Allergic Rhinitis Reduces Quality of Life in Children with Asthma Vaida Taminskiene 1, Steve Turner 2, Jon Ayres 3, Somnath Mukhopadhyay 4, Colin Palmer 5, Anil Mehta 6, Egle Vaitkaitiene 7, Arunas Valiulis 8 1 Institute of Public Health, Vilnius University, Vilnius, Lithuania 2 Child Health, University of Aberdeen, Aberdeen, 3 Department of Occupational Health, University of Birmingham, Birmingham, 4 Department of Paediatrics, University of Brighton, Brighton, 5 Department of Genetics, University of Dundee, Dundee, 6 Department of Women and Children, University of Dundee, Dundee, UK, 7 Medical Academy, Lithuanian University of Health Science, Kaunas, 8 Clinic of Children s Diseases & Institute of Public Health, Vilnius University, Vilnius, Lithuania
About 300 million people worldwide suffer from asthma symptoms, with 250,000 annual deaths attributed to the disease. 1 Asthma is one of the most common chronic diseases among children. 2 The prevalence of asthma in different countries varies widely. 3 Asthma is a burden to the patient, family members and society. 1 1 World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach, 2007. 2 CDC. Asthma Facts: CDC s National Asthma Control Program Grantees. 2013 3 World Allergy Organization (WAO) White Book on Allergy, 2011. PREVALENCE OF ASTHMA SYMPTOMS AMONG 13-14 YEAR OLDS (ISAAC) Source: Lai CKW et al. Thorax, 2009. The Global Asthma Report 2014. Auckland, New Zealand: Global Asthma Network, 2014.
Burden of disease, measured by disability adjusted life years (DALYs) per 100,000 population attributed to asthma by age group and sex. Global population, 2010. Source: Institute for Health Metrics and Evaluation (IHME). The Global Asthma Report 2014. Auckland, New Zealand: Global Asthma Network, 2014.
Allergic rhinitis and asthma Most patients with asthma also have allergic rhinitis. 10% to 40% of patients with allergic rhinitis have asthma comorbidity. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative aims to educate and implement evidencebased management of allergic rhinitis in conjunction with asthma worldwide. Allergic rhinitis is associated with reduced Quality of life () independent of asthma but does coexistent rhinitis add to the reduced associated with asthma? BousquetJ et al. Allergic Rhinitis and its Impact on Asthma (ARIA): Achievements in 10 years and future needs. Journal of Allergy and Clinical Immunology, 2012;130(5): 1049 1062
Study design A part of The Paediatric Asthma Gene Environment Study (PAGES) http://www.asthma-pages.com/ Quality of life () was determined in 553 children
Study methods Questionnaires: - Asthma Questionnaire - Children s Asthma Control Test (CACT) - The Paediatric Asthma Quality of Life Questionnaire (PAQLQ) Overall score and scores for three domains (Symptoms, Emotions and Activity). 7-point R. Likert scale (higher score -> better ) Allergic conditions including eczema, rhinitis and food allergies were self reported. Asthma severity was determined by the British Thoracic Society/SIGN Asthma Guideline
Characteristics of study participants Children from primary (58,2%) and secondary (41,8%) care 2-16 years age, mean age 10,3 (±3,5) 56,4% (n=312) were boys 27,3% (n=151) were exposed to smoking
Prevalence of concomitant allergic diseases in children with asthma, % 18,5 41,2 Neither 20,5 Only allergic rhinitis Only eczema Both 19,8 N=553
Quality of Life and its association with asthma severity and control Overall Median 5,9 IQR 4,7; 6,8 Asthma severity, Rho Asthma control, Rho -0,313** 0,630** N=553; *p<0.05; **p<0.001
Quality of Life and its association with asthma severity and control Overall Symptoms Emotions Activity Median 5,9 5,9 6,4 3,4 IQR 4,7; 6,8 4,6; 6,7 5,1; 7,0 2,8; 4,6 Asthma severity, Rho Asthma control, Rho -0,313** -0,306** -0,321** -0,087* 0,630** 0,641** 0,578** -0,057 N=553; *p<0.05; **p<0.001
of children with asthma association with allergic diseases Rhinitis ever Current rhinitis Overall Symptom s Emotion s Activity Yes (n=310) 5,9* 5,8* 6,3* 3,4 No (n=241) 6,1* 6,0* 6,5* 3,4 Yes (n=211) 5,7** 5,7** 6,1** 3,4 No (n=340) 6,1** 6,0** 6,5** 3,4 *p<0.05; **p<0.001
of children with asthma association with allergic diseases Rhinitis ever Current rhinitis Eczema ever Current eczema Hospitalization with eczema Food allergies Overall Symptom s Emotion s Activity Yes (n=310) 5,9* 5,8* 6,3* 3,4 No (n=241) 6,1* 6,0* 6,5* 3,4 Yes (n=211) 5,7** 5,7** 6,1** 3,4 No (n=340) 6,1** 6,0** 6,5** 3,4 Yes (n=356) 5,9 5,9 6,4 3,4 No (n=195) 6,0 6,0 6,4 3,4 Yes (n=215) 5,8 5,8 6,3 3,4 No (n=336) 6,0 6,0 6,5 3,4 Yes (n=20) 5,4 5,3 5,6 3,6 No (n=551) 6,0 5,9 6,4 3,4 Yes (n=169) 5,9 5,9 6,4 3,4 No (n=382) 6,0 5,9 6,5 3,4 *p<0.05; **p<0.001
Asthma severity and other allergic diseases Asthma severity was associated with: - current eczema (p<0.001) - allergic rhinitis ever (p=0.001) - current allergic rhinitis (p=0.007) - food allergies (p=0.045)
Independent determinants of of children with asthma Number of resident smokers % reduction in [95% CI] P value 1 (ref to none) 6 [1, 13] 0.283 2 (ref to none) 11 [2, 23] 0.017 Current rhinitis (ref to none) 9 [4, 16] 0.001 BTS step treatment Socioeconomic status 2 (ref to 1) 7 [-4, 18] <0.001 3 (ref to 1) 5 [-5, 17] <0.001 4 and 5 (ref to 1) 42 [24, 61] <0.001 per increase in category 12 [8, 16] 0.005 n=508; Adjusted R-square 0.154; p-value<0.0001
Conclusions The for children with asthma in Scotland is generally good. The in children with asthma is significantly associated with presence of rhinitis, but not eczema or food allergies. Better asthma control and management as well as treatment of concomitant allergic diseases can improve the of children with asthma.
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