Asthma, Rhinitis, other Respiratory Diseases
Rhinitis therapy and the prevention of hospital care for asthma: A case-control study

https://doi.org/10.1016/j.jaci.2003.11.034Get rights and content

Abstract

Background

Although clinical trials have demonstrated that rhinitis therapy improves subjective and objective measures of asthma, it is uncertain whether treatment of allergic rhinitis significantly affects the frequency of asthma exacerbations.

Objective

The objective of this study was to determine whether treatment with intranasal corticosteroids and/or second-generation antihistamines is associated with changes in rates of asthma exacerbations resulting in emergency room visits and/or hospitalizations in patients with asthma and allergic rhinitis.

Methods

This was a nested, case-control study.

Results

Treatment with either nasal corticosteroids or second-generation antihistamines was associated with a lower risk of asthma-related emergency room treatment and hospitalization (adjusted odds ratio [OR], 0.51; 95% CI, 0.34 to 0.77 and 0.34, 0.18 to 0.62, respectively). Patients who used nasal cortico-steroids had a significantly lower risk of both asthma-related emergency room treatment and hospitalization (adjusted OR, 0.75; 95% CI, 0.62 to 0.91 and 0.56, 0.42 to 0.76, respectively), whereas there was a trend toward lower risk of emergency room treatment and hospitalization in patients who used second-generation antihistamines (adjusted OR, 0.88; 95% CI, 0.62 to 1.26 and 0.68, 0.40 to 1.14, respectively). Combined treatment with both medications was associated with a further lowering of the risk of both emergency room treatment and hospitalization (adjusted OR, 0.37; 95% CI, 0.19 to 0.73 and 0.22, 0.07 to 0.63).

Conclusions

In patients with asthma, treatment of concomitant allergic rhinitis was associated with significant reductions in risk of emergency room treatment and hospitalization for asthma.

Section snippets

Data source

The study population of patients with both allergic rhinitis and asthma was selected from a northeastern United States, commercial, managed-care organization with approximately 215,000 enrollees. The plan maintains extensive and comprehensive computerized records containing administrative, medical, and pharmacy claims for their membership. Diagnoses (recorded with the use of ICD-9 codes), procedures, laboratory tests, physician visits, emergency room visits, hospitalizations, and pharmacy

Demographics

Three hundred sixty-one patients were treated in the emergency room and/or hospitalized for exacerbations of asthma and were matched to 1444 control patients (TABLE I, Table II). Case patients used more antiasthma medications and had received more hospital care for asthma exacerbations during the year before the index month than did the control group.

Asthma-related emergency room visits

The results of the crude and multivariate analyses for asthma-related emergency room visits and hospitalizations are shown in Table III. Use of

Discussion

These results suggest that treatment of allergic rhinitis reduces the risk of emergency room visits and hospitalizations for asthma. To our knowledge, this is the first case-control study to show such a relation.

A recently published cohort study reported that composite exposure of nasal corticosteroids or second-generation antihistamines was associated with a reduction in the composite outcome of hospitalization or emergency room use for asthma.17 Their study differed from ours in three

Acknowledgments

We are particularly indebted to Domenic Iezzoni, MD, and Elon Ronberg for their work on earlier analyses that made the current study possible. We also thank Randy Artiglere, Niketa Schueler, and Tony Yang, PhD, for their work on programming and Susan Garavaglia, PhD, and Charles M. Alcorn, ScD, for their insights and comments on earlier versions of the manuscript.

References (24)

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Integrated Therapeutics Group, Inc, Supported by Schering-Plough, Kenilworth, NJ.

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