|Year : 2017 | Volume
| Issue : 6 | Page : 647-651
A correlation of symptomatology with lung function in patients with allergic rhinosinusitis
A Ajiya1, AD Salisu1, OGB Nwaorgu2
1 Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan, Nigeria
|Date of Acceptance||03-Feb-2016|
|Date of Web Publication||27-Jun-2017|
Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Allergic rhinosinusitis is clinically defined as a symptomatic disorder of the nose induced by an IgE-mediated inflammation following allergen exposure to the membrane lining of the nose. It constitutes a global health problem. Both allergic rhinosinusitis and bronchial asthma are systemic inflammatory conditions that often coexist. Objective: The objectives of the study are to assess the pattern of allergic rhinosinusitis and to correlate nasal symptom score with lung volumes of patients with allergic rhinosinusitis. Methods: This is a prospective study of all the adult patients with clinically diagnosed allergic rhinosinusitis at the study center. Patients' biodata, symptoms, and signs were obtained using a specially designed form. The symptoms were scored using nasal symptom scoring protocol and the lung volumes determined using spirometry. The data were collated and analyzed using SPSS Version 15 statistical software. Results: There were 300 patients and another 300 nonallergic individuals as control. The most common presenting symptom was nasal congestion (98%), whereas the most common sign was engorged turbinates (91%). The most common trigger of allergic symptoms was dust (72.3%). Spirometric test results were below 90% on average in both sexes and significantly (P < 0.05) below those of the participants in the control group. A large number of patients with abnormal spirometry results have total nasal symptom scores of above 5 (n = 119), whereas few (n = 7) had symptom scores of 5 and below. There was a statistically significant correlation between high total nasal symptom score and abnormal spirometry (χ2 = 72, P = 0.0001). Conclusion: There is a significant correlation between nasal symptom score and reduced lung volumes in patients with allergic rhinosinusitis even in the absence of asthma.
Keywords: Allergic rhinosinusitis, correlation, lung function
|How to cite this article:|
Ajiya A, Salisu A D, Nwaorgu O. A correlation of symptomatology with lung function in patients with allergic rhinosinusitis. Niger J Clin Pract 2017;20:647-51
|How to cite this URL:|
Ajiya A, Salisu A D, Nwaorgu O. A correlation of symptomatology with lung function in patients with allergic rhinosinusitis. Niger J Clin Pract [serial online] 2017 [cited 2022 Dec 5];20:647-51. Available from: https://www.njcponline.com/text.asp?2017/20/6/647/187321
| Introduction|| |
Allergic rhinosinusitis is clinically defined as a symptomatic disorder of the nose induced by an IgE-mediated inflammation following allergen exposure to the membrane lining of the nose. Both allergic rhinosinusitis and bronchial asthma are systemic inflammatory conditions that often coexist.
Allergic rhinosinusitis has been demonstrated to be an independent risk factor for the onset of asthma in children and adults., The presence of allergic rhinosinusitis is associated with worse asthma control in children and adults., Both rhinosinusitis and asthma can be triggered by the same factors, whether allergic or nonspecific. Asthma is characterized by a reversible airflow obstruction and forced expiratory volume in 1 s is considered the main parameter to evaluate bronchial obstruction. Bronchial asthma is present in 20–50% of patients with allergic rhinosinusitis: While allergic rhinosinusitis is reported in about 80% of patients with bronchial asthma., However, the exact pathogenesis of this comorbidity remains controversial. Furthermore, spirometric studies have shown bronchial hyperreactivity in patients with allergic rhinosinusitis., In addition, studies have demonstrated a clear relationship between nasal symptom severity and bronchial hyperreactivity.,,
Prevalence studies of allergic rhinosinusitis in Nigeria are few. However, reports showed prevalence ranging between 29.6% and 39.7%.,, On the other hand, the prevalence of bronchial asthma worldwide was around 200 million with a mortality of around 0.2 million/year, with prevalence of between 6.6% and 15.2% in Nigeria.,
Allergic rhinosinusitis and bronchial asthma are therefore prevalent in Nigeria, with previous studies reporting 39.7% (ISAAC I998 report) and 15.2% for allergic rhinosinusitis and bronchial asthma, respectively., It is thus the aim of this study to assess the pattern of allergic rhinosinusitis and correlate nasal symptom score with lung volumes of patients with allergic rhinosinusitis in our environment. The limitations of the study included recall bias of symptoms by the patients and lack of facilities to conduct confirmatory tests for allergic rhinosinusitis.
| Methods|| |
This study was a prospective, descriptive, cross-sectional study conducted on 300 consecutive eligible patients diagnosed clinically with allergic rhinosinusitis at the ENT clinic of Aminu Kano.
