Is rhinitis alone or associated with atopic eczema a risk factor for severe asthma in children?

Abstract

The objective of this study was to evaluate the role of rhinitis (R) and atopic eczema (E) on asthma severity among asthmatic (A) schoolchildren identified by the International Study of Asthma and Allergies in Childhood written questionnaire (WQ). WQ was applied to parents of 6-7-yr-old schoolchildren (SC, n=3033), and to adolescents (AD, 13-14 yr old, n=3487), living in Sao Paulo, Brazil. An affirmative response to 'has your child/have you had wheezing/whistling in the last year' identified those with A, and an affirmative response to 'the last 12 months has your child/have you had sneezing/runny/blocked nose when he/she you did not have a cold/flu?' identified those with R. Subjects with an affirmative response to 'has your child/have you had this itchy rash at any time in the past 12 months?' were identified as having E. Subjects who had R associated with A were identified as AR and those with A associated with R and E as ARE. A who had at least two affirmative responses to questions for asthma severity: speech disturbance, more than four acute attacks, sleep disturbance, and wheezing with exercise were defined as having severe asthma. 22.1% AD and 24.3% SC were identified as A; 47.1% of those AD and 42.0% SC had AR and 10.0% of those AD and 12.8% of SC had ARE. Considering ARE, AR and A groups, speech disturbance during an acute episode of asthma was significantly higher among ARE AD (20.0% vs. 11.5% vs. 8.7%, p<0.05), and ARE SC (22.1% vs. 13.9% vs. 10.5%, p<0.05) in comparison with A. Likewise, more than four acute attacks in the last year was significantly higher among ARE AD (24.0% vs. 14.0% vs. 10.5%, p<0.05) and ARE SC (32.6% vs. 19.4% vs. 12.8%, p<0.05) as the frequency of sleep disturbance due to wheezing, for AD (61.3% vs. 42.0% vs. 38.4%, p<0.05) and SC (77.9% vs. 67.3% vs. 58.4%, p<0.001) and for 'wheezing associated with exercise' for AD (72.0% vs. 47.5% vs. 39.9%, p<0.001) and SC (36.8% vs. 31.4% vs. 14.1%, p<0.001). Prevalence of severe asthma was higher among ARE AD (57.3% vs. 31.9% vs. 27.0%, p<0.05) and ARE SC (52.6% vs. 36.9% vs. 22.5%). In patients with A, the presence of R or E are risk factors for severe asthma, and both together (R and E) are a higher risk.

Rinite alérgica: indicadores de qualidade de vida

“…(44) Population surveys estimate that 38% of all AR patients also have asthma and that 78% of all asthma patients also have rhinitis. (45,46) According to some studies, AR occurs in more than 75% of patients with allergic asthma and in more than 80% of patients with non-allergic asthma.…”

Distribution of severity of asthma in childhood

“…A prevalência de asma e indicadores de gravidade tem sido estimada mundialmente através de inquéritos epidemiológicos baseados no protocolo ISAAC, sem levar em consideração os critérios clínicos para uma classificação mais precisa da gravidade, nem a avaliação da função pulmonar 7,8 . Nesses estudos, além das variações de características inerentes a cada população, são utilizados diferentes critérios de gravidade, levando a resultados divergentes e de difícil comparação.…”

Prevalência e associação de asma e rinite em adolescentes de 13 e 14 anos de Fortaleza, Ceará, Brasil

“…Os dados do presente estudo estão de acordo com aqueles registrados em um estudo populacional realizado no Japão, onde 60% dos pacientes adultos com asma mostraram sintomas de rinite 35 ; mas superior à taxa desta comorbidade observada entre adolescentes asmáticos de São Paulo 36 , em estudo ISAAC. Por outro lado, a taxa de rinoconjuntivite alérgica, entre os portadores da asma, esteve menor que a média registrada na fase I do ISAAC 17 .…”

“…Os dados aqui obtidos foram semelhantes àqueles registrados em São Paulo, em estudo ISAAC que evidenciou freqüência significativamente maior de relato de "quatro ou mais crises de sibilos no último ano", "distúrbio do sono devido a sibilos", "crises de sibilos limitando a fala" e "broncoespasmo induzido por exercício" entre adolescentes com a comorbidade asma-rinite, em relação àqueles com asma, mas sem rinite 36 . Vale ressaltar a exceção observada, no presente estudo, quando se compara "quatro ou mais crises de sibilos no último ano" e "sono interrompido mais que uma noite por semana" entre os adolescentes com asma-rinite e aqueles com asma sem rinite, cujas diferenças não foram significativas.…”