Allergic Rhinitis Reduces Quality

of Life in Children with Asthma

Vaida Taminskiene1 , Steve Turner 2, Jon Ayres3, Somnath

Mukhopadhyay4, Colin Palmer5, Anil Mehta6, Egle Vaitkaitiene7, Arunas Valiulis8

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 evidence-based management of allergic rhinitis in conjunction with asthma worldwide.

Allergic rhinitis is associated with reduced Quality

of life (QoL) independent of asthma but does coexistent rhinitis add to the reduced QoL 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 (QoL) 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 QoL domains (Symptoms, Emotions and Activity).

• 7-point R. Likert scale (higher score -> better QoL)

• 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, %

41,2

19,8

20,5

18,5

Neither

Only allergicrhinitisOnly eczema

Both

N=553

Quality of Life and its association

with asthma severity and control

N=553;

QoL

Overall

Score

Median 5,9

IQR 4,7; 6,8

Asthma

severity, Rho -0,313**

Asthma control,

Rho 0,630**

*p<0.05; **p<0.001

Quality of Life and its association

with asthma severity and control

N=553;

QoL

Overall

Score

QoL

Symptoms

Score

QoL

Emotions

Score

QoL

Activity

Score

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 -0,313** -0,306** -0,321** -0,087*

Asthma control,

Rho 0,630** 0,641** 0,578** -0,057

*p<0.05; **p<0.001

QoL of children with asthma

association with allergic diseases

QoL

Overall

Score

QoL

Symptom

s Score

QoL

Emotion

s Score

QoL

Activity

Score

Rhinitis

ever

Yes (n=310) 5,9* 5,8* 6,3* 3,4

No (n=241) 6,1* 6,0* 6,5* 3,4

Current

rhinitis

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

QoL of children with asthma

association with allergic diseases

QoL

Overall

Score

QoL

Symptom

s Score

QoL

Emotion

s Score

QoL

Activity

Score

Rhinitis

ever

Yes (n=310) 5,9* 5,8* 6,3* 3,4

No (n=241) 6,1* 6,0* 6,5* 3,4

Current

rhinitis

Yes (n=211) 5,7** 5,7** 6,1** 3,4

No (n=340) 6,1** 6,0** 6,5** 3,4

Eczema

ever

Yes (n=356) 5,9 5,9 6,4 3,4

No (n=195) 6,0 6,0 6,4 3,4

Current

eczema

Yes (n=215) 5,8 5,8 6,3 3,4

No (n=336) 6,0 6,0 6,5 3,4

Hospitalization

with eczema

Yes (n=20) 5,4 5,3 5,6 3,6

No (n=551) 6,0 5,9 6,4 3,4

Food

allergies

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 QoL

of children with asthma

% reduction in

QoL [95% CI]

P value

Number of

resident smokers

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 treatment

step

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

Socioeconomic

status

per increase in

category

12 [8, 16] 0.005

n=508; Adjusted R-square 0.154; p-value<0.0001

Conclusions

• The QoL for children with asthma in

Scotland is generally good.

• The QoL 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 QoL of children

with asthma.

Ačiū!

Takk!

Thank you!