Teaching Hospital, Kano, that satisfied the inclusion criteria. An equal number of normal individuals matched in age and gender was recruited as control group. The control group included the following: Medical students, nurses, medical doctors, and other nonmedical staff of the hospital.
The study was carried out over a 6-month period in the year 2012.
This study was performed in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethical Review Committee of Aminu Kano Teaching Hospital. Informed consent was also obtained from each patient before recruitment.
This study included consenting patients who presented with two or more of the following symptoms: Nasal blockage/obstruction, excessive sneezing, excessive nasal itching, and anterior/posterior watery nasal discharge. Patients with history of sinonasal tumors, nasal polyps, diagnosis of asthma, contraindication to spirometry, or chronic chest disorder were excluded from the study.
The minimum sample size was determined using the Fischer's formula. An assumption of 23% was made by extrapolation from a previous study among the adult population in Turkey.
To allow for attrition, N was approximated to 300.
A specially designed form was used to record participants' biodata and occupation while their symptoms were scored using Lund's symptom score protocol. Subsequently, each participant had spirometry (Vitalograph ALPHA, AL 015019, made in Ennis, Ireland) and the data were analyzed using the Statistical Package for Social Sciences (SPSS) Version 15 statistical software (SPSS Inc., Chicago, Illinois, USA).
| Results|| |
Three hundred participants were recruited into the study group and another 300 matched in age and gender as a control group. There were 117 males (39%) and 183 (61%) females with M: F ratio of 1:1.6. The age of the participants ranged from 18 to 49 years and the mean ± standard deviation was 29.3 ± 8.2 years. The majority of the participants were aged between 18 and 29 years (58%), with fewer individuals in the older age group (42%). Most of the participants (70%) had positive family history of atopy. [Table 1] shows the general characteristics of the study population.
The most common trigger of symptoms reported by participants was dust allergy (72.3%) followed by allergy to smoke or kitchen fumes (44%). [Table 2] shows self-reported triggers of allergic symptoms in the study population.
In both sexes, reduced lung volumes were more common in patients with allergic rhinosinusitis than in normal individuals. The differences in lung volumes were statistically significant between participants with allergic rhinosinusitis and normal individuals (P < 0.05). [Table 3] shows the spirometric test results for participants.
The most common symptom presented in the severe form among the participants in the study was sneezing (n = 164), but the majority of the patients had complaints of nasal congestion (98%) followed by running nose (96%). [Table 4] shows the classification of patients with allergic rhinosinusitis based on their symptom scores.
|Table 4: Classification of patients with allergic rhinosinusitis based on their symptom scores|
Click here to view
A large number of patients with abnormal spirometry results have total nasal symptom scores of above 5 (n = 119), whereas few (n = 7) had symptom scores of 5 and below. [Table 5] shows a cross-tabulation of total nasal symptom scores of participants and spirometry interpretations.
|Table 5: Cross-tabulation of total nasal symptom scores and spirometry interpretation|
Click here to view
There is a statistically significant correlation between high total nasal symptom scores of patients with allergic rhinosinusitis and abnormal spirometry readings (χ2 = 72, P < 0.0001).
The most common physical examination finding in the participants with allergic rhinosinusitis was engorged turbinates (91%), followed by dull tympanic membrane (82.3%) and anterior nasal discharge (56.7%). [Figure 1] depicts the distribution of physical findings in participants with allergic rhinosinusitis.
|Figure 1: Distribution of physical findings in patients with allergic rhinosinusitis|
Click here to view
| Discussion|| |
Remarkable relationship exists between the upper and lower airways. In fact, some authors have found that the treatment of nasal symptoms in patients with asthma has led to good disease control.,, Allergic rhinosinusitis may contribute to worsen asthma through different pathophysiologic mechanisms: Postnasal dripping, naso-bronchial reflex, oral breathing, and systemic allergic inflammation.
In this study, the majority of patients with allergic rhinosinusitis were females. This is consistent with several studies worldwide,,,, but in contrast with reports from some authors locally and internationally.,, The higher prevalence in females is attributed to a greater cough reflex sensitivity of the female airway, the impact of hormones on the airway, and physiological differences between men and women in airway reactivity to allergens.
