Lack of control of severe asthma is associated with co-existence of moderate-to-severe rhinitis

Background: Retrospective studies provide evidence that rhinitis is associated with more severe asthma. The aim of this study was to evaluate prospectively whether rhinitis is a predictor of increased asthma severity. Methods: Five hundred and fifty-seven patients with severe asthma were enrolled. During 1 year of follow-up, each patient was evaluated every 3 months with a record of emergency room visits and supply of topical corticosteroids for asthma and rhinitis. In the 1 year of follow-up visit, the patients were checked for rhinitis diagnosis, severity and answered questionnaires for asthma symptoms and quality of life. Results: Eighty-two (15%) patients had no rhinitis, 299 (54%) had mild rhinitis and 176 (31%) moderate/severe rhinitis. In logistic regression models, moderate/severe rhinitis was a predictor for any emergency room visit in the follow-up period [3.83 (2.00-7.35)], for the presence of uncontrolled asthma after 1 year of follow-up [12.68 (1.73-92.85)], for < 10% improvement of the airway obstruction [2.94 (1.48-5.85)] and < 50% reduction in the number of emergency room visits [2.90 (1.02-8.26)] in the year of follow-up. It was also associated with a smaller chance of more than 90% reduction in the number of emergency room visits in the year of follow-up [0.27 (0.12-0.60)]. In a multivariate linear regression model, severity of rhinitis was positively correlated with a score of asthma severity and inversely correlated to an index of quality of life. Conclusions: In a population with severe asthma, moderate/severe rhinitis is a strong predictor for greater severity of asthma.