Asthma, Rhinitis, Other Respiratory Diseases
Rhinitis as an independent risk factor for adult-onset asthma,☆☆

https://doi.org/10.1067/mai.2002.121701Get rights and content

Abstract

Background: For many years, the association between asthma and rhinitis has primarily been attributed to a common allergic background. Recently, it has been suggested that asthma and rhinitis are associated in the absence of atopy. The nature of this association is not well known. Objective: The purpose of this study, which was performed in a large, longitudinal community population, was to determine the extent to which rhinitis is an independent risk factor for adult-onset asthma. Methods: We carried out a nested case-control study from the longitudinal cohort of the Tucson Epidemiologic Study of Obstructive Lung Diseases. One hundred seventy-three incident patients with physician-confirmed asthma were compared with 2177 subjects who reported no asthma or shortness of breath with wheezing. Potential risk factors, including the presence of rhinitis, were assessed before the onset of asthma (patients) or before the last completed survey (control subjects). Results: Rhinitis was a significant risk factor for asthma (crude odds ratio, 4.13; 95% confidence interval, 2.88-5.92). After adjustment for years of follow-up, age, sex, atopic status, smoking status, and presence of chronic obstructive pulmonary disease, the magnitude of the association was reduced but still highly significant (adjusted odds ratio, 3.21; 95% confidence interval, 2.19-4.71). After stratification, rhinitis increased the risk of development of asthma by about 3 times both among atopic and nonatopic patients and by more than 5 times among patients in the highest IgE tertile. Patients with rhinitis with persistent and severe nasal symptoms and a personal history of physician-confirmed sinusitis had an additional increased risk of asthma development. Conclusion: We conclude that rhinitis is a significant risk factor for adult-onset asthma in both atopic and nonatopic subjects. The nature of the association between rhinitis and asthma is open to interpretation. (J Allergy Clin Immunol 2002;109:419-25.)

Section snippets

Methods

We used data that were collected as part of the Tucson Epidemiologic Study of Obstructive Lung Diseases, a prospective cohort study of a stratified cluster sample of 1655 Anglo-white Tucson households enrolled between March 1972 and April 1973. Details of the enrollment process and interview techniques have been previously reported.17

Between 1972 and 1992, participating subjects were monitored in 12 periodic surveys taken approximately 1.5 to 2 years apart. During each survey, subjects

Results

In Table I the demographic and clinical characteristics of control subjects and asthmatic patients are compared.

. Demographic and clinical characteristics of control subjects and asthmatic patients

Empty CellControl subjectsAsthmatic patientsP value
No.2177173
Years* of follow-up (mean ± SD)11.6 ± 6.59.6 ± 5.2<.001
Age† in years (n = 2350; mean ± SD)52.96 ± 21.250.81 ± 19.3NS
Sex (n = 2350; % male)47.333.5.001
Positive skin test response (n = 2013; %)40.156.4<.001
IgE z score (n = 1771; mean ± SD)−0.025 ± 1.0

Discussion

We found rhinitis to be a significant and independent risk factor for adult-onset asthma before, as well as after, the age of 50 years.

The effect of rhinitis on the onset of asthma has been already investigated in longitudinal studies. Huovinen et al6 found that hay fever increased the risk of development of asthma during a 15-year follow-up period by 4 times among adult men and by 6 times among women. However, no information on atopic status was available. Similarly, in the cohort of Brown

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Drs Guerra, Sherrill and Martinez were funded by a grant (HL 56177) from the National Heart, Lung, and Blood Institute. Dr Guerra is a fellow from the Institute of Respiratory Diseases, IRCCS Policlinico Hospital, University of Milan, Milan, Italy.

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Reprint requests: Robert A. Barbee, MD, Arizona Respiratory Center, University of Arizona, 1501 N Campbell Ave, PO Box 245030, Tucson, AZ 85724-5030.

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