Fifty-eight percent of patients with allergic rhinosinusitis were below the age of 30 years. This is similar to findings by Desalu et al. in Ilorin, North-central Nigeria. The result is also consistent with the observation that the disease is common in childhood, peaks in the early 20 s, and then decreases.,,
A larger proportion of the participants have family history of allergic disease or atopy. This is similar to findings by Md.nawad et al. and Olusesi et al., Several studies on risk factors for allergic rhinosinusitis worldwide have shown that the strongest risk factor for the development of allergic symptoms has been a strong family history of allergic disease irrespective of the varying prevalence and environmental risk factors across populations and societies.,
The most common reported trigger of allergic symptoms in this study was allergy to dust. Although skin sensitivity tests were not performed, the results were consistent with findings from other studies in Nigeria and other continents, where house dust was the greatest trigger of allergic rhinosinusitis,,,,,, although most of the patients gave more than one cause of their allergic symptoms.
The majority of patients in this study presented with complaints of nasal congestion. This is different from reported findings in Nigeria and other parts of the world.,,, However, the symptom with most severity was sneezing. Moreover, the most common physical finding in patients with allergic rhinosinusitis in this study was engorged inferior or middle turbinates, which is in agreement with reports by Lasisi et al. in Ibadan, Nigeria.
Spirometry results in this study showed that reduced lung volumes were more commonly found in patients with allergic rhinosinusitis than in normal individuals. This is consistent with findings from some longitudinal studied that associated allergic rhinosinusitis and the onset of bronchial hyperreactivity in adults.,
Airway obstruction was found to be common in allergic rhinosinusitis patients with high total nasal symptom scores. This is similar to reports by Cirillo et al. and Ciprandi et al., where nasal symptom intensity was found to be closely associated with bronchial hyperreactivity and reduced lung volumes.,,
The findings of this study, however, should be considered in the context of the potential limitations of the study.
| Conclusion|| |
High total nasal symptom scores are associated with airway obstruction in patients with allergic rhinosinusitis without asthma. The most common symptoms of allergic rhinosinusitis were nasal congestion and running nose. However, the symptom most associated with high symptom score was sneezing.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bousquet J, Van Cauwenberge P, Khaltaev N; Aria Workshop Group; World Health Organization. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001;108 Suppl 5:S147-334.
Pallasaho P, Juusela M, Lindqvist A, Sovijärvi A, Lundbäck B, Rönmark E. Allergic rhinoconjunctivitis doubles the risk for incident asthma – Results from a population study in Helsinki, Finland. Respir Med 2011;105:1449-56.
Shaaban R, Zureik M, Soussan D, Neukirch C, Heinrich J, Sunyer J, et al.
Rhinitis and onset of asthma: A longitudinal population-based study. Lancet 2008;372:1049-57.
de Groot EP, Nijkamp A, Duiverman EJ, Brand PL. Allergic rhinitis is associated with poor asthma control in children with asthma. Thorax 2012;67:582-7.
Clatworthy J, Price D, Ryan D, Haughney J, Horne R. The value of self-report assessment of adherence, rhinitis and smoking in relation to asthma control. Prim Care Respir J 2009;18:300-5.
Beers MH, Berkow R, editors. The Merck Manual of Diagnosis and Therapy. 17th
ed. White House Station, NJ: Merck Research Laboratories; 1999. p. 521-32.
Demoly P, Bousquet J. The relation between asthma and allergic rhinitis. Lancet 2006;368:711-3.
Ciprandi G, Tosca MA, Signori A, Cirillo I. Bronchial hyperreactivity in patients with allergic rhinitis: Forced expiratory flow between 25 and 75% of vital capacity might be a predictive factor. Allergy Asthma Proc 2011;32:4-8.
Ciprandi G, Cirillo I, Vizzaccaro A, Klersy C, Marseglia GL, Pallestrini E. Bronchial hyperreactivity is related to airfow limitation and independent of allergen exposure in Hay fever patients. The Internet Journal of Asthma, Allergy and Immunology. 2004;4:1. Available from: http://print.ispub.com/api/0/ispub-article/9086
[Last accessed on 2015 Nov 23].
Cirillo I, Vizzaccaro A, Marseglia G, Klersy C, Tosca MA, Ciprandi G. The relationship between FEF25-75 and skin test sensitization, nasal inflammation, and bronchial hyperreactivity in young subjects without asthma. The Internet Journal of Asthma, Allergy and Immunology. 2005;4(1). Available from:http://print.ispub.com/api/0/ispub-article/5680
. [Last accessed on 2015 Nov 23].
