Early bronchial airflow impairment in patients with persistent allergic rhinitis and bronchial hyperreactivity

Summary

Background

Allergic rhinitis and its impact on asthma (ARIA) document underlines the link between upper and lower airways. Patients suffering from allergic rhinitis frequently (up to 80%) show bronchial hyperreactivity (BHR).

Objectives

This study aimed at evaluating a group of subjects suffering from persistent allergic rhinitis, with BHR but with nasal symptoms only, to investigate the type and intensity of nasal symptoms, nasal and bronchial airflow, and BHR grade during the pollen season.

Methods: One hundred and twenty one polysensitized rhinitics were investigated. Total symptom score (TSS) was assessed in all patients. Rhinomanometry, spirometry and methacholine bronchial challenge were performed in all patients.

Results

65 (53.7%) patients had impaired FEF 25–75 values. TSS correlated with nasal airflow ($P<0.001$) and BHR grade ($P<0.001$). Nasal airflow correlated with FEF 25–75 values ($P<0.05$) and BHR ($P<0.001$). FEF 25–75 values correlated with FEV₁ levels ($P<0.003$), BHR grade ($P<0.001$), and nasal obstruction symptom ($P<0.05$). Severe BHR correlated with FEV₁ ($P<0.05$) and FEF 25–75 ($P<0.03$) values, nasal airflow ($P<0.05$) and nasal symptoms ($P<0.001$).

Conclusions

This study evidences that early bronchial impairment is frequently detectable in patients with persistent allergic rhinitis and BHR. Moreover, nasal function is strictly related with bronchial calibre and BHR grade. Therefore, careful evaluation of lower airways should be investigated in all rhinitics as suggested by the ARIA document.