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Effect of Nasal Obstructive Disorders on Sinonasal Symptoms in Children with Different Levels of Bronchial Asthma
T I Eliseeva1, S V Krasilnikova1, N A Geppe2
1Department of Hospital Pediatrics and Department of ENT Diseases, Nizhny Novgorod State Medical Academy, 10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005, Russia.
Insights
Nasal obstructive diseases (NOD) in children with allergic rhinitis/rhinosinusitis and asthma show weaker symptom correlations. Asthma control is more closely linked to nasal and sinus symptoms when NOD is absent.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Otolaryngology
Background:
- Allergic rhinitis (AR) and allergic rhinosinusitis (ARS) are common upper airway pathologies (UAP) in children with bronchial asthma (BA).
- Nasal obstructive diseases (NOD) frequently coexist with AR/ARS and BA, potentially influencing symptom perception and asthma control.
- Understanding the interplay between UAP, NOD, and asthma control is crucial for comprehensive pediatric respiratory care.
Purpose of the Study:
- To investigate the effect of nasal obstructive diseases (NOD) on the correlation between nasal/synonasal symptoms and asthma control in children with atopic bronchial asthma (BA).
- To assess the relationship between asthma control, nasal symptoms, and quality of life in children with AR/ARS, considering the presence or absence of NOD.
Main Methods:
- Eighty-two children (mean age 9.8 years) with atopic BA were evaluated.
- Assessments included the Asthma Control Questionnaire (ACQ-5), Total Nasal Symptom Score (TNSS), Sino-Nasal Outcome Test-20 (SNOT-20), and rhinovideoendoscopy for NOD.
- Statistical analysis examined correlations between symptom scores and asthma control, stratified by the presence of NOD.
Main Results:
- Significant correlations were found between asthma control (ACQ-5) and both nasal symptoms (TNSS) and quality of life (SNOT-20).
- These correlations were stronger in children without NOD compared to those with coexisting AR/ARS and NOD.
- Multimorbid UAP, including NOD, was present in 76.3% of the studied children.
Conclusions:
- The association between bronchial asthma control and the severity of nasal and synonasal symptoms is more pronounced in children without multimorbid upper airway pathologies, specifically NOD.
- The presence of nasal obstructive diseases may attenuate the perceived relationship between upper airway symptoms and overall asthma control.
- This highlights the importance of identifying and managing coexisting nasal obstructive diseases in asthmatic children to better understand and potentially improve asthma control.
Abstract:
Allergic rhinitis (AR) and allergic rhinosinusitis (ARS) are typical upper airway pathologies (UAP) in children with bronchial asthma (BA) frequently accompanied with nasal obstructive diseases (NOD). In order to establish the effect of NOD on correlations between nasal and synonasal symptoms with clinical assessments of asthma control, 82 children, 9.8 [8.9; 10.7] years old, with atopic BA were assessed using ACQ-5 for the BA control level, TNSS for nasal symptoms, and SNOT-20 for synonasal quality of life in combination with rhinovideoendoscopy for NOD. All patients had AR/ARS; in 76.3% (63/82) of children, UAP had a multimorbid character with the presence of NOD. Significant correlations were found between ACQ-5 and TNSS (R=0.40, p < 0.0001) and ACQ-5 and SNOT-20 (R=0.42, p < 0.0001). Correlations between TNSS/ACQ-5 and SNOT-20/ACQ-5 were higher in patients who do not have a combination of AR/ARS with NOD (R=0.67, p=0.0012; R=0.50, p=0.022, resp.) than in patients who have AR/ARS combined with NOD (R=0.30, p=0.015; R=0.26, p=0.04, resp.). Thus, the association of BA control level with the expression of nasal and synonasal symptoms is higher in children who do not have multimorbid UAP.
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