The relationship between allergic rhinitis and asthma is often a common and progressive one as Professor Erkka Valovirta highlighted in the previous expert opinion video. Many patients with asthma also experience allergic rhinitis, and the misdiagnosis or undertreatment of allergic rhinitis appears to play a large role in asthma severity. Comorbid allergic rhinitis in patients with asthma can lead to poorer asthma symptom control and increased exacerbations; besides the additional burden on patient quality of life, there is also a socioeconomic burden that arises from the costs of managing the conditions.
The increased cost can be due to a number of factors including more frequent outpatient and emergency hospital visits and hospitalisations. A Korean study comparing paediatric asthma patients with and without allergic rhinitis investigated the cost of asthma-related health insurance claims. It showed that the increased healthcare needs of patients with comorbid allergic rhinitis increased total annual expenditure from $217 per patient for those without allergic rhinitis to $273 per patient with allergic rhinitis (Kang et al., 2008). This increased cost has also been reported in France, as Belhassen et al. revealed patients with perennial allergic rhinitis alone had a lower annual cost reimbursed by a social security system, ranging between €111–€188 per patient, compared to an annual cost of €226–€375 per patient with perennial allergic rhinitis and asthma (Belhassen et al., 2016).
Given the increased cost associated with the development of allergic rhinitis, could the management of allergic rhinitis reduce asthma exacerbations and in turn reduce asthma-associated costs? Dr Glenis Scadding explains how treating the two conditions together could be beneficial for reducing economic costs.
A recent study from Taiwan has demonstrated the importance of treating allergic rhinitis symptoms in patients with asthma. The study analysed data from a national database of health records, including hospitalisations and prescriptions, and compared the occurrence of acute asthma exacerbations in two age groups of patients with asthma: pre-school aged 2–6 years old (n = 6,506), and school-aged 7–18 years old (n = 4,202). The prevalence of acute asthma exacerbations was higher in the pre-school aged group compared to the school-aged group (adjusted HR: 1.68, 95% CI 1.44–1.95), and the rate of allergic rhinitis was higher in pre-school aged children compared to school-aged children (54.7% vs. 45.29%).
This study also supports Dr Glenis Scadding’s suggestion that treating allergic rhinitis in patients with asthma can reduce exacerbation risks. Patients receiving intranasal corticosteroids (INCS) and/or second-generation antihistamines (SGAH) had a significant reduction in the occurrence of acute asthma exacerbations compared to no allergic rhinitis treatment (INCS adjusted HR: 0.32, 95% CI 0.26–0.41; SGAH adjusted HR: 0.44, 95% CI 0.34–0.58; INCS and SGAH adjusted HR: 0.30, 95% CI 0.22–0.40; no treatment adjusted HR: 0.89, 95% CI 0.68–1.17). Importantly, the association between reduced exacerbations risk and allergic rhinitis treatment was seen in both age groups (Yu et al., 2018).
The reduction in acute exacerbations could indeed be beneficial in reducing the socioeconomic burden as Dr Scadding suggests, but future studies are needed to investigate the potential financial savings.
Treating allergic rhinitis symptoms in patients with asthma has clear benefits, by improving symptom management and could even ease the societal financial burden. Therefore, the importance and impact of treating these two conditions together shouldn’t be overlooked, and instead, allergic rhinitis management should remain a priority when tailoring treatments for patients with asthma.
To learn more about managing asthma and allergic rhinitis together click here.
Professor Erkka Valovirta reviews the effect of undiagnosed allergic rhinitis on asthma control and discusses if allergic rhinitis could be contributing to uncontrolled asthma?