Z Chen, Henan Provincial People's Hospital; J Wang, The First Affiliated Hospital of Zhengzhou University; X Xia, The Second Affiliated Hospital of Zhengzhou University; Z Luo, Foshan First People Hospital; N Zhang, The First Affiliated Hospital of Guangzhou Medical University; Z Chen, Guangdong General Hospital; Y Zhou, The First Affiliated Hospital of SUN YAT-SEN University; Z Zhao, Guangzhou First Municipal People's Hospital; T Zhang, The Third Affiliated Hospital SUN YAT-SEN University; J Li, SUN YAT-SEN Memorial Hospital of SUN YAT-SEN University; R Zhi, Guangzhou Panyu Central Hospital; Y Huang, Hainan Provincial People's Hospital; F Wu, Huizhou People's Hospital; C Chen, The First Affiliated Hospital of Shantou University Medical College; W Song, Peking University Shenzhen Hospital; Y Fu, Shenzhen People's Hospital; J Huang, The Fifth Affiliated Hospital of SUN YAT-SEN University; Y Chen, The First Affiliated Hospital of Guangxi Medical University; C Liu, West China Hospital, Sichuan University; Y Liu, Sichuan Provincial People's Hospital; A Liu, Kunming General Hospital of Chengdu Military Region; Q Hao, First Affiliated Hospital of Kunming Medical University; Y Ma, First People's Hospital of Yunnan Province; K Lin, Xinqiao Hospital, Third Military Medical University; W Xiong, Southwest Hospital of the Third Military Medical University; Y Su, The First Affiliated Hospital of Chongqing Medical University; Y Ouyang, Affiliated Hospital of Zunyi Medical College; X Zhang, Guizhou Provincial People’s Hospital; C Wu, Xijing Hospital, Xi’an; L Yang, First Affiliated Hospital, Xi'an Jiaotong University; W Hou, Second Affiliated Hospital, Xi'an Jiaotong University; H Yue, The First Affiliated Hospital of Lanzhou University; Y Gao, Gansu Provincial Hospital; X Yang, Xinjiang Uigur Municipal People's Hospital; Y Zhang, Urumqi General Hospital of Lanzhou Military Region; Z Wang, The First Hospital of Xinjiang Medical University; J Huo, The First Hospital, Haerbing Medical University; X Liu, The Second Hospital of Heilongjiang Province; L Peng, The First Hospital of Jilin University; J Zhang, The Second Hospital of Jilin University; P Chen, H Xie, General Hospital of Shenyang Military Command; L Kong, The First Affiliated Hospital of China Medical University; D Wang, No.202 PLA Hospital of Shenyang; G Zhao, The First Affiliated Hospital of Dalian Medical University