Ciprandi G, Cirillo I, Vizzaccaro A, Monardo M, Tosca MA. Early bronchial airflow impairment in patients with persistent allergic rhinitis and bronchial hyperreactivity. Respir Med 2005;99:1606-12.
Desalu OO, Salami AK, Iseh KR, Oluboyo PO. Prevalence of self reported allergic rhinitis and its relationship with asthma among adult Nigerians. J Investig Allergol Clin Immunol 2009;19:474-80.
Oladeji SM, Nwalolo CC, Akinola OO. Prevalence of allergic disorders among university students in a tertiary institution in Nigeria. IOSR J Dent Med Sci 2015;14:12-6.
Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al.
Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC phases one and three repeat multicountry cross-sectional surveys. Lancet 2006;368:733-43.
Rai SP, Patil AP, Vardhan V, Marwah V, Pethe M, Pandey IM. Best treatment guidelines for bronchial asthma. Med J Armed Forces India 2007;63:264-8.
Oni AO, Erhabor GE, Egbagbe EE. The prevalence, management and burden of asthma – A Nigerian study. Iran J Allergy Asthma Immunol 2010;9:35-41.
Desalu OO, Oluboyo PO, Salami AK. The prevalence of bronchial asthma among adults in Ilorin, Nigeria. Afr J Med Med Sci 2009;38:149-54.
Cingi C, Topuz B, Songu M, Kara CO, Ural A, Yaz A, et al.
Prevalence of allergic rhinitis among the adult population in Turkey. Acta Otolaryngol 2010;130:600-6.
Jankre LN, Ogisi FO. Nasal symptoms in bronchial asthma. East Afr Med J 2008;3:185-97.
Kersten ET, van Leeuwen JC, Brand PL, Duiverman EJ, de Jongh FH, Thio BJ, et al.
Effect of an intranasal corticosteroid on exercise induced bronchoconstriction in asthmatic children. Pediatr Pulmonol 2012;47:27-35.
Global initiative for Asthma. In: Pocket guide for asthma management and prevention. National Heart, Lung and Blood institute, National institute of Health, Bethesda, MD, 1997, NHI Publication no.96-3659B.
Gern JE, Busse WW. Contemporary Diagnosis and Management of Allergic Diseases and Asthma. Pennsylvania, PA: Handbook in Health Care Company; 2007. p. 81-96.
Olusesi AD, Said MA, Amodu EJ. A correlation of symptomatology with nasal smear eosinophilia in non-infectious chronic rhinitis preliminary report. Niger J Clin Pract 2007;10:238-42.
Azam M, Prasad MN, Kumar MA. Prevalence and pattern of allergic and non-allergic rhinitis in hospitalized patients in a tertiary health care: A cross sectional study. IOSR J Dent Med Sci 2014;13:16-20.
Lasisi AO, Lawal HO, Ogun GO, Oluwasola A, Odubanjo MO, Salisu A, et al
. Correlation between eosinophilia and nasal features in allergic rhinosinusitis – A pilot study. J Asthma Allergy Educ 2010;1:219-22.
Nepali R, Sigdel B, Baniya P. Symptomatology and allergen types in patients presenting with allergic rhinitis. Banglad J Otorhinolaryngol 2012;18:30-5.
Lasisi AO, Abdullahi M. The inner ear in patients with nasal allergy. J Natl Med Assoc 2008;100:903-5.
Maksimovic N, Tomic-Spiric V, Jankovic S, Jovic-Vranes A, Terzic-Supic Z, Jankovic J, et al
. Risk factors of allergic rhinitis: A case-control study. Healthmed 2010;4:63-70.
Choi SH, Yoo Y, Yu J, Rhee CS, Min YG, Koh YY. Bronchial hyperresponsiveness in young children with allergic rhinitis and its risk factors. Allergy 2007;62:1051-6.
Navarro A, Valero A, Juliá B, Quirce S. Coexistence of asthma and allergic rhinitis in adult patients attending allergy clinics: ONEAIR study. J Investig Allergol Clin Immunol 2008;18:233-8.
Wang HY, Zhang CQ, Sun BQ, Li SY, Zheng JP, Zhong NS. A survey on the relationship between atopy and bronchial asthma among adolescents in the city of Guangzhou, China. Zhonghua Jie He He Hu Xi Za Zhi 2007;30:504-8.
Shaaban R, Zureik M, Soussan D, Antó JM, Heinrich J, Janson C, et al.
Allergic rhinitis and onset of bronchial hyperresponsiveness: A population-based study. Am J Respir Crit Care Med 2007;176:659-66.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]