|Year : 2015 | Volume
| Issue : 2 | Page : 116-120
Baseline lung function of patients with allergic rhinosinusitis in Kano
Abdulrazak Ajiya1, Emmanuel Sara Kolo1, Onyekwere George B 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 Web Publication||10-Nov-2015|
Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Background: Allergic rhinosinusitis is a global health problem both economically and socially with significant impact on the quality of life of the afflicted. This is worsened when bronchial asthma, a comorbidity, is present. Aim and Objective: This study aimed to determine the baseline lung function status of patients with allergic rhinosinusitis. Participants and Methods: All adult patients seen in the Otolaryngology Out-patient Clinic of the study centre with clinically diagnosed allergic rhinosinusitis were prospectively entered in the study. The participants' biodata, symptoms and signs were obtained using a specially designed interviewer-administered questionnaire. The baseline lung function values of the patients were determined using spirometry as a measuring tool. The data were collated and analysed using SPSS version 15 statistical software. Results: There were 300 patients and 300 control participants. Sixty-one percentage were females and 39% as males with a male: female ratio of 1:1.6. The age ranged between 18 and 49 years (mean = 29.3). Seventy percentage had positive family history of allergy, while 19% were obese. Allergic rhinosinusitis was the most common amongst students (38%). In the study group, the lung volumes were below 90% and above 90% in the control group; which was statistically significant (P = 0.05). Older age group (odds ratio, 13.0), female gender (odds ratio, 10.9) and negative family history of allergy (odds ratio, 7.7) were found to be associated with abnormal spirometry results in patients with allergic rhinosinusitis. Conclusion: There is impairment in baseline lung function of patients with allergic rhinosinusitis, even in the absence of asthma.
Keywords: Allergic rhinosinusitis, bronchial asthma, co-morbidity, lung function values
|How to cite this article:|
Ajiya A, Kolo ES, Nwaorgu OB. Baseline lung function of patients with allergic rhinosinusitis in Kano. Niger J Basic Clin Sci 2015;12:116-20
|How to cite this URL:|
Ajiya A, Kolo ES, Nwaorgu OB. Baseline lung function of patients with allergic rhinosinusitis in Kano. Niger J Basic Clin Sci [serial online] 2015 [cited 2021 Jun 23];12:116-20. Available from: https://www.njbcs.net/text.asp?2015/12/2/116/169293
| Introduction|| |
Allergic rhinosinusitis constitutes a global health problem that causes major illnesses and disabilities. Both allergic rhinosinusitis and bronchial asthma are systemic inflammatory conditions that often coexist as confirmed by Annesi-Maesano in a cross-sectional epidemiological study which showed prevalence ranging above 40% in some countries.
According to the document, 'allergic rhinitis and its impact on asthma' (ARIA) 2008 by Bousquet et al., allergic rhino sinusitis is clinically defined as a symptomatic disorder of the nose induced by an immunoglobulin E-mediated inflammation following allergen exposure to the membrane lining of the nose. Bronchial asthma is defined as a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular mast cells, eosinophils, T-cells, macrophages, neutrophils and epithelial cells. Rhinosinusitis and bronchial asthma have been evaluated and treated as separate disorders, but recent advances in the understanding and knowledge of the underlying processes have moved current opinion towards the concept of unifying the management of these disorders. The 'united airway disease hypothesis' proposes that upper and lower airway diseases are both manifestations of a single inflammatory process.
The prevalence of self-reported allergic rhinosinusitis and its relationship with asthma among adult Nigerians showed that 31.8% of individuals with allergic rhinosinusitis have asthma; while 63.9% of those with asthma have allergic rhinosinusitis. Several studies in Nigeria reported high prevalence of both allergic rhino sinusitis and bronchial asthma. Few, if any, reported on the baseline lung function status of patients with allergic rhino sinusitis.
This study aimed to determine the baseline lung function status of patients with allergic rhinosinusitis in adult Nigerians.
| Participants and Methods|| |
This study was a prospective, descriptive, cross-sectional study conducted on 300 consecutive eligible patients diagnosed clinically with allergic rhinosinusitis at the Ear, Nose, and Throat Clinic of Aminu Kano Teaching Hospital, Kano, that satisfied the inclusion criteria. The study was carried out over a 6-month period in the year 2012. The study is an extract from a dissertation submitted to the West African College of Surgeon. 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.
The 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. This is the clinical diagnostic criteria as proposed by ARIA document in 2008. Excluded were patients with history of sino-nasal tumours, nasal polyps, diagnosis of asthma, contraindication to spirometry or chronic chest disorder. An equal number of normal individuals matched in age and gender were recruited as control group. The control group included: Medical students, nurses, medical doctors and other health workers. The control group was selected using a simple random sampling technique among the listed groups. The selected individuals were initially interviewed to rule out both allergic rhinosinusitis and asthma before recruitment.
A minimum sample size was determined using Fischer's formula. An assumption of 23% was made by extrapolation from a previous study amongst adult population in Turkey.
Therefore: N = Z 2 PQ/D 2
N = 3.84 * 0.23 * 0.77/0.0025
N = 272.
To allow for attrition, N was approximated to 300.
Limitations of this study included recall bias of symptom by participants. In addition, the diagnosis of allergic rhinosinusitis was not supported by skin test, eosinophil count and others.
