Asthma and allergic rhinitis

Original Article
Allergy Asthma Immunol Res. 2010 April;2(2):108-113. doi: 10.4168/aair.2010.2.2.108 pISSN 2092-7355 • eISSN 2092-7363

Asthmatics Without Rhinitis Have More Fixed Airway Obstruction Than Those With Concurrent Rhinitis
An-Soo Jang, Jong-Sook Park, June-Hyuk Lee, Sung-Woo Park, Do-Jin Kim, Soo-Taek Uh, Young-Hoon Kim, Choon-Sik Park*
Asthma and Allergy Research Group, Divisionof Allergy and Respiratory Diseases, Soonchunhyang University, Bucheon Hospital, Bucheon, Korea
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Purpose: Rhinitis and asthma usually occur together. There are increasing evidences that allergic rhinitis (AR) may influence the clinical course of asthma. The aim of this study is to evaluate clinical parameters and therapeutic response in patients with between asthma and asthma with AR. Methods: Four-hundred eighty-five patients with asthma and 428 asthmatics with AR, who had lesser than50 years old and smoked less than 10 pack-years were recruited. We compared FEV1 and FEV1/FVC following bronchodilator, atopy, IgE, emphysema on HRCT, and aspirin intolerance between two groups. Also we compared physiologic fixed airway obstruction defined using FEV1/FVC and FEV1 less than 75% following anti-asthmatic drug for 1 year. Results: 46.8% (428/913) asthmatics suffered from AR. Therewere no differences of total IgE, body mass index, PC20, sputum eosinophils and emphysema on HRCT between two groups. The age in asthmatics was higher than that in those with AR. FEV1/FVC was lower in asthmatics than in those with AR. The prevalence of atopy was higher in asthmatics with AR than in asthmatics. Aspirin intolerance was higher in asthmatics with AR than in asthmatics (42/218 versus13/109, P=0.001). Fixed airway obstruction were more observed in asthmatics than in those with AR (39/319 versus 28/355, P=0.001) after anti-asthmatic drug for 1 year. Conclusions: Asthmatics with AR had more atopy and aspirin intolerance than asthmatics, and asthmatics had poor response to anti-inflammatory drugs than those with concurrent rhinitis, indicating that asthmatics have more fixed airwayobstruction than those with concurrent rhinitis. Key Words: Asthma; allergic rhinitis; airway obstruction

INTRODUCTION
Close association exists between allergic rhinitis (AR) and asthma. There are increasing evidences that AR may influence the clinical course of asthma adults.1-6 Putative mechanisms linking rhinitis to asthma are explained by direct and indirect effect.7 The direct effects arenaso-bronchial reflex, postnasal drip of inflammatory cells and/or mediators from the nose into the lower airways, and absorption of inflammatory cells and/or mediators from the nose into the systemic circulation and ultimately the lung. The indirect effects are nasal obstruction causing reduction in filtration, humidification, and warming function of the nose.8 Rhinitis patients showed a lowerdegree of bronchial hyperresponsiveness (BHR) to allergen than asthmatics, but responded to allergen inhalation with changes in airway inflammation and in maximal response plateau very similar to asthmatics.8 The differences between asthma and AR in symptoms depend on a quantitatively different response to environmental allergen inhalation.8

Eosinophilic inflammation may be present in subjectswith AR and BHR even when there are no symptoms of asthma.9 There is a little report about comparative data of clinical and therapeutic response between asthmatics and asthmatics with AR. The aim of this study is to evaluate clinical parameters and therapeutic response to asthma between asthmatics and asthmatics with AR.

MATERIALS AND METHODS
Patients Subjects were recruited from the Genome...