BASELINE LUNG FUNCTION OF PATIENTS WITH ALLERGIC RHINOSINUSITIS
IN KANO.
*
A.Ajiya,
*
A.D Salisu,
**
O.G.B Nwaorgu.
*
Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria & **
Department of Otorhinolaryngology, College of Medicine, University of Ibadan.
Correspondence:
Dr Abdulrazak Ajiya,
Department of Otorhinolaryngology,
Aminu Kano Teaching Hospital, Kano, Nigeria.
Email: ajiyaabdulrazak@yahoo.com.
.
Abstract
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/Objective: This study aimed to determine the baseline lung function status of patients with
allergic rhinosinusitis.
Methods: All adult patients seen in the Otolaryngology outpatient 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 analyzed using SPSS version
15 statistical software.
Results: There were 300 patients, and 300 control participants. Sixty-one percent were females
and 39% as males with a male:female of 1:1.6. The age ranged between 18-49 years
(mean=29.3). Seventy percent had positive family history of allergy, while 19% were obese.
Allergic rhinosinusitis was 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.
Key words: Allergic rhinosinusitis, Bronchial Asthma, Co-morbidity, Lung function values
Introduction
Allergic rhino sinusitis constitutes a global health problem that causes major Illnesses and
disabilities1. 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 countries2.
According to the document “allergic rhinitis and its impact on asthma” 2008 by Bousquet et al ;
Allergic rhino sinusitis 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 nose1.
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 cells3. 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 process4.
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 rhinosinusitis5 with several studies in Nigeria reporting
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 rhino-sinusitis at the ENT clinic of Aminu
Kano Teaching Hospital Kano that satisfied the inclusion criteria. 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. 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.
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 (Vitalograph ALPHA, AL 015019, made in Ennis, Ireland) and the data analyzed
using SPSS version 15 statistical software.
Results
Three hundred participants were recruited into 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 49years (29.3± 8.2 years). The majority of the
participants are aged between 18 and 29years (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.
TABLE 1: GENERAL CHARACTERISTICS OF THE STUDY POPULATION (n=300).
NUMBER OF PATIENTS
PERCENTAGE (%)
Age: 18-29yr
174
58
30-49yr
126
42
183
61
117
39
57
19
243
81
Family Hx of atopy: yes
210
70
No
90
30
Sex: female
Male
Obesity: obese
not obese
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.
TABLE 2: DISTRIBUTION OF OCCUPATION OF STUDY GROUP.
OCCUPATION
NUMBER OF
PERCENTAGE
PATIENTS
(%)
STUDENTS
114
38
HOUSEWIVES
67
22.3
CIVIL
30
10
89
29.7
SERVANTS
OTHERS
In both sexes, reduced lung volumes were more common in patients with allergic rhinosinusitis
than in normal individuals. The difference in lung volumes were statistically significant between
participants with allergic rhinosinusitis and normal individuals (p <0.05). Table three shows the
spirometry test results for participants.
TABLE 3: SPIROMETRY TEST RESULTS FOR PARTICIPANTS.
Parameters
NORMAL
VALUES
Study Group
Control Group
p-values
85.4(9.0)
93.8(9.6)
<0.0001
89.5(12.7)
94.0(10.2)
<0.0001
80.7(8.2)
92.2(8.8)
<0.0001
86.3(11.8)
92.9(8.8)
<0.0001
0.9(0.06)
0.9(0.1)
0.008
0.9(0.1)
0.9(0.1)
0.026
FeV1(%):Men
Women
80% to 120%
FVC(%):Men
Women
FeV1/FVC(L):Men
Women
80% to 120%
Within 5% of
the predicted
ratio
DATA ARE EXPRESSED IN MEANS (SD).
Tables 4 and 5 show that abnormal Spirometry results were associated with age 30years 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.
VARIABLE
NORMAL
ABNORMAL
CHI-SQUARE
p-value
72.0
<0.0001
SPIROMETRY SPIROMETRY
AGE(yr): >30
99
27
<30
75
99
59
58
115
68
OBESITY :Obese
32
25
Not obese
142
101
FAMILY HX: Yes
109
25
No
65
101
SEX :Men
4.5
Women
0.03
0.1
0.75
72.0
<0.0001
TABLE 5: DETERMINANTS OF ABNORMAL SPIROMETRY RESULTS IN
PATIENTS WITH ALLERGIC RHINOSINUSITIS
PREDICTOR
ODDS RATIO
95%CONFIDENCE
p-VALUE
INTERVAL
AGE(yr): >30
13.0
<30
6.4-26.3
Referent(1.00)
GENDER: Men
<0.0001
Referent(1.00)
Women
10.9
4.9-24.2
<0.0001
OBESITY :Obese
0.5
0.2-1.1
0.1
3.8-16.7
<0.0001
Not obese
FAMILY HX: Yes
No
Referent(1.00)
Referent (1.00)
7.7
Discussion
The ISAAC report showed that in general, with some exceptions, higher levels of allergic
rhinosinusitis are observed in communities with higher levels of asthma6.
In this study, the majority of patients with allergic rhinosinusitis were females. This is consistent
with several studies worldwide1,7,8,9, but in contrast with reports from some authors locally and
internationally5,10,11. 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 allergens8.
Fifty eight percent of patients with allergic rhinosinusitis are below the age of 30years. This is
similar to findings by Desalu et al in Ilorin, North central Nigeria5. The result is also consistent
with the observation that the disease is common in childhood, peaks in the early 20s, and then
decreases1,8,12.
A larger proportion of the allergic rhinosinusitis group have family history of allergic disease or
atopy. This is similar to findings by Olusesi et al in Abuja , the Nigerian capital 9. 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
societies13,14.
Obesity was not a common finding in the patients with allergic rhinosinusitis .This supports
reports from studies in Nigeria5 and Japan15, where obesity was either not a risk factor for
allergic rhinosinusitis or has negative associations with prevalence of allergic rhinosinusitis.
Students were the most commonly affected by allergic rhinosinusitis in this study. This is in
slight contrast to reports in Nigeria and Nepal9,10, but consistent with similar study done in
Bangladesh16.
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 that there is a strong association between allergic rhinosinusitis and the
onset of bronchial hyperreactivity in adults in the general population17.
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 and his colleagues reported gender
not to be a significant risk factor for bronchial hyperreactivity in patients with allergic
rhinosinusitis18, in contrast to the findings of this study. However, previous reports by Paoletti
and his colleagues evidenced in support of findings of this study19.
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. 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.
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