A specially designed form was used to record participants' biodata and occupation, while their symptoms were recorded using Lund's symptom score protocol. Subsequently, each participant had spirometry done (Vitalograph ALPHA, AL 015019, made in Ennis, Ireland). The body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters. The participants were categorised as follows:
- Below 18.5: Underweight
- 18.5–24.9: Healthy
- 25.0–29.9: Overweight
- 30.0–39.9: Obese
- Over 40: Extreme or high-risk obesity.
Data were analysed using SPSS version 15 statistical software (SPSS Inc., Chicago, Illinois, USA).
| Results|| |
Three hundred participants were recruited in the study group and another 300 matched for age and gender as a control group. There were 117 (39%) males and 183 (61%) females with M: F ratio of 1:1.6.
The age of the participants ranged from 18 to 49 years (29.3 ± 8.2 years). The majority of the participants are aged between 18 and 29 years (58%), with fewer individuals (42%) in the older age group. Most of the participants (70%) in the study group had positive family history of atopy. Only 19% of the participants in the study group were obese. [Table 1] shows the general characteristics of the study population.
In the study population, allergic rhinosinusitis was most common in students (38%), followed by housewives (22.3%). [Table 2] shows the distribution of occupation 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 spirometry test results for participants.
[Table 4] and [Table 5] show that abnormal spirometry results were associated with age 30 years and above (odds ratio, 13.0), female gender (odds ratio, 10.9) and negative family history of allergy (odds ratio, 7.7); but obesity was found to decrease the risk of abnormal spirometry result (odds ratio, 0.5).
|Table 4: Factors affecting spirometry results in patients with allergic rhinosinusitis|
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|Table 5: Determinants of abnormal spirometry results in patients with allergic rhinosinusitis|
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| Discussion|| |
The International Study of Asthma and Allergies in Children report showed that in general, with some exceptions, higher levels of allergic rhinosinusitis are observed in communities with higher levels of asthma.
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 percentage of patients with allergic rhinosinusitis are below the age of 30 years. This is similar to the 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 20s and then decreases.,,
A larger proportion of the allergic rhinosinusitis group have family history of allergic disease or atopy. This is similar to the findings by Olusesi et al. in Abuja, the Nigerian capital. 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.,
Obesity was not a common finding in the patients with allergic rhinosinusitis. This supports reports from studies in Nigeria  and Japan, where obesity was either not a risk factor for allergic rhinosinusitis or has negative associations with prevalence of allergic rhinosinusitis.
Students were most commonly affected by allergic rhinosinusitis in this study. This is in slight contrast to reports in Nigeria and Nepal,, but consistent with similar study done in Bangladesh.
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 a longitudinal study, which shows a strong association between allergic rhinosinusitis and the onset of bronchial hyperreactivity in adults in the general population.
Determinants of abnormal spirometry results in this study were found to be age above 30 years, female gender and negative family history of allergy. However, obesity was found to be protective against abnormal lung function test results. Cirillo et al. reported gender not to be a significant risk factor for bronchial hyperreactivity in patients with allergic rhinosinusitis, in contrast to the findings of this study. However, previous reports by Paoletti et al. evidenced in support of findings of this study.
The findings of this study, however, should be considered in the context of the potential limitations of the study.
| Conclusion|| |
There is impairment of spirometry readings in patients with allergic rhinosinusitis, even in the absence of asthma.
| Recommendation|| |
The management of allergic rhinosinusitis in our hospitals should involve a multidisciplinary approach involving the rhinologist, respiratory physician and ophthalmologist, such that patients will be followed up carefully to evaluate the possible onset of asthma.
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 5 Suppl: S147-334.
Annesi-Maesano I. Epidemiological evidence for the relationship between upper and lower airway disease. In: Corren J, editor. Relationship between Upper and Lower Airway Disease. Series Lung Biology in Health and Disease. Vol. 18. New York: Marcel Dekker; 2003. p. 105-28.
Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, et al.
Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 2008;31:143-78.
Togias A. Rhinitis and asthma: Evidence for respiratory system integration. J Allergy Clin Immunol 2003;111:1171-83.
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.
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.
Jensen MD. Obesity. In: Goldman L, Schafer AI, editors. Goldman's Cecil Medicine. Philadelphia: Elsevier health Sciences; 2011.
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.
Klossek JM, Annesi-Maesano I, Pribil C, Didier A. INSTANT: National survey of allergic rhinitis in a French adult population based-sample. Presse Med 2009;38:1220-9.
Gern JE, Busse WW. Contemporary Diagnosis and Management of Allergic Diseases and Asthma. Pennsylvania, PA: Handbook in Health Care CO.; 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.
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, 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.
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.
Kusunoki T, Morimoto T, Nishikomori R, Heike T, Ito M, Hosoi S, et al.
Obesity and the prevalence of allergic diseases in schoolchildren. Pediatr Allergy Immunol 2008;19:527-34.
Chowdhury MA, Rabbani SM, Yasmeen N, Malakar M. Allergic rhinitis: Present perspective. Banglad J Otorhinolaryngol 2010;16:44-7.
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.
Cirillo I, Pistorio A, Tosca M, Ciprandi G. Impact of allergic rhinitis on asthma: Effects on bronchial hyperreactivity. Allergy 2009;64:439-44.
Paoletti P, Carrozzi L, Viegi G, Modena P, Ballerin L, Di Pede F, et al.
Distribution of bronchial responsiveness in a general population: Effect of sex, age, smoking, and level of pulmonary function. Am J Respir Crit Care Med 1995;151:1770-